PMC9382589_01
(A) Transthoracic echocardiography showed an irregular hyperechoic mobile mass (1.2 x 0.9 cm in size, white arrow) with a stalk arising from the right atrium adjacent to the aortic root; (B) Transesophageal echocardiography showed an additional mobile mass (1.3 x 0.8 cm in size, white arrow) on the ventricular side of the non-coronary cusp of aortic valve; (C) Coronary computed tomography angiography showed abnormal thickness of non-coronary cusp of aortic valve, which represented the cardiac papillary fibroelastoma (red arrow) on the aortic valve.
fcvm-09-908567-g0001.jpg
PMC9382589_01_fcvm-09-908567-g0001.jpg
F1
TTE revealed an irregular hyperechoic mobile mass (1.2 x 0.9 cm in size) with a stalk arising from the RA adjacent to the aortic root (Figure 1A). Intraoperative transesophageal echocardiography (TEE) after anesthesia detected an additional mobile mass (1.3 x 0.8 cm in size) on the ventricular side of the non-coronary cusp of the AV (Figure 1B). AV regurgitation and complete excision of the masses. As only still echo images were regular archived, we retrospectively found abnormal thickness of non-coronary cusp of AV on coronary CTA, representing the CPF which was misdiagnosed as degenerative thickening of leaflet (Figure 1C).
(A) CPF was located on the ventricular side of non-coronary cusp of aortic valve (white arrows); (B) CPF (white arrows) was located in the RA adjacent to aortic root with a stalk (green arrow). CPF, cardiac papillary fibroelastoma; NCC, non-coronary cusp; RCC, right-coronary cusp; LCC, left-coronary cusp; RA, right atrium; TV, tricuspid valve.
fcvm-09-908567-g0002.jpg
PMC9382589_01_fcvm-09-908567-g0002.jpg
F2
After transverse aortotomy, the tumor was located on the ventricular side of the noncoronary cusp of the AV (Figure 2A) and was easily excised by shaving its stalk. AV leaflet inspection confirmed their anatomical preservation. The right atrial tumor (Figure 2B) was successfully excised on a beating heart by shaving its stalk (Supplementary Video 1).
(A) Macroscopic inspection of the tumors when immersed in water showed a "sea anemone" phenomenon. On the left is the tumor on the aortic valve, and on the right is the tumor in the right atrium. (B,C) Histopathologic examination of the tumors [panel (B) represents the tumor on the aortic valve and panel (C) represents the tumor in the right atrium] with hematoxylin-eosin staining (100x) confirmed the diagnosis of cardiac papillary fibroelastomas.
fcvm-09-908567-g0003.jpg
PMC9382589_01_fcvm-09-908567-g0003.jpg
F3
When immersed in water, both tumors showed "the sea anemone" phenomenon, which strongly suggested the presence of CPFs (Figure 3A). Histopathological examination demonstrated bundles of papillary projections with a collagenous core surrounded by a single layer of endothelium, and a final diagnosis of multifocal CPFs was made (Figures 3B,C).