[Aortic Valve Replacement for Multiple Papillary Fibroelastomas:Report of a Case]

Papillary fibroelastoma (PFE) is a benign tumor that is usually solitary and can cause embolic events. A 77-year-old woman complained exertional dyspnea. Transthoracic echocardiography incidentally detected a four-mm mobile, highly echogenic mass on the noncoronary cusp of the aortic valve and sur- gical removal was indicated. During surgery, multiple anemone-like lesions were found on all three cusps. Valve preservation deemed unsafe;therefore, we resected all three cusps and performed aortic valve replacement using bioprosthesis (INSPIRIS RESILIA 19 mm) in the supra-annular position. Pathological examination showed papillary fronds with elastic cores and myxoid stroma, covered by endothelium, consistent with PFE, and confirmed the multiplicity. Postoperative course was uneventful, and the patient was discharged on postoperative day 14. At six-month follow-up, echocardiography showed no recurrence of the tumor. In cases of multiple aortic valve PFEs, especially in older patients whom safety of valve preservation is uncertain, valve replacement may be an appropriate strategy. A meticulous intraoperative saline testing and cusp-to-cusp inspection of the valve is useful while choosing the optimal procedure.