An echogenic mass on the aortic valve

Excerpt

An asymptomatic 64-year-old patient came for a routine check-up following inferior wall myocardial infarction (MI) and stent insertion in France 6 months previously. He had no cardiovascular risk factors or significant past medical history. Systemic examination was normal as were his haematological and biochemical parameters. A routine echocardiogram (TTE) revealed a mass on the non-coronary leaflet of the aortic valve (AV) with normal left ventricular function and no other valvular abnormalities. Subsequent transoesophageal echocardiography confirmed a pedunculated echogenic mobile mass 0.5–1 cm in diameter attached to the aortic side of AV (Fig. 1a and online video files). Further imaging with cardiac MR described the hypointense mobile mass as possible fibroelastoma. The patient underwent excision of the tumour (Fig. 1b) and AV replacement. Histopathology revealed a central fibrous core surrounded by a layer of loose connective tissue with variable elastic tissue with the surface covered by endothelial cells, consistent with papillary fibroelastoma (Fig. 2). His post-operative recovery was uneventful and was later discharged.

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