Characterization of an Aortic Valve Papillary Fibroelastoma Using Three-Dimensional Transillumination Echocardiography

Figures

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  Figure 1. Two-dimensional TEE of the AV from the midesophageal long (A) and short-axis (B) diastolic views demonstrates a PFE (arrows) on the right coronary leaflet of the AV. Three-dimensional TEE of the AV in short-axis diastolic views at slightly different frames and angles (C-D) demonstrates the irregular borders of the PFE (arrows). Ao, Aorta; LA, left atrium; LV, left ventricle; PV, pulmonic valve; RA, right atrium.

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  Figure 2. Three-dimensional TEE with TI of the AV in short axis, with the virtual light source positioned above (A-B) and at the level (C-D) of the PFE (white arrows). Placing the light source at the level of the PFE enhances the irregularity of the margins using shadowing as contrast (C). The irregularity of the margins is also visualized in the shadows below the PFE (D, yellow arrows). IAS, Interatrial septum; LA, left atrium; PV, pulmonic valve; RA, right atrium.

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  Figure 3. (A) Surgical view of an AV PFE in situ. (B) Gross pathologic specimen of a PFE submerged in saline with a classic “sea anemone” appearance. (C) A 100× histological specimen of the PFE showing multiple, branching fonds of paucicellular, avascular fibroelastic tissue lined by a single layer of endocardium.

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  Figure 4. Comparison of noninvasive 3D TEE (A) and 3D TI echocardiography (C) to a gross surgical specimen (B) of an AV PFE (red and white arrows). IAS, Interatrial septum; LA, left atrium; PV, pulmonic valve.