Papillary fibroelastoma of the aortic valve: operative approaches upon incidental discovery

Papillary fibroelastomas are the most common benign neoplasms of the cardiac valvular structures, and they are being recognized more frequently because of higher-resolution imaging technology. Papillary fibroelastomas are associated with substantial complications that are secondary to systemic embolism. Incidentally discovered papillary fibroelastomas are treated on the basis of their size, mobility, and associated comorbidities and symptoms. Surgical resection should be offered to all patients who have symptoms and to asymptomatic patients who have pedunculated lesions or tumors larger than 1 cm in diameter. Valve-sparing excision produces good long-term results in most instances.Herein, we present the case of a patient who was scheduled for elective myocardial revascularization and in whom an aortic valve papillary fibroelastoma was discovered incidentally during routine intraoperative transesophageal echocardiography. The timely recognition of this asymptomatic tumor enabled a modified operative approach: the patient underwent myocardial revascularization with concomitant valve-sparing resection of the tumor. We discuss the pathophysiology of fibroelastomas of the aortic valve and operative approaches to the management of these tumors when they are discovered incidentally.