Papillary fibroelastoma arising from left ventricular outflow tract

Papillary fibroelastoma arising from left ventricular outflow tract 826 Image Focus IMAGE FOCUS doi:10.1093/ehjci/jey044 Online publish-ahead-of-print 28 March 2018 .................................................................................................................................................... 1 2 1 1 2 C.J. Coats *, J. Reid , S. Wright , P. Sonecki , and N. Al-Attar 1 2 Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK; and Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY, UK * Corresponding author. Tel: 144141 451 6127; Fax: 144141 201 2217. E-mail: carolinecoats@doctors.org.uk A 70-year-old female patient with previous transient ischaemic attacks underwent pre-operative transthoracic echocardiography for aortic stenosis. A mobile mass was incidentally noted in the left ventricular outflow tract (LVOT) (A). Transoesophageal echocardiography con- firmed a solitary lesion near a heavily calcified aortic valve, without sub-aortic obstruction (B; Supplementary data online, Video S1). Tissue velocity imaging demonstrated the mass was attached to the basal infero-septum rather than the valve (C; Supplementary data online, Video S2). During surgery, a filamentous lesion was excised from the interventricular septum, 2 cm from the right coronary cusp of the aortic valve. Like most papillary fibroelastomas, the lesion was small (D) and resembled a ‘sea anemone’ with a gelatinous membrane and multiple papillary projections (E). Histological examination was consistent with a benign papillary fibroelastoma with avascular papillary fronds (F; H&E100) and elastic fibres (black) within the papillae (G;elastic MSB200). Primary cardiac tumours are rare. Papillary fibroelastomas are typically attached to cardiac valves (frequently aortic) and due to their small size (5–20 mm diameter) may be difficult to distinguish from vegetations. Their location on the ventricular endocardium is very un- usual. Although a benign tumour, it carries very high risk of embolic complications. Long-term prognosis is excellent with complete surgical resection. Tissue velocity imaging is a widely available modality that can enhance the visualization of moving tissue providing greater confi- dence and precision in diagnosis. It is a useful adjunct to acoustically difficult transthoracic studies. In this patient, it enabled better delinea- tion of the aortic valve and LVOT anatomy. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/7/826/4955958 by Ed 'DeepDyve' Gillespie user on 26 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Papillary fibroelastoma arising from left ventricular outflow tract

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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2047-2404
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10.1093/ehjci/jey044
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Abstract

826 Image Focus IMAGE FOCUS doi:10.1093/ehjci/jey044 Online publish-ahead-of-print 28 March 2018 .................................................................................................................................................... 1 2 1 1 2 C.J. Coats *, J. Reid , S. Wright , P. Sonecki , and N. Al-Attar 1 2 Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK; and Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY, UK * Corresponding author. Tel: 144141 451 6127; Fax: 144141 201 2217. E-mail: carolinecoats@doctors.org.uk A 70-year-old female patient with previous transient ischaemic attacks underwent pre-operative transthoracic echocardiography for aortic stenosis. A mobile mass was incidentally noted in the left ventricular outflow tract (LVOT) (A). Transoesophageal echocardiography con- firmed a solitary lesion near a heavily calcified aortic valve, without sub-aortic obstruction (B; Supplementary data online, Video S1). Tissue velocity imaging demonstrated the mass was attached to the basal infero-septum rather than the valve (C; Supplementary data online, Video S2). During surgery, a filamentous lesion was excised from the interventricular septum, 2 cm from the right coronary cusp of the aortic valve. Like most papillary fibroelastomas, the lesion was small (D) and resembled a ‘sea anemone’ with a gelatinous membrane and multiple papillary projections (E). Histological examination was consistent with a benign papillary fibroelastoma with avascular papillary fronds (F; H&E100) and elastic fibres (black) within the papillae (G;elastic MSB200). Primary cardiac tumours are rare. Papillary fibroelastomas are typically attached to cardiac valves (frequently aortic) and due to their small size (5–20 mm diameter) may be difficult to distinguish from vegetations. Their location on the ventricular endocardium is very un- usual. Although a benign tumour, it carries very high risk of embolic complications. Long-term prognosis is excellent with complete surgical resection. Tissue velocity imaging is a widely available modality that can enhance the visualization of moving tissue providing greater confi- dence and precision in diagnosis. It is a useful adjunct to acoustically difficult transthoracic studies. In this patient, it enabled better delinea- tion of the aortic valve and LVOT anatomy. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/7/826/4955958 by Ed 'DeepDyve' Gillespie user on 26 June 2018

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: Mar 28, 2018

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