A rare case of Papillary Fibroelastoma Involving the Pulmonic Valve

Papillary fibroelastomas involving the pulmonic valve are rare and may present incidentally or with nonspecific cardiopulmonary symptoms. We report a 75-year-old woman with an incidentally discovered right ventricular outflow tract mass ultimately identified as a papillary fibroelastoma arising from the ventricular aspect of the left pulmonic valve cusp. Multimodality imaging, including transthoracic and transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging, confirmed a mobile, pedunculated lesion without associated valve dysfunction. The mass was excised on cardiopulmonary bypass through a pulmonary arteriotomy without aortic cross-clamping. Post-resection TEE confirmed preserved pulmonic valve morphology and function. Histopathologic analysis confirmed the lesion to be a papillary fibroelastoma. The patient recovered uneventfully and was discharged home on postoperative day 4. This case underscores the pivotal role of TEE in defining pulmonic valve mass morphology and providing real-time intraoperative guidance.