Aortic valve papillary fibroelastoma that developed rapidly after open-heart surgery

Abstract

The patient was a 76-year-old woman who underwent left atrial thrombectomy in November 2003 at our hospital. A mass adhered to the non-coronary aortic cusp was found during annual echocardiography, and the patient was admitted to our hospital. Transthoracic echocardiography detected two masses with pendulum-like movement: a 7-mm mass adhered to the non-coronary cusp and a 5-mm mass on the right coronary cusp. Papillary fibroelastoma was diagnosed based on the absence of inflammatory reactions or valvular destruction. Anticoagulant therapy was continued to prevent left atrial thrombus formation. At surgery, a 7-mm mass was adhered to the belly of the non-coronary cusp and a 5-mm pediculate mass was attached to a site near the nodule of Arantius of the right coronary cusp. Movable fibrous connective tissue 4 mm in length was present at two sites near the nodule of Arantius of the left coronary cusp, and these were also excised. All excised specimens, including those considered to be connective tissue, were found to be papillary fibroelastoma on pathological examination. Four papillary fibroelastomas that developed in all the cusps, including two small connective tissue-like morphologies and two sea anemone-like morphologies, indicated the process of papillary fibroelastoma growth and looked like 'a family'.