PMC4715320_01
Transthoracic echocardiography. a, parasternal long-axis view shows a round mass (6 x 5 mm, arrow) on the aortic side of the non-coronary cusp of the aortic valve in 2010. b, parasternal long-axis view shows a round mass (6 x 5 mm, arrow) on the aortic side of the non-coronary cusp of the aortic valve in 2015. c, parasternal short-axis view shows a round mass (arrow) on the aortic side of the non-coronary cusp of the aortic valve in 2015. d, Apical 4 chamber view shows moderate mitral regurgitation
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Fig1
A 50-year-old woman was first admitted to our hospital in 2010, when transthoracic echocardiography (TTE) revealed a mass on the non-coronary cusp for the first time (Fig. 1), and electrocardiogram showed sinus rhythm. TTE revealed moderate mitral stenosis (mitral valve area, 1.1 cm2), moderate mitral regurgitation, mild tricuspid regurgitation, mild to moderate aortic valve regurgitation, and a round mass (6 x 5 mm) on the aortic side of the non-coronary cusp (Fig. 1).
Gross specimen of the resected mass and the non-coronary cusp of the aortic valve
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Fig2
The aortic valve was also thickened, and a flower-like mass with multiple papillary fronds (8 x 8 mm) was found on the aortic side of the non-coronary cusp (Fig. 2).
Hematoxylin and eosin stain (original magnification x 20)
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Fig3
The connective tissue of PFE contains mature collagen with irregular elastic fibers that are oriented longitudinally (Figs. 3 and 4).
Verhoeff's elastic stain (original magnification x 20)
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Fig4
The connective tissue of PFE contains mature collagen with irregular elastic fibers that are oriented longitudinally (Figs. 3 and 4).