Echocardiographic diagnosis of aortic valve papillary fibroelastoma.

A 77-year-old asymptomatic woman with incidental transthoracic echocardiographic (TTE) discovery of an aortic valve mass is presented. The 2-dimensional TTE showed a multilobulated, mobile, pedunculated mass (width, 1.5 cm; circumference, 5.8 cm), which appeared on transesophageal echocardiography (TEE) to be attached by a thin stalk to the ventricular surface of the noncoronary aortic cusp (Fig. 1). There was no aortic insufficiency. Fig. 1 Two-dimensional transesophageal echocardiogram, short-axis view, shows a mobile mass attached to an aortic cusp by a thin stalk. Through a transaortic approach, the mass was surgically excised. The resultant cusp defect was repaired with a Prolene suture. Intraoperative TEE showed normal aortic valve function. Gross and histologic examination led to a final diagnosis of papillary fibroelastoma (Fig. 2). Fig. 2 Gross appearance of the excised valve tumor: note the multiple small fronds resembling a sea anemone.