case_images: PMC11816450_01
case_images: (A):severe stenosis of right coronary artery; (B):chronic occlusion of circumflex artery and severe stenosis of intermedius branch; (C,D):transesophageal echocardiography, showing papillary fibroelastoma attached to the right cusp of the pulmonary valve.
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case_images: The dyspnea persisted; therefore, the patient underwent coronary angiography, which revealed chronic occlusion of the circumflex artery, severe distal stenosis of the right coronary artery, and severe stenosis of the intermediate branch (Figure 1A,B). Intraoperative transesophageal echocardiography (TEE) revealed a round, oval, mobile, well-defined tumor approximately 1.1 x 0.8 cm in diameter, attached to the surface of the right cusp of the pulmonary valve (Figure 1C,D).
case_images: (A):transversal section on IRM demonstrating a 1.1 x 0.8 cm spherical structure attached to the pulmonary valve; (B):sagittal section on IRM.
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case_images: T1-weighted sequences, mildly hyperintense on T2-weighted sequences, with no central enhancement but peripheral enhancement with gadolinium on delayed post-contrast sequences. These tissue characteristics supported the diagnosis of a papillary fibroelastoma (Figure 2A,B).
case_images: (A):intraoperative aspect of the papillary fibroelastoma; (B):repair of the right cusp of the pulmonary valve; (C,D):transesophageal echocardiography, postoperative aspect with no residual regurgitation.
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case_images: The tumor was friable, mobile, measuring approximately 1.1 x 1.0 cm, and attached to the pulmonary artery side of the right cusp of the pulmonary valve (Figure 3A). Since only a small amount of valvular tissue was resected, valve repair was successfully performed using a continuous suture with 5.0 Prolene, Ethicon Inc., Cornelia, GE, USA, without the need for autologous pericardium or other biological materials (Figure 3B-D).
case_images: The postoperative characteristics of the papillary fibroelastoma. (A):the "sea anemone" macroscopic aspect; (B,C):microscopic examination reveals multiple avascular villous projections (B) covered by endothelial cells (C).
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case_images: The macroscopic appearance of the tumor was similar to a sea anemone when placed in serum (Figure 4A). The diagnosis of papillary fibroelastoma was confirmed by histopathological analysis (Figure 4B,C).