Multiple papillary fibroelastomas discovered during follow-up for myocardial infarction

Abstract

Papillary fibroelastoma (PFE) is the second most common benign tumor of cardiac origin after myxoma. Most PFEs are single lesions, and multiple lesions are rare. A woman in her 50s underwent primary percutaneous coronary intervention for anterior acute myocardial infarction. Transthoracic echocardiography showed multiple masses of the aortic valvular structure. Transesophageal echocardiography revealed three round mobile structures on the aortic valves (5.0 × 3.6 mm and 4.4 × 3.2 mm on the left coronary cusp, and 2.3 × 3.8 mm on the noncoronary cusp). These masses were found at the same site by transthoracic echocardiography and transesophageal echocardiography. The transesophageal echocardiography showed these masses more clearly. These masses were considered to be PFEs, because some of them had pedicles. Embolization of these tumors could lead to serious complications; hence, these tumors were successfully resected. The surgical findings revealed six tumors in the aortic valve. On the basis of a pathological examination, these tumors were diagnosed as PFEs. Eventually, multiple PFEs were found in the aortic valve during the follow-up for myocardial infarction.