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Papillary fibroelastoma of the aortic valve and coronary artery disease visualized by 64-slice CT

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 350–353 (2008)Cite this article

Abstract

Background A 75-year-old male with a history of myocardial infarction and recent transient ischemic attack was referred to a cardiology clinic for preoperative evaluation before a cystectomy. Transthoracic and transesophageal echocardiography revealed a mobile mass on the right coronary cusp of the aortic valve. Multislice CT demonstrated a significant narrowing in the proximal left anterior descending coronary artery.

Investigations Physical examination, chest radiography, laboratory testing, electrocardiography, transthoracic and transesophageal echocardiography, multislice-CT coronary angiography, pathological and histological examination of the surgically excised tissue.

Diagnosis Papillary fibroelastoma of the aortic valve in conjunction with coronary artery disease.

Management Surgical excision of the mobile lesion and an end-to-side anastomosis of the left internal mammary artery to the left anterior descending coronary artery.

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Figure 1: Transesophageal echocardiography demonstrated a papillary fibroelastoma (thick arrow) attached to the patient's aortic valve (thin arrow).
Figure 2: CT coronary angiogram with multiplanar reformation in the axial view showing nonsignificant calcified plaque in the left main stem and a significant noncalcified stenosis of the proximal left anterior descending artery.
Figure 3: Multislice-CT data enabled clear visualization of the papillary fibroelastoma.
Figure 4: The papillary fibroelastoma (arrow) was removed via the transaortic route with preservation of the aortic valve.
Figure 5: Pathological specimen of the excised papillary fibroelastoma (hematoxylin and eosin staining), demonstrating a frond-like arborizing structure.

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Authors and Affiliations

  1. RN de Visser is a Cardiologist at St Elisabeth Hospital, Tilburg,

    Randall N de Visser

  2. C van Mieghem is Chief of the Cardiac Imaging Department and Co-Director of Interventional Cardiology at the Medical Center, Rijnmond Zuid,

    Carlos van Mieghem

  3. JP Kerker is a Cardiologist at Ikazia Hospital, AC Weustink is a Research Fellow and TW Galema is a Cardiologist and Head of the Outpatient Clinic at the Erasmus Medical Center, Rotterdam, the Netherlands,

    Annick C Weustink, Jacques P Kerker & Tjebbe W Galema

  4. NC van Pelt is a Consultant Cardiologist at Middlemore Hospital, Auckland, New Zealand.,

    Niels C van Pelt

Authors
  1. Randall N de Visser
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  2. Carlos van Mieghem
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  3. Niels C van Pelt
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  4. Annick C Weustink
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  5. Jacques P Kerker
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  6. Tjebbe W Galema
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Corresponding author

Correspondence to Tjebbe W Galema.

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The authors declare no competing financial interests.

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de Visser, R., van Mieghem, C., van Pelt, N. et al. Papillary fibroelastoma of the aortic valve and coronary artery disease visualized by 64-slice CT. Nat Rev Cardiol 5, 350–353 (2008). https://doi.org/10.1038/ncpcardio1212

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  • DOI: https://doi.org/10.1038/ncpcardio1212

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