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Giant Fibroelastoma of the Aortic Valve

DOI: 10.1155/2013/754235

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Abstract:

Fibroelastomas account for less than 10% of all cardiac tumours, representing the most common valvular and the second most common cardiac benign tumour, following myxomas. Fibroelastomas are histologically benign; they can result in life-threatening complications such as stroke, acute valvular dysfunction, embolism, ventricular fibrillation, and sudden death. Surgical resection should be offered to all patients who have symptoms and to asymptomatic patients who have pedunculated lesions or tumors larger than 1?cm in diameter. Valve-sparing excision produces good long-term results in most instances. We report our surgical experience of a giant fibroelastoma in the aortic valve. 1. Introduction Cardiac fibroelastomas are the most common benign neoplasms of the cardiac valvular structures. Fibroelastoma is often attached to valve leaflets, most often to the aortic valve, and less frequently to the tricuspid, mitral, and pulmonary valves. Although most cases of fibroelastoma are incidental findings because they are asymptomatic, some show a strong propensity toward embolization, causing angina, myocardial infarction, transient ischemic attack, stroke, or sudden death when the tumor is in the left side of the heart. Here, we report our treatment of a giant aortic valve fibroelastoma. 2. Case Report An 18-year-old man was referred for the evaluation of fatigue, chest pain, and syncope. His fatigue initially consisted of effort intolerance. He did not initially seek medical attention for his fatigue and syncope. His chest discomfort was described as a squeezing sensation that was substernal in location without radiation to any other position. His syncope was always preceded by substernal chest pressure, dizziness, and breathlessness. A transesophageal echocardiogram demonstrated a 70?mm mobile mass adherent to the left coronary cusp of the aortic valve, sign of left ventricular outflow tract obstruction. The mass was a pedunculated, echo dense, stipple in texture structure, with well-demarcated borders, features typical of a fibroelastoma. The cardiac fibroelastoma was responsible for left ventricular outflow tract obstruction and valvular dysfunction. The patient underwent surgical excision of the mass. Preparation for operation, median sternotomy, cardiopulmonary bypass, and myocardial management were performed. The tumor was found to have a wide attachment to the surface of the ventricular aspect of the left coronary cusp extending from the aortic annulus to the edge of the cusp. Tumor had well-demarcated borders and homogenous texture in appearance (Figure

References

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[2]  R. R. Gopaldas, P. V. Atluri, A. S. Blaustein, F. G. Bakaeen, J. Huh, and D. Chu, “Papillary fibroelastoma of the aortic valve: operative approaches upon incidental discovery,” Texas Heart Institute Journal, vol. 36, no. 2, pp. 160–163, 2009.
[3]  D. L. Ngaage, C. J. Mullany, R. C. Daly et al., “Surgical treatment of cardiac papillary fibroelastoma: a single center experience with eighty-eight patients,” Annals of Thoracic Surgery, vol. 80, no. 5, pp. 1712–1718, 2005.
[4]  J. M. Grinda, J. P. Couetil, S. Chauvaud et al., “Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization,” Journal of Thoracic and Cardiovascular Surgery, vol. 117, no. 1, pp. 106–110, 1999.

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