“A rare atypical aortic valve papillary fibroelastoma in a young patient: a case report on diagnosis and surgical challenges”

Papillary fibroelastoma (PFE) is a rare, benign cardiac tumor that most commonly involves the heart valves, particularly the aortic valve. Although often asymptomatic, PFEs can lead to serious complications such as embolic or ischemic events. This case highlights an atypical presentation of PFE in a young patient, emphasizing the diagnostic and management challenges encountered. A 24-year-old male presented with angina-like chest pain. Transthoracic echocardiography (TTE) revealed a mobile, pedunculated mass attached to the aortic side of the right non-coronary commissure of the aortic valve. Further imaging confirmed the mass contributed to coronary blood flow obstruction, with no evidence of coronary artery disease. Preoperative evaluation revealed a protamine sulfate allergy, requiring adjustments to anticoagulation management. Given the risk of embolization and coronary obstruction, surgical resection was performed successfully without complications. The postoperative course was uneventful, and repeat imaging demonstrated no recurrence or residual regurgitation. This case emphasizes the importance of recognizing PFE as a potentially serious condition, even in young patients. It highlights the necessity of individualized management strategies for uncommon presentations and provides additional insight into the perioperative considerations associated with allergies to critical surgical medications.