Improved Preoperative Assessment of Papillary Fibroelastoma by Dynamic Three-Dimensional Echocardiography
A 53-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.
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.
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