Frésard, Isabelle

Goy, Jean-Jacques

Gugger, Mathias

Stalder, Mario

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CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehp500Online publish-ahead-of-print 19 November 2009Cardiac fibroelastoma causing anginaIsabelle Fre´sard1, Mario Stalder2, Mathias Gugger3, and Jean-Jacques Goy1*1Cardiology Division, Hoˆpital Cantonal, Fribourg 1700, Switzerland; 2Service of Cardiothoracic Surgery, Inselspital, Bern, Switzerland; and 3Anatomopathology Department,Inselspital, Bern, Switzerland* Corresponding author. Tel: þ41 792 136 465, Fax: þ41 244 260 731, Email: jjgoy@goyman.comAn 80-year-old woman wasreferred to our hospitalfor coronary angiogrambecause of unstable anginapectoris in spite of optimalmedical treatment. Stentplacement (drug elutingstent, DES) on the LADwas performed 3 yearsbefore. Physical examinationand ECG were normalwithout cardiac murmur.Cardiac catheterizationshowed a patent DES onthe LAD and an ostial occlu-sion of the right coronaryartery (RCA). Non-selectiveinjection typically showedan intra-aortic mass attachedto the right Valsalva sinus(Panel A). Transthoracicechocardiography andcardiac CT scan (Panels Band C ) confirm the presenceof a tumour. The patient wasreferred for surgery. A 1 cmspherical mass attached tothe aortic valve (not aleaflet) by a short pediclewith small hair-like projec-tions was found (Panels Dand E). This mass wasremoved and saphenouscoronary artery bypass graft-ing was performed on theRCA. Outcome wasuneventful. The histopathol-ogy examination founda papillary fibroelastoma(Panels F and G). It is a rarebenign cardiac tumouraccounting for 10% of allprimary cardiac neoplasms. More than 80% are symptomatic and located on the left side of the heart. Stroke, sudden death, ischaemia,and rhythm disturbances are common symptoms. Surgical excision is recommended, even in asymptomatic patients, because of thepotential of thromboembolism and a low operative risk of 2%. Our case is remarkable by the location of the mass not on a leafletbut at the origin of the RCA in the Valsalva sinus and its presentation as an acute coronary syndrome.Published on behalf of the European Society of Cardiology. All rights reserved.& The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.380 Cardiovascular flashlight

Cardiac fibroelastoma causing angina

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