Cardiac papillary fibroelastoma incidentally detected via transesophageal echocardiography after induction of anesthesia in a patient undergoing coronary artery bypass grafting

Abstract

 We report the case of a patient with cardiac papillary fibroelastoma (CPF) of the aortic valve detected via transesophageal echocardiography (TEE) that was not identified preoperatively. A 71-year-old woman with triple vessel disease and old myocardial infarction was scheduled to undergo elective off-pump coronary artery bypass grafting (CABG). After the induction of anesthesia, TEE revealed mobile pedunculated masses at the aortic valve arising from the endocardium of the left and non-coronary cusps. Aortic valve regurgitation and valve stenosis were not observed, and similar mobile pedunculated masses were not identified in any other valves. However, since patients with such lesions are at risk for thromboembolic complications, stroke, myocardial ischemia, and acute aortic valve dysfunction, resection of the masses combined with CABG under cardiopulmonary bypass was scheduled. The surgery was performed without incident, and the patient had a successful recovery with no cardiac and neurological complications. Pathological examination revealed a diagnosis of CPF of the aortic valve.