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Ann Thorac Surg 2004;77:725
© 2004 The Society of Thoracic Surgeons

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Images in cardiothoracic surgery

Elective surgery for fibroelastoma of the aortic valve

^a Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
^b Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
^c Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

^* Address reprint requests to Dr Koolbergen, Department of Cardiothoracic Surgery, Leiden University Medical Center, PO 9600, 2300 RC Leiden, The Netherlands.
e-mail: d.r.koolbergen{at}lumc.nl

Cardiac papillary fibroelastomas are rare benign tumors that most often originate from the valvular endocardium. They are normally discovered at routine autopsy or after embolic complications have occurred [1, 2]. The embolic material may arise from either fragments of the tumor or from thrombus that not uncommonly forms around the tumor. Because of this threat of embolic complications such as stroke or myocardial infarction, it is generally advised to perform prompt surgical resection of the tumor with preservation of the native valve [1, 2]. Unfortunately, these severe and sometimes lethal complications are often the first symptoms of primary cardiac valve tumors. However, preoperative noninvasive echocardiographic diagnosis is feasible and can be made with a good degree of confidence [3].

In this case, an aortic valve tumor was diagnosed when the patient, a 50-year-old woman, underwent preoperative examination for a noncardiac surgical procedure. The patient had a blank history of cardiac disease and no cardiac or neurologic symptoms. Because slight electrocardiographic changes were observed, the cardiologist was consulted. A systolic murmur was heard at the apex and the second right intercostal space. Electrocardiography showed sinus tachycardia and nonspecific ST segment changes in V4 to V6. Echocardiography revealed normal left ventricular function and a tumor attached to the right coronary cusp. There was no aortic stenosis or insufficiency. The tumor had the typical echocardiographic appearance of a nonhomogenous, round, echocardiographically dense structure (Fig 1). At surgery we found a papillary tumor attached with a small stalk to the free edge of the right coronary cusp and simply excised it. The typical macroscopic appearance resembling a sea anemone is shown in Figure 2. Characteristic histopatological findings of multiple papillary fronds with a dense core of connective tissue, containing elastic fibers (Elastin van Gieson staining) covered with endothelial cells, are shown in Figure 3.

View larger version (85K): [in this window] [in a new window]   Fig 1.

View larger version (143K): [in this window] [in a new window]   Fig 2.

View larger version (128K): [in this window] [in a new window]   Fig 3.

1. Edwards F.H., Douglas H., Amram C., et al. Primary cardiac valve tumors. Ann Thorac Surg 1991;52:1127-1131.[Abstract]
2. Grinda J., Couetil J.P., Chauvaud S., et al. Cardiac valve fibroelastoma: surgical excision for revealed or potential embolization. J Thorac Cardiovasc Surg 1999;117:106-110.[Abstract/Free Full Text]
3. Yee H.C., Nwosu J.E., Lii A.D., et al. Echocardiographic features of papillary fibroelastoma and their consequent management. Am J Cardiol 1997;80:811-814.[Medline]

This article has been cited by other articles:

				G. M Novaro, R. E Cabrales, and W D. Boyd Mitral Valve Papillary Fibroelastoma: Surgical Considerations Asian Cardiovasc Thorac Ann, June 1, 2006; 14(3): e58 - e59. [Abstract] [Full Text] [PDF]

				T. Bossert, J. F. Gummert, and F. Mohr Papillary Fibroelastomas and Other Cardiac Tumors Should Be Resected on an Urgent Basis Ann. Thorac. Surg., February 1, 2005; 79(2): 756 - 756. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David R. Koolbergen Pieter Voigt Maciej Kolowca Robert A. Dion Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Koolbergen, D. R. Articles by Dion, R. A. Search for Related Content PubMed PubMed Citation Articles by Koolbergen, D. R. Articles by Dion, R. A. Related Collections Cardiac - other