CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 7, August 2012
AFRICA
e7
Case Report
Triple papillary fibroelastomas in an asymptomatic
patient
D KIREYEV, MH ASHRAF, MF WILSON
Abstract
Papillary fibroelastoma is the third most common type
of primary cardiac tumour. Even though the majority of
patients with these tumours are asymptomatic, they may
present with embolic phenomena, syncope and death. This
report describes a patient with papillary fibroelastomas
affecting all three cusps of the aortic valve, with accompany-
ing transoesophageal echocardiography and images of surgi-
cal specimens of the tumours.
Keywords:
cardiac tumours, aortic valve, papillary fibroelas-
toma, echocardiography, surgical specimen
Submitted 15/3/11, accepted 6/312
Cardiovasc J Afr
2012;
23
: e7–e9
DOI: 10.5830/CVJA-2012-024
Primary tumours of the heart are extremely rare, with an
incidence of 0.002 to 0.1%.
1,2
After cardiac myxomas and
lipomas, papillary fibroelastomas are the third most common
type of primary cardiac tumour.
3,4
Even though they are often
asymptomatic, they may manifest as emboli, with life-threatening
consequences.
Case report
An 81-year-old woman with a history of atrial fibrillation was
found to have a small fibroelastoma attached to the aortic valve
during a routine transthoracic echocardiogram one year prior
to admission. Recent echocardiography revealed a significant
increase in size of the tumour.
The patient was referred for a transoesophageal echo-
cardiogram (TEE) for further evaluation of the tumour. TEE
showed preserved ejection fraction, mild aortic, mitral and
tricuspid regurgitation, and a 6 × 7-mm mobile mass attached to
the left coronary cusp of the aortic valve, which was consistent
with fibroelastoma (Figs 1, 2).
Due to the increasing size of the mass and the risk of an
embolic event, the patient was referred for surgery. Instead
of a conventional coronary angiogram, where there was a
potential for embolisation of the tumour, the patient underwent
a pre-operative cardiac computed tomography (CT) angiogram
using 64-slice MDCT with intravenous contrast. It showed a left
ventricular ejection fraction (LVEF) of 71%, calcium score of
679 Agatston units, moderate right coronary artery calcification
(606 Agatston units) and mild stenosis in the left circumflex
coronary artery after the first obtuse marginal branch. Review
of the valvular structures showed a mass associated with the left
coronary cusp of the aortic valve (Fig. 3).
Department of Cardiology, State University of New York,
Buffalo NY, USA
D KIREYEV, MD,
Department of Cardiothoracic Surgery, Kaleida Health,
Buffalo NY, USA
MH ASHRAF, MD
Department of Cardiology, Kaleida Health, Buffalo NY, USA
MF WILSON, MD
Fig. 1. Transoesophageal echocardiogram of the fibroelas-
tomas with the aortic valve closed.
Fig. 2. Transoesophageal echocardiogram of the fibroelas-
tomas with the aortic valve open.
