European Journal of Echocardiography Advance Access published online on April 1, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen019
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
Aortic valve fibroelastoma causing cerebral infarction
Alexander Hansen* and
Werner Oel
Department of Cardiology, Klinik Koesching, Krankenhausstr. 19, D-85092 Koesching, Germany
* Corresponding author. E-mail address: alexander_hansen{at}klinik-koesching.de
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Abstract
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We report incidental findings of aortic valve fibroelastoma
in a patient with embolic complications during routine transthoracic
echocardiography.
Keywords: Heart tumour; Echocardiography
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Case
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A 54-year-old otherwise healthy man presented with dizziness.
Cerebral MRT demonstrated multiple intracerebral embolic lesions.
Transthoracic echocardiography and TEE examinations revealed
a large aortic valve mass, sized
20 mm in diameter (
Figure 1,
see Supplementary material online, Clips 1–2) with mild
aortic regurgitation (see Supplementary material online, Clips
3–4). No other source for embolism could be detected.
Since the patient had no clinical signs of endocarditis and
no valvular destruction was observed, a tumour was suspected
and the patient referred for surgical resection of that mass.
Since the tumour was relatively large, a valve-sparing resection
was not possible. Postoperative pathological examination confirmed
the diagnosis of a papillary fibroelastoma.
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Discussion
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Primary aortic valve tumours are rare. Papillary fibroelastomas
are benign cardiac tumours arising from the normal endocardial
components.
1,2 They are avascular, usually small, and are attached
to valvular structures. Most of these lesions are clinically
silent, but bare risks of systemic or intracerebral embolization.
The typically benign nature of papillary fibroelastomas and
the small risk of recurrence may favour a conservative valve-sparing
technique.
3,4
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Supplementary material
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Supplementary material is available at in the online version.
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References
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- Klarich KW, Enriquez-Sarano M, Gura GM, et al. Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathological correlation. J Am Coll Cardiol (1997) 30:784–90.[Abstract]
- Grinda JM, Couetil JP, Chauvaud S, et al. Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolisation. J Thorac Cardiovasc Surg (1999) 117:106–10.[Abstract/Free Full Text]
- Yee HC, Nwosu JE, Lii AD, et al. Echocardiographic features of papillary fibroelastoma and their consequences and management. Am J Cardiol (1997) 80:811.[CrossRef][Web of Science][Medline]
- Giannessini C, Kubis N, Guyen AN, et al. Cardiac papillary fibroelastoma: a rare cause of ischemic stroke in the young. Cerebrovasc Dis (1999) 9:45–9.[Web of Science][Medline]
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Abstract
Case