Abstract
A 65-year-old man had been, at first, diagnosed with aortic valve endocarditis vegetation following the transesophageal echocardiography findings: a small floating mass on the aortic side of the aortic valve inducing severe aortic valve regurgitation (Figure 1A). 1 However, the patient had not experienced fever in the last 3 months, and the blood culture was negative for the presence of infection. The patient did not match Duke’s criteria for endocarditis diagnosis. He had been admitted with a diagnosis of suspected fibroelastoma to the cardiac surgery unit to undergo aortic valve replacement. Intraoperative findings showed a pedicle little mass (diameter 1.5 cm) with numerous filamentous ends. The neo-formation had been removed and fixed in formalin. Macroscopic observation of the formalin plunged sample revealed a particular “sea anemone” appearance of the lesion (Figure 1B). Histological examination showed a 1.5-cm lesion with multiple papillary fronds, consisting of hyalinized hypocellular stroma lined by flat endocardial cells (Figure 1C and D). 2 The final diagnosis was of papillary fibroelastoma.
(A) Transesophageal echocardiography. The yellow star shows the little mass on the aortic side of the aortic valve (short-axis view). (B) Macroscopic view of the formalin plunged sample, please note the “sea anemone” appearance of the lesion. (C) Panoramic view of the sample showing a papillary lesion with multiple fronds (magnification 3×; Leica DMD108 digital microscope). (D) details of a papillary frond with an hypocellular stroma, lined by flat endothelial cells (magnification 200×; Leica DMD108 digital microscope).
The patient received an aortic bioprosthesis. He had a regular postoperative stay and was discharged on the fifth postoperative day. The 1-year follow-up transthoracic echocardiography showed good hemodynamic parameters of the bioprosthesis.
