A case with unusual masses on aortic and mitral valve

Introduction: A 70 year old man with cardiac risk factors (i.e., obesity, smoking and hypercholesterolemia) and a history of right carotid endarterectomy (from two years earlier) presented for a left carotid endarterectomy. Methods: Two years earlier, the results of transthoracic echocardiography (TTE) and coronary angiography were normal. The patient had no previous history of stroke or transient ischemic attack. Preoperative TTE revealed the presence of a small (about 6.6 mm in diameter), spherical and mobile structure, with smooth borders and homogeneous endocardial echodensity, attached to a first-order chordae of the anterior mitral valve leaflet associated with mild mitral regurgitation. Transesophageal echocardiogram also revealed a similar mass on the right cusp of the aortic valve (about 7 mm in diameter), associated with mild aortic insufficiency and no other echocardiographic anomaly. Results: Three-dimensional TTE confirmed the presence of two masses attached to a first-order chordae of the anterior mitral valve leaflet and of the right leaflet of the aortic valve. Preoperative coronary computed tomography (CT) angiography, and then coronary angiography revealed a significant proximal lesion of the right coronary artery. Brain CT did not reveal any lesions. Both masses were surgically excised with a combined approach of right coronary artery by-pass and right carotid endarterectomy. No valve repair was necessary and no pathological mitral or aortic regurgitation was detected after surgery. Conclusions: Histopathological examination confirmed the diagnosis of papillary fibroelastoma. One year later, the patient had not suffered any abnormal event and presented with a good left ventricular function and no mass recurrence on imaging.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)