Aortic valve fibroelastoma: transesophageal echocardiographic diagnosis and surgical excision

An asymptomatic 31-year-old woman was admitted for evaluation of a heart murmur accidentally discovered at a routine medical examination. A transesophageal echocardiogram disclosed an ostium secundum atrial septal defect and a small mass attached to the inner surface of the non-coronary cups of the aortic valve. The patient underwent closure of the atrial septal defect and excision of the mass without damage to the aortic valve. Hystological analysis of the mass was consistent with the diagnosis of papillary fibroelastoma. Papillary fibroelastoma is the most common of the cardiac valve tumors. It is benign, generally small and asymptomatic, but it has a definite tendency to produce serious embolic complications. Therefore, elective surgical resection is usually recommended. The tumor is most often an incidental finding at autopsy; occasionally it is recognized during life in patients evaluated for embolic events of unclear ethiology. This is one of a few cases in which the diagnosis of a completely asymptomatic fibroelastoma has been accomplished preoperatively, thus allowing a successful surgical therapy.