PMC8710145_01
Transesophageal echocardiography (mid-esophageal four-chamber view) of the mitral valve showing a floating structure on the anterior leaflet.
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To rule out endocarditis, echocardiography was performed, showing floating structures on the leaflets of the mitral valve ( Fig. 1 ).
Computed tomography of the thorax (Siemens Somatom Definition Edge) with contrast agent (Solutrast 370, Iopamidol) showing a solid structure on the mitral valve.
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Despite negative results from the blood cultures, the patient was then admitted to our clinic for minimally invasive mitral valve replacement (three-dimensional endoscopic via right lateral thoracotomy) due to morphologically unchanged structures on the mitral leaflets and the high embolic risk ( Fig. 2 ).
Operative situs during minimally invasive cardiac mitral valve surgery. Cauliflower-like adhesive lesions on the A2 segment of the anterior mitral valve leaflet and on the P3 segment of the posterior leaflet were resected. The mitral valve was replaced with a biological prothesis (Edwards Perimount Magna Mitral Ease 31 mm) preserving the entire subvalvular apparatus.
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Intraoperatively, two cauliflower-like lesions on the anterior and posterior mitral valve leaflets were resected ( Fig. 3 ).
(
A
) Histopathological analysis (hematoxylin and eosin stain) of the specimen showing irregularly branching papillae (magnification x50) composed of fibroelastic tissue. (
B
) x200 magnification (elastic Van Gieson stain) showing characteristic triphasic pattern with a prominent elastic central core within the papillae.
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Histopathological investigations showed irregular branching papillae composed of fibroelastic tissue covered by normal endocardium, consistent with PFEs with predominance of fibrous stroma ( Fig. 4 ). The patient denied further genetic testing or coloscopy at this time and was discharged home in good clinical condition 10 days after the surgery ( Fig. 4 ).