Cardiac Papillary Fibroelastoma: A Treatable Cause of Transient Ischemic Attack and Ischemic Stroke Detected by Transesophageal Echocardiography Robert.

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Cardiac Papillary Fibroelastoma: A Treatable Cause of Transient Ischemic Attack and Ischemic Stroke Detected by Transesophageal Echocardiography Robert D. Brown, M.D., Bijoy K. Khandheria, M.D., William D. Edwards, M.D. Mayo Clinic Proceedings Volume 70, Issue 9, Pages 863-868 (September 1995) DOI: 10.4065/70.9.863 Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Multiplane transesophageal echocardiographic (TEE) images of 55-year-old woman. A, Diastolic frame, showing three cusps of aortic valve and fibroelastoma on left coronary cusp (arrow). Transducer angle is at 45°. B, Systolic frame, revealing fibroelastoma (arrow). C, Long-axis view, showing frondlike echodense mass (arrow) attached to left coronary cusp and protruding into ascending aorta. Mass was later confirmed to be fibroelastoma. Echocardiographic view can be obtained by rotating transducer to 135° when using multiplane TEE. AV = aortic valve; LA = left atrium; LVOT = left ventricular outflow tract; PA = pulmonary artery. Mayo Clinic Proceedings 1995 70, 863-868DOI: (10.4065/70.9.863) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 A, Gross photograph of cardiac papillary fibroelastoma of aortic valve as revealed on transesophageal echocardiography in Figure 1. Surgically resected specimen shows several branching frondlike stalks. B, Low-power photomicrograph, showing regular elastin deposition (black material) at core of papillary fronds. (Elastic-van Gieson stain; original magnification, x23.) C, Medium-power photomicrograph, showing irregular surface but no adherent thrombus. (Elastic-van Gieson stain; original magnification, x53.) Mayo Clinic Proceedings 1995 70, 863-868DOI: (10.4065/70.9.863) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Transgastric long-axis multiplane transesophageal echocardiographic view at 84°, demonstrating fibroelastoma (arrow) on anterior leaflet of mitral valve of 40-year-old woman. LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract. Mayo Clinic Proceedings 1995 70, 863-868DOI: (10.4065/70.9.863) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Multiplane transesophageal echocardiographic images of 68-year-old man. A, Long-axis view, demonstrating papillary fibroelastoma(arrows) attached to left coronary cusp and protruding into left ventricular outflow tract. B, Short-axis view, demonstrating aortic valvewith fibroelastoma (arrow). AV = aortic valve; LA = left atrium; LVOT = left ventricular outflow tract; RVOT = right ventricular outflow tract. Mayo Clinic Proceedings 1995 70, 863-868DOI: (10.4065/70.9.863) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions