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(Circulation. 2002;106:1300.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Improved Preoperative Assessment of Papillary Fibroelastoma by Dynamic Three-Dimensional Echocardiography

Wolfgang Dichtl, MD, PhD; Ludwig C. Müller, MD; Otmar Pachinger, MD; Severin P. Schwarzacher, MD; Silvana Müller, MD

From the Department of Internal Medicine, Division of Cardiology (W.D., O.P., S.P.S., S.M.), and the Department of Cardiac Surgery (L.C.M.), Leopold-Franzens-Universität Innsbruck, Innsbruck, Austria.

Correspondence to Wolfgang Dichtl, MD, PhD, Department of Internal Medicine, Div Cardiology, Leopold-Franzens-Universität Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria. E-mail wolfgang.dichtl{at}uibk.ac.at

A53-year-old man with a history of non-Q-wave myocardial infarction and intermittent chest pain was diagnosed with a papillary fibroelastoma (PFE) of the aortic valve by the use of transthoracic echocardiography (TTE) (Figure). The PFE was further characterized by dynamic 3-dimensional echocardiography (DTDE; TomTec Imaging System Incorp). The use of DTDE yielded important additional information about the PFE, in particular about its spatial relationship to the ostium of the right coronary artery, which caused intermittent occlusion and coronary ischemia. The structure was pedunculated on a thin stalk (approximately 3 mm in diameter) and was therefore highly mobile and did not alter the aortic valve directly. The patient quickly recovered from the operation and thus far has not suffered from signs of myocardial ischemia or other forms of embolic disease.

View larger version (56K): [in this window] [in a new window]   Conventional 2D echocardiography showing a mass in the bulbus aortae near the aortic valve. An exact topographic location, however, is not possible (A). DTDE allows the precise characterization of the PFE in terms of location, size, surface, and relation to the aortic valve (B). DTDE also points out the high mobility of the pedunculated tumor and its thin stalk (C). D and E, DTDE and intraoperative situs of the PFE from a supravalvular view, which shows the close spatial relationship of the PFE to the ostium of the right coronary artery. RCA indicates the ostium of the right coronary artery; S, stalk.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dichtl, W. Articles by Müller, S. Search for Related Content PubMed PubMed Citation Articles by Dichtl, W. Articles by Müller, S. Related Collections Echocardiography CV surgery: valvular disease