Aortic valve papillary fibroelastoma: a rare cause of angina.

A 66-year-old woman with diabetes mellitus and a history of hypertension presented with intermittent episodes of chest pain and palpitations. An electrocardiogram showed no previous ischemic events but revealed atrial fibrillation. Transthoracic echocardiography disclosed a round, mobile mass on the aortic valve. Transesophageal echocardiography showed the mass (14 × 10 mm) on the aortic side of the right coronary cusp (Fig. 1). It was unclear whether the mass was a thrombus, a tumor, or a vegetation, but given its position and mobility, urgent surgical excision was planned. Fig. 1 Preoperative transesophageal echocardiograms (mid-esophageal long-axis views) show the mass on the aortic valve during A) diastole and B) systole. The mass was connected to the free margin of the right aortic valve leaflet and threatened to obstruct the right coronary ostium (Fig. 2). A complete excision was performed, and the valve leaflets were spared. Macroscopically, the mass resembled a sea anemone (Fig. 3), which supported a diagnosis of papillary fibroelastoma (PFE). Histopathologic evaluation confirmed the diagnosis. Fig. 2 Intraoperative photograph shows a round, mobile mass on the free margin of the right coronary cusp of the aortic valve. Fig. 3 Macroscopic appearance of the neoplasm, in saline solution. The multiple frond-like structures give the appearance of a sea anemone.