Surgical aortic valve replacement and CABG successfully treated a 71-year-old woman with severe eccentric aortic regurgitation caused by a noncoronary cusp fibroelastoma evading standard imaging.
Case Report (n=1)
Severe eccentric aortic regurgitation caused by cusp masses such as fibroelastoma can be underestimated by standard noninvasive testing, highlighting the critical role of transesophageal echocardiography when clinical suspicion persists.
Abstract Introduction Severe eccentric aortic regurgitation (AR) can present insidiously and evade detection on routine cardiac evaluations. Noninvasive studies, including transthoracic echocardiography (TTE) and stress testing, may appear normal despite clinically significant valvular disease. We report a case of severe eccentric AR due to a fibroelastoma on the noncoronary cusp, which contributed to cusp distortion, in a patient with progressive dyspnea and orthopnea. Case Presentation A 71-year-old woman with hypertension, chronic kidney disease stage IV, type 2 diabetes mellitus, hyperlipidemia, hypothyroidism post-thyroidectomy, and obstructive sleep apnea presented with worsening dyspnea, orthopnea, and bilateral lower extremity edema. Prior workup was largely unremarkable: Despite these findings, she demonstrated wide pulse pressure (112/56 mmHg) with bounding pulses and persistent symptoms. The patient underwent surgical aortic valve replacement and single-vessel coronary artery bypass grafting. Postoperatively, she was managed in the cardiovascular ICU with standard antihypertensives, atrial fibrillation prophylaxis, diabetes management, thyroid hormone replacement, and dual antiplatelet therapy. She demonstrated symptomatic improvement and hemodynamic stabilization. Discussion This case emphasizes that severe eccentric AR may be underestimated by standard TTE, stress testing, or cardiac catheterization, particularly when an eccentric jet or structural abnormality such as a fibroelastoma is present. The fibroelastoma contributed to cusp distortion, exacerbating regurgitation severity. Transesophageal echocardiography is critical for accurate assessment when clinical suspicion persists. Recognition of wide pulse pressure and bounding pulses is essential for timely diagnosis. Conclusion Persistent dyspnea and orthopnea despite negative prior cardiac evaluations warrant advanced imaging. Eccentric AR caused or worsened by cusp masses, such as fibroelastoma, should be considered, as early detection and surgical intervention improve outcomes. This abstract is funded by: None
Sallam et al. (2026) conducted a case report in Severe eccentric aortic regurgitation secondary to noncoronary cusp fibroelastoma (n=1). Surgical aortic valve replacement and single-vessel coronary artery bypass grafting was evaluated. Surgical aortic valve replacement and CABG successfully treated a 71-year-old woman with severe eccentric aortic regurgitation caused by a noncoronary cusp fibroelastoma evading standard imaging.