Ann Thorac Surg 2007;83:2220-2222
© 2007 The Society of Thoracic Surgeons
Case Reports
Aortic Valve Lipoma
Tsutomu Matsushita, MD, PhDa,*,*,
Anh Tuan Huynh, MBBSa,*,
Taranpreet Singh, FRACSa,
Sarah Armarego, FANZCAb,
Mark Formby, FRCPAc,
Alan F. Boyd, FRACSa,
Geoff S. Oldfield, FRACPd
a Department of Cardiothoracic Surgery, John Hunter Hospital, New Lambton, Australia
b Department of Anesthesia, John Hunter Hospital, New Lambton, Australia
c Department of Intensive Care, John Hunter Hospital, New Lambton, Australia
d Department of Anatomical Pathology, John Hunter Hospital, New Lambton, Australia
Accepted for publication January 15, 2007.
* Address correspondence to Dr Matsushita, Department of Cardiothoracic Surgery, John Hunter Hospital, Lookout Rd, New Lambton, NSW, 2305, Australia (Email: atmatsu{at}tokyonet.com.au).
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Abstract
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Cardiac lipoma (especially on the aortic valve) is extremely rare. We report a patient suffering from shortness of breath, chest pain, and recent presyncopal episodes who was found to have a mass on the aortic valve with mild aortic regurgitation. The patient had an uneventful aortic valve replacement.
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Introduction
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Lipoma, the tumor composed of adipose tissue is the second most common primary benign neoplasm of the adult heart after myxoma, followed by fibroelastoma [1]. This can occur anywhere in the heart including the myocardium, pericardium, endocardium and epicardium, and the intracavitary lesion may manifest with dyspnea secondary to blood flow obstruction. We present an extremely rare case of aortic valve lipoma in an adult patient.
A 61-year-old woman had recently been suffering from shortness of breath, chest pain, and presyncopal episodes. Cardiovascular examination revealed a mild, early diastolic heart murmur. Transthoracic echocardiography demonstrated a mass (1.4 cm in diameter) arising from the aortic valve. It was believed to be caused by either a primary cardiac tumor, such as a fibroelastoma, or by her previous history of five resections of primary malignant melanomas and three secondaries removed in the past 25 years of metastatic melanoma.
She was referred to surgery and transesophageal echocardiography (Fig 1) in the operating room confirmed the findings of the transthoracic echocardiography with the additional information that the hyperechoic broad-based smooth surface mass was arising from the left coronary leaflet. There was mild aortic regurgitation. The patient was placed on cardiopulmonary bypass. After cardioplegic arrest, the ascending aorta was opened and a 1.2 x 1.0 x 1.0 cm encapsulated pedicled mass arising from the ventricular side of the left coronary leaflet was found and excised with the valvular leaflet (Fig 2). A 25-mm sized bioprosthetic aortic heart valve was implanted. The histopathology revealed that the yellow well-encapsulated tumor was located within the substance of the leaflet consisting of a well-circumscribed lobular proliferation of predominantly mature fat cells. The appearances were consistent with a lipoma of the valve leaflet (Fig 3). The postoperative course was uneventful. The patient was discharged on postoperative day 6.
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Fig 1. The transesophageal echocardiogram of the (A) long axis view and the (B) short axis view. A hyperechoic homogenous smooth surface mass directly arising from the ventricular side of the left coronary cusp of the aortic valve (arrows).
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Fig 2. (A) Macroscopic view of the yellowish encapsulated tumor on the excised left coronary cusp of the aortic valve. (B) The cross section of the fatty tumor.
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Fig 3. Histologic aspect of the tumor. (A) The tumor consists of well-circumscribed lobulated adipose tissue. (B) Higher power of tumor histology showing uniform mature fat cells.
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Comment
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Primary cardiac tumors on the valve are rare. Approximately 75% of these constitute papillary fibroelastoma followed by myxoma and fibroma [2]. Lipomas on the valve are extremely rare, and we believe that seven lipomas on the mitral valve, three on the tricuspid valve, one on the pulmonary valve, and only one on the aortic valve have been previously reported [3, 4]. The widespread use of transthoracic echocardiography for any clinical cardiac-related symptoms has shown a number of masses on the cardiac valves as found in our case. In this case, papillary fibroelastoma, which was the major primary cardiac tumor on the valve, was the most probable diagnosis from the echocardiography. The development of radiologic imaging, especially magnetic resonance (MR) imaging may show the nature of the tumor [5, 6]. The MR images demonstrate a smooth, round mass with a signal intensity characteristic of fat. However, considering that this patient had a significant past history of malignant melanoma resections and that 50% of patients with metastatic malignant melanoma are found to have had cardiac involvement based on autopsies [7, 8], we believed that the mass could be a metastatic melanoma. The neoplasm, including benign lipoma on the valve, can cause either valve regurgitation or obstruction leading to lethal symptoms such as syncope. The treatment of choice is surgical resection. Although the color and shape of the tumor was more consistent with those of a benign tumor rather than a malignant melanoma, the aortic valves were totally excised to avoid the risk of local recurrence of tumor. The patients generally have good outcomes.
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Footnotes
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* These authors contributed equally to this article. 
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References
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Abstract
Introduction
