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(Circulation. 2008;117:e190-e191.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Papillary Fibroelastoma of the Tricuspid Valve Seen on Magnetic Resonance Imaging

Sebastian Kelle, MD; Amedeo Chiribiri, MD; Rudolf Meyer, MD; Eckart Fleck, MD; Eike Nagel, MD

From the Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (S.K., R.M., E.F.); Department of Radiology, Johns Hopkins University, Baltimore, Md (S.K.); Department of Internal Medicine, Division of Cardiology, University of Turin, Turin, Italy (A.C.); and Division of Imaging Sciences, King’s College London, London, UK (E.N.).

Correspondence to Sebastian Kelle, MD, German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail kelle@dhzb.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 72-year–old female patient with atypical chest pain and atherosclerotic risk profile was referred for cardiac magnetic resonance imaging at 3.0 Tesla (Phillips Achieva, Phillips Medical Systems, Best, The Netherlands), sus pected of having coronary artery disease. A resting ECG showed no signs of ischemia or chronic myocardial infarction (Figure 1A). Routinely performed echocardiography revealed a small suspicious mass at the tricuspid valve (Figure 1B). Cardiac magnetic resonance cine imaging revealed normal left ventricular function but, at rest, hypokinesia of the lateral wall of the basal slice. As an additional finding, an 8x8-mm, highly mobile, spherical pedunculate mass attached to the posterior tricuspid valve leaflet was found (Figure 2). T1-weighted images revealed the mass to be homogeneous but with higher signal intensity compared with myocardium. On the basis of a fat-suppression sequence, no fatty content of the tumor was found. Delayed enhancement images of the tricuspid valve tumor after administration of Gd-DTPA demonstrated hyperintense signal caused by the fibroelastic tissue of the mass. In addition, a 50% to 75% subendocardial scar of the lateral wall at basal level could be demonstrated. This lesion was located in correspondence to a wall motion abnormality at rest and was highly suspicious of ischemia due to underlying coronary artery disease. Invasive coronary angiography revealed triple-vessel disease with high-grade stenosis (Figure 3A). Bypass surgery and removal of the valvular tumor were performed.

View larger version (85K):   Figure 1. Resting ECGs (A) demonstrate no signs of ischemia or chronic myocardial . . . [Full Text of this Article]