Cardiac calcified amorphous tumor originating from the aortic valve: A rare case report.

A 74-year-old female complained of chest tightness for >10 years. Out-patient transthoracic echocardiography (TTE) revealed a hyper-echogenic mass at the aortic root and mild tricuspid valve regurgitation. TTE was performed again which showed details of the mass: an approximate 15×10 mm irregular and lobulated mass above the non-coronary cusp without interfering with the aortic valve (Fig. 1a, 1b). Preoperative cardiac magnetic resonance imaging (MRI) and contrast-computed tomography (CT) both identified the signal of the soft tissue in the non-coronary sinus (Fig. 1c-1f, arrows). Surgical removal of the tumor with or without aortic replacement was agreed by patient and medical team.

Figure 1

3D transesophageal echocardiography images (a, b) and cardiac magnetic resonance imaging (MRI) and contrast-computed tomography (CT) images. (c, d) Sagittal and transverse planes of cardiac MRI images of the cardiac CAT in the non-coronary cusp (arrows point out cardiac CAT). (e, f) Transverse and sagittal planes of contrast CT images of cardiac CAT in the non-coronary cusp (arrows point out the cardiac CAT)

The aorta was cross-clamped followed by the routine aortic incision. The aortic valve was exposed, and the tumor was found to be connected to the non-coronary cusp with a thin peduncle (Fig. 2a, 2b). The tumor was completely removed from the cusp without destroying the cusp. The function of the aortic valve was completely preserved.

Figure 2

Intraoperative image and gross pathological photo of cardiac CAT (a, b) and hematoxylin and eosin (H&E) staining images of the removed cardiac CAT (c, d) (magnifying 100, 200 and 400 times)

Postoperatively, the patient was transferred to the cardiac intensive care unit and then discharged on postoperative day 7. Hematoxylin and eosin (H&E) staining images showed calcification and eosinophilic amorphous material in the dense collagenous fibrous tissue (Fig. 2c-2e). The diagnosis was confirmed as cardiac calcified amorphous tumor (CAT). On the 6-month follow-up, the patient was doing well and no recurrent tumor was found.

In summary, our case report presented a patient with an extremely rare cardiac CAT that originated from the non-coronary cusp of the aortic valve and who underwent complete surgical removal of the tumor with preserved aortic valve function.