Aortic valve fibroelastoma: a rare cause of stroke

Abstract

The prevalence of primary cardiac tumours varies from 0.02% to 0.45%. Cardiac papillary fibroelastoma (CPF) is a rare tumour diagnosed incidentally on imaging. The clinical manifestations result from thromboembolisation and include transient ischaemic attack, stroke and sudden cardiac death. We present a patient aged 57 years with CPF arising from the aortic valve. The patient presented with right hemiparesis due to acute stroke. He received tissue plasminogen activator with complete resolution of neurological symptoms. Echocardiography revealed a broad-based, gelatinous, non-mobile mass on the left aortic cusp. The tumour was excised sparing the aortic valve. The patient recovered rapidly without any complications. The histopathological examination confirmed the diagnosis of CPF. A review of the literature suggests that CPF is a rare but treatable cause of stroke. The course is not clear and there are no tumours or patient-related characteristics which could predict the risk of thromboembolisation. Surgical treatment is definite and is relatively safe.

Figure 1

Long-axis view of the transoesophageal echocardiogram image showing mass on the left aortic value cusp.

Figure 2

The gross specimen of resected tumour appearing like gelatinous nodule which is different from typical appearance resembling a sea anemone described in the literature.

Figure 3

Histological examination under high-power field displaying a mass composed of multiple fronds of acellular collagen and dense elastin covered by flat endothelial cells highly characteristic of papillary fibroelastoma.