Afonso, D

Arsénio, A

Banazol, N

Branco, LM

Cardona, L

Pinto, E

Sousa, C

Repository of the Hospital Center of Central Lisbon

Uma Massa Estranha na Válvula Aórtica

Repositório do Centro Hospitalar de Lisboa Central, EPE

Recebido para publicação: ?????????? • Aceite para publicação: ????????Received for publication: ?????????? • Accepted for publication: ????????453IMAGEM EM CARDIOLOGIAAn unusual aortic valve mass [36]CATARINA S. SOUSA1, NUNO BANASOL2, DANIELA AFONSO2, EUGÉNIA PINTO2, LORETE CARDONA 2, LUÍSA BRANCO2, ANTÓNIO ARSÉNIO11Centro Hospitalar Lisboa Norte - Hospital Pulido Valente, Lisboa; Portugal 2Centro Hospitalar Lisboa Central Hospital de Santa Marta, Lisboa, PortugalRev Port Cardiol 2011; 30 (04): 453-455Key wordsCardiac papillary fibroelastomaUma massa estranha na válvula aórticaPalavras-Chave Fibroelastoma papilar cardíaco2010-IC-160AbrilCASE REPORTA55-year-old woman was referred by herfamily physician for a transthoracicechocardiogram in our echocardiography lab-oratory as a part of routine screening.Her past medical history and physicalexamination were unremarkable.The transthoracic echocardiogramrevealed a mobile mass adjacent to the aorticvalve on the aortic side (Figure 1-A –parasternal short-axis view, and Figure 1-B,– parasternal long-axis view). The aorticvalve had normal function and no othermasses were noted. Due to the patient’s pooracoustic window a transesophageal echocar-diogram was performed to further assess themass’s attachment and characteristics.The mass was round and echodense (21x10mm), with well defined borders, pedunculatedand attached to the commissure between thenoncoronary and right coronary cusps, sugges-tive of a fibroelastoma (Figure 1-C – 120°,Figure 1-D – 45°, and Figure E – 45°).Because of the tumor’s size and location andthe possibility of further enlargement, thepatient was referred for elective cardiac surgery.A valve sparing technique was used. A20x10 mm mass was extracted with a gelatinousand frond-like appearance (Figure 1-F). Offbypass a moderately eccentric regurgitant aorticvalve jet was noted on color Doppler (betweenthe noncoronary and right coronary cusps),prompting aortic valve replacement with a St.Jude 19 mm mechanical prosthetic valve.The patient’s recovery was uneventful.The histopathological examination revealeda cardiac papillary fibroelastoma (Figure 1-G).454Rev Port Cardiol Vol. 30 Abril 11 / April 112010-IC-160AbrilDISCUSSIONPrimary cardiac tumors are rare and in75% of cases benign. Papillary fibroelastomais the third most common primary cardiactumor, after myxoma and fibroma. Commonlyattached to the aortic or mitral valve (less fre-quently to the right side cardiac valves), it canbe asymptomatic but can also present withsystemic embolization or recurrent pulmonaryedema due to flow obstruction.Advances in echocardiography withimproved resolution have enabled the recog-nition of small, poorly defined valvular lesionsthat were not identified previously.Due to the possibility of embolization orobstruction, surgical excision should be per-formed in symptomatic patients, in thoseundergoing cardiac surgery, and with largeand extremely mobile fibroelastomas.Pedido de SeparatasAddress for reprints:Catarina SousaServiço de Cardiologia - 2Hospital Pulido ValenteAlameda Linhas Torres - 1171769-001 Lisboa - PortugalTel. 217 548 000e-mail: sousa.cat@gmail.comFigure. 1-A, 1-B, 1-C, 1-D, 1-E, 1-F, 1-G455Catarina S. Sousa, et al.Rev Port Cardiol 2011; 04: 453-4562010-IC-160Abril1. Jallad, N; Parikh, R; Daoko, J; Albareqdar, E; Al-Dehneh, A;Goldstein, J; Shamoon, F; Connolly, M. Concurrent primary car-diac tumors of differing histology and origin. Tex Heart Inst J.2009; 36(6):591-3.2. Sun, J; Asher, C; Yang, X; Cheng, G; Scalia, G; Massed, A;Griffin, B; Ratliff, N; Stewart,W; Thomas, J. Clinical and echocar-BIBLIOGRAFIA / REFERENCESdiographic characteristics of papillary fibroelastomas. Circulation.2001;103:2687-2693.3. Bicer, M; Cikirikcioglu,M; Pektok,E; Muller, H; Dettwiler, S;Kalangos,A. Papillary fibroelastoma of the left atrial wall: a casereport. J Cardiothorac Surg. 2009;4:208.Reunião Anual do Grupo de Estudosde Ecocardiografia28 e 29 de Outubro de 2011

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Uma Massa Estranha na Válvula Aórtica

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Repositório do Centro Hospitalar de Lisboa Central, EPE