Sudden Death in a Woman With Fibroelastoma of the Aortic Valve Chronically Occluding the Right Coronary Ostium
An 89-year-old woman was hospitalized for ischemic cardiopathy and anemia. Her initial ECG showed sinus tachycardia, incomplete right bundle-branch block, and nonspecific ST- and T-wave changes. On day 19 after admission, during a gastroscopy, the patient suddenly collapsed. Cardiopulmonary resuscitation was unsuccessful.
At autopsy, the heart weighed 460 g, and the left ventricular chamber was significantly dilated. The closure line of the free edge of the right aortic cusp presented a pedunculated fibroelastoma whose distal end completely occluded the right coronary ostium (Figure⇓). The posteroinferior wall of the left ventricle, the posteromedial papillary muscle, and the posterior third of the interventricular septum were replaced by fibrous tissue. The aortic valve cusps were slightly sclerotic, with focal fusion of their free edges. The lesion was probably related to healed valvulitis. The postinflammatory endocardial cell damage and the subsequent irregularity of the closure line with exposure of the underlying collagen of the valve probably played a role in the formation of the fibroelastoma.
Systemic embolization is a frequent complication of any cardiac tumor. Occasionally, these lesions may cause obstructive symptoms interacting with the transvalvular blood flow. In the case reported here, the fibroelastoma did not present embolic potential or transvalvular blood flow disorders.
We gratefully thank Gianfranco Clari and Giuliano Grandi for excellent photographic assistance.
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 Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 1999 by American Heart Association