Elderly woman with a history of stroke and a mass in the aortic root. Papillary fibroelastoma. – Case report

A woman in her mid-seventies with a history of chronic atrial fibrillation (AF), coronary artery disease, polymyalgia rheumatica, and type 2 diabetes was found in a semi-comatose state in her home. In the emergency room, she presented with left arm weakness and aphasia. Magnetic resonance imaging of the brain revealed multiple acute infarcts attributed to cardiac emboli, although transthoracic echocardiography (TTE) did not detect cardiac thrombi. Following extensive rehabilitation, she was readmitted with chest pain and dyspnea, which were thought to be related to a bradycardia-induced heart failure. She received a pacemaker, but her clinical state did not improve. Therefore, cardioversion of her AF was planned; however, prior to the procedure, transesophageal echocardiography (TEE) revealed a mass in the aortic root. The mass, which was attached to the non-coronary aortic valve cusp, was surgically removed via open-heart surgery, and the valve was repaired to prevent aortic insufficiency. The patient fared well postoperatively. Histological analysis confirmed papillary fibroelastoma, which is the third most common benign heart tumor after myxoma and lipoma. This case, which is the first documented report of a papillary fibroelastoma of the aortic valve in Iceland, demonstrates the importance of considering cardiac tumors in patients with embolic stroke.