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C J Coats, J Reid, S Wright, P Sonecki, N Al-Attar, Papillary fibroelastoma arising from left ventricular outflow tract, European Heart Journal - Cardiovascular Imaging, Volume 19, Issue 7, July 2018, Page 826, https://doi.org/10.1093/ehjci/jey044
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Extract
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).
Primary cardiac tumours are rare. Papillary fibroelastomas are typically attached to cardiac valves (frequently aortic) and due to their small size (5–20 mm diameter) may be difficult to distinguish from vegetations. Their location on the ventricular endocardium is very unusual. Although a benign tumour, it carries very high risk of embolic complications. Long-term prognosis is excellent with complete surgical resection. Tissue velocity imaging is a widely available modality that can enhance the visualization of moving tissue providing greater confidence and precision in diagnosis. It is a useful adjunct to acoustically difficult transthoracic studies. In this patient, it enabled better delineation of the aortic valve and LVOT anatomy.
