Fibroelastoma and Embolic Stroke
A 40-year-old healthy woman presented with an acute expressive aphasia and right hemiparesis. An angiogram revealed an occluded left middle cerebral artery consistent with an embolic stroke. In the Figure⇓, panel A, a four-chamber view from a transesophageal echocardiogram, shows a 1.5-cm spherical mass on the posterior mitral valve leaflet (white arrow; LA indicates left atrium; LV, left ventricle; and AML, anterior mitral leaflet). The differential diagnosis of this lesion included thrombus, vegetation, mitral annual calcification, and tumor. Successful surgical excision of the mass and mitral valve reconstruction with implantation of a Carpentier ring was performed. Panel B is a cut section of the mass stained with hematoxylin-eosin magnified 20×. The image demonstrates the characteristic pathological findings of a fibroelastoma, which include multiple papillary fronds composed of a central core of connective tissue, collagen, and elastic fibers surrounded by hyperplastic endocardial cells. It is likely that one of the fronds dislodged and embolized. After 1 year, the motor and speech deficits have improved.
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 © 1998 by American Heart Association