Angina and sudden death resulting from papillary fibroelastoma of the aortic valve

A 75-year-old woman presented with recurrent severe chest pain radiating to her back. The initial ECG was normal, and clinically an aortic dissection was suspected. The patient became hypotensive during a chest computed tomography scan with infusion, had subsequent repeated cardiac arrests, and died. Autopsy revealed a 1.5-cm polypoid lesion, a papillary fibroelastoma, on the aortic valve, which effectively occluded the ostium of the left coronary artery in a ball-valve effect. In addition, an embolic fragment of the tumor was found in the left anterior descending artery. This is the sixth reported case of angina and/or sudden death resulting from this lesion. Of the 75 cases reported in the literature, most are incidental necropsy findings, although neurologic emboli and outflow tract obstruction have been described.