Subaortic Membrane Papillary Fibroelastoma

Area of Science:

• Cardiology
• Pathology
• Cardiac Surgery

Background:

• Subaortic membranes are congenital heart anomalies that can be associated with various complications.
• Cardiac papillary fibroelastomas (PFEs) are the most common primary cardiac tumors, typically found on valves.
• Mobile masses on cardiac structures warrant thorough investigation due to potential embolic risks.

Observation:

• A 61-year-old male presented with an incidental finding of a mobile mass on a subaortic membrane during an annual exam.
• Transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and cardiac computerized tomography angiography (CTA) confirmed a 9x3mm mobile mass.
• Intraoperative visualization described the mass as "sea anemone-like."

Findings:

• Pathological examination and immunohistochemical staining confirmed the mass as a cardiac papillary fibroelastoma (PFE).
• This is the first reported case of a PFE originating from a subaortic membrane.
• The patient underwent successful surgical excision of the PFE and subaortic membrane.

Implications:

• This case highlights an unusual location for PFE, emphasizing the importance of comprehensive cardiac imaging.
• Despite being benign, PFEs require careful consideration for surgical management to mitigate risks of thromboembolism.
• Early diagnosis and intervention for cardiac masses, regardless of location, are crucial for patient outcomes.