[Acute Coronary Syndrome Caused by Papillary Fibroelastoma:Report of a Case]
Yoshikuni Kishi1, Hideo Yoshida, Tohru Mohri
1Department of Cardiovascular Surgery, Okayama University, Okayama, Japan.
Insights
A mobile cardiac tumor caused acute coronary syndrome by obstructing the right coronary artery. Surgical removal of the papillary fibroelastoma resolved symptoms and restored normal blood flow.
Area of Science:
- Cardiology
- Cardiac Surgery
- Oncology
Background:
- Acute coronary syndrome (ACS) in elderly patients necessitates prompt diagnosis and intervention.
- Cardiac tumors, though rare, can present with significant cardiovascular compromise.
- Right coronary artery (RCA) ostial stenosis requires careful management to prevent myocardial ischemia.
Observation:
- A 72-year-old female presented with severe chest pain due to acute coronary syndrome.
- Coronary angiography revealed sub-total occlusion of the RCA ostium.
- Echocardiography identified a 10 mm mobile mass in the right coronary cusp of the aortic valve.
Findings:
- Two drug-eluting stents were deployed at the RCA ostium to maintain patency and stabilize hemodynamics.
- Surgical resection of the aortic valve mass was successfully performed.
- Pathological examination confirmed the tumor to be a papillary fibroelastoma.
Implications:
- Papillary fibroelastomas can cause significant coronary artery obstruction and ACS.
- Stent placement can serve as a temporizing measure for ostial lesions caused by cardiac masses.
- Complete surgical excision is curative, with good long-term prognosis and minimal residual aortic regurgitation.
Abstract:
A 72-year-old female had persistent severe chest pain while climbing stairs. She was diagnosed as having acute coronary syndrome, and underwent an emergency coronary angiography (CAG). The right coronary artery (RCA) ostium was sub-totally occluded. Echocardiography revealed a 10 mm mobile mass at the right coronary cusp of the aortic valve. To avoid total obustruction on two drug eluting stents were placed at the RCA ostium so as to have the proximal end protrude into the right Valsalva sinus. Thus, her hemodynamic condition was stabilized. The tumor was surgically resected and the stents were easily removed. Pathologically, the tumor was papillary fibroelastoma. Postoperative aortic regurgitation was minimal echocardiography, and CAG showed normal RCA.
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