This case demonstrates the incidental echocardiographic identification and successful surgical excision of a benign papillary fibroelastoma in the left ventricular outflow tract.
Emphasizes echocardiography for detecting rare cardiac masses; leaves open evidence-based thresholds for excising asymptomatic fibroelastomas.
A 70-year-old female patient with previous transient ischaemic attacks underwent pre-operative transthoracic echocardiography for aortic stenosis. A mobile mass was incidentally noted in the left ventricular outflow tract (LVOT) (A). Transoesophageal echocardiography confirmed a solitary lesion near a heavily calcified aortic valve, without sub-aortic obstruction (B; Supplementary data online, Video S1). Tissue velocity imaging demonstrated the mass was attached to the basal infero-septum rather than the valve (C; Supplementary data online, Video S2). During surgery, a filamentous lesion was excised from the interventricular septum, 2 cm from the right coronary cusp of the aortic valve. Like most papillary fibroelastomas, the lesion was small (D) and resembled a ‘sea anemone’ with a gelatinous membrane and multiple papillary projections (E). Histological examination was consistent with a benign papillary fibroelastoma with avascular papillary fronds (F; H&E ×100) and elastic fibres (black) within the papillae (G; elastic MSB ×200).
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Coats et al. (2018) studied this question.
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