PMC8200485_01
Transthoracic echocardiography: (A) Subxyphoid view shows pedunculated mass (red arrow) localization in Valsalva sinus. (B) Long-axis view measuring tumor size 1.9 x 1.5 cm (red arrow). (C) Short-axis view at aortic valve level demonstrates tumor (red arrow) originating immediately after the separation of the left and right coronary cusp. (RV) Right ventricle. (LV) Left ventricle. (AoB) Aortic bulb. (LA) Left atrium. (RCC) Right coronary cusp. (NCC) Noncoronary cusp. (LCC) Left coronary cusp. (D) Transthoracic three-dimensional echocardiography: view of the aortic valve (yellow arrow) from the aortic side, which shows the aortic cusps' normal appearance. (AoV) Aortic valve. (Ao) Aorta.
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F1
An irregular round mobile mass (dimensions 1.9 x 1.5 cm) was seen in the lumen of the aortic bulb, attached immediately after the separation of the left and right aortic coronary cusp, that fluttered in the aortic lumen and didn't enter the left ventricle (Figures 1A-C). There were no wall motion abnormalities and no other structural valve abnormalities noted including aortic stenosis or regurgitation (Figure 1D).
Computed tomography of the chest: (A) A large fibroelastoma (red arrow) in the aortic bulb. (B) Cross-section showing localization of fibroelastoma (red arrow) right next to the left coronary artery ostium. (AoB) Aortic bulb. (LV) Left ventricle. (LCA) Left coronary artery. (RCA) right coronary artery.
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F2
It observed a large irregular hypodense tumor-like lesion in the bulbar aorta that was occasionally prolapsing into the left main coronary artery ostium and which corresponded to fibroelastoma (Figure 2).
Surgical view after transverse aortotomy: (A) Fibroelastoma (blue arrow) localization in the Valsalva sinus. (B) A tumor (blue arrow) was attached by a thin stalk (red arrow) between the right and left coronary aortic cusps at the aortic side. Notice normal anatomical preservation of the aortic valve leaflets. The left coronary cusp was hidden behind the tumor. (RCC) Right coronary cusp. (NCC) Noncoronary cusp. (LCC) Left coronary cusp.
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F3
In contrast, the aortic valve leaflets inspection determined their anatomical preservation (Figure 3).
Pathological exam of papillary fibroelastoma: (A) Gross specimen. (B) Histological finding stained by hematoxylin-eosin method (a fragment from a tumor nodule constructed of numerous papillary formations lined with endothelial cells while a stromal papilla is constructed of a homogeneous, hypocellular portion of edematous connective tissue) on a low magnification.
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F4
A pathohistological examination made the final diagnosis of papillary fibroelastoma (Figure 4).