Dynamic obstruction of the left main coronary artery ostium by a papillary fibroelastoma
L Christian Napp1, Hassina Baraki, Ingo Kutschka
1Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Insights
This study reports a rare case of papillary fibroelastoma, a benign heart tumor, found in the aortic root. This extracardiac tumor caused acute myocardial infarction by obstructing coronary arteries.
Area of Science:
- Cardiology
- Cardiac Pathology
- Oncology
Background:
- Benign cardiac tumors are typically incidental echocardiographic findings, most commonly intracardiac myxomas.
- Extracardiac tumors are rare but can present significant clinical challenges.
Observation:
- A patient presented with acute myocardial infarction and an incidental finding of an extracardiac tumor in the aortic root.
- The tumor was observed to obstruct the left main coronary artery ostium during diastole.
Findings:
- Diagnostic imaging included transesophageal echocardiography and coronary computed tomography angiography.
- Surgical excision and histological analysis confirmed the mass as a papillary fibroelastoma.
- The tumor was associated with severe coronary artery disease, necessitating bypass surgery.
Implications:
- Papillary fibroelastoma is the second most common benign cardiac tumor and has a high propensity for embolization.
- Extracardiac papillary fibroelastoma, though rare, poses a significant risk of spontaneous or catheterization-associated embolization.
- This case highlights the critical importance of diagnosing and managing extracardiac tumors presenting with acute coronary syndromes.
Background:
Benign tumours of the heart are usually detected as incidental findings during echocardiography. Most cases are intracardiac tumours, with myxoma being the most frequent entity. We present images of a patient with acute myocardial infarction and a concomitant extracardiac benign tumour in the aortic root.
Methods:
Transesophageal echocardiography, coronary computed tomography angiography, cardiac surgery and histology of the excised tumour were performed.
Results:
A mobile mass was found in the aortic root obstructing the left main coronary artery ostium during diastole. Coronary CT angiography indicated severe coronary artery disease and the patient underwent bypass surgery and excision of the tumour. The excised tumour was identified as papillary fibroelastoma.
Conclusions:
Papillary fibroelastoma is the second most benign tumour of the heart. More than other tumours it is prone to embolization. Extracardiac location as in our case is very rare but dangerous since embolization may occur spontaneously or associated with catheterization.
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