Resting angina due to papillary fibroelastoma of the right coronary cusp
Eiji Taguchi1, Koichi Nakao2, Toshiharu Sassa3
1Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan.
Insights
A rare cardiac tumor, papillary fibroelastoma, caused chest pain in a 63-year-old man by blocking the coronary artery. Surgical removal and valve replacement were successful, relieving symptoms.
Area of Science:
- Cardiovascular Medicine
- Pathology
Background:
- Papillary fibroelastomas are rare, benign cardiac tumors, typically found on heart valves.
- They can cause significant symptoms due to embolization or obstruction.
Observation:
- A 63-year-old male presented with rest chest pain.
- Echocardiography revealed a mobile, ball-like mass on the right coronary cusp of the aortic valve.
Findings:
- Pathological examination confirmed the mass as a papillary fibroelastoma.
- Surgical aortic valve replacement with a mechanical valve was performed successfully.
- Coronary angiography showed no organic lesions, suggesting the mass caused transient coronary occlusion.
Implications:
- This case highlights papillary fibroelastoma as a cause of cardiac symptoms, including chest pain.
- Early diagnosis and surgical intervention are crucial for favorable outcomes.
- The findings contribute to understanding the pathophysiology of cardiac tumors and their management.
Abstract:
A 63-year-old man with chest pain at rest was referred to our hospital. Transthoracic echocardiography showed a mobile ball-like mass at the top of the right coronary cusp. Subsequently, transesophageal echocardiography also showed a mobile mass at the right coronary cusp. Aortic valve replacement with a mechanical valve was performed under general anesthesia. We diagnosed this condition as papillary fibroelastoma based upon the pathological findings with hematoxylin and eosin staining, and Elastica van Gieson staining. Coronary angiography revealed no organic lesions. The operation was successful, and the patient remains asymptomatic. We speculate that the resting chest pain was induced by transient occlusion of the right coronary orifice by the tumor. We describe this rare case in detail including a review of the literature.
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