Papillary Fibroelastoma of the Aortic Root Causing Intermittent Coronary Ostial Obstruction: The Diagnostic Power of 3D Transesophageal Echocardiography

We describe a patient with recurrent, brief episodes of chest discomfort caused by a highly mobile papillary fibroelastoma originating from the aortic wall and intermittently encroaching on the right coronary artery ostium. Initial 2D and 3D transthoracic and 2D transesophageal echocardiography identified a highly mobile mass in the ascending aorta above the aortic valve; the exact site of attachment and its relationship to the coronary ostia could not be clearly defined. Three-dimensional transesophageal echocardiography enabled precise anatomical reconstruction of the lesion and surrounding structures, clearly demonstrating its pedicle and proximity to the right coronary ostium. This imaging modality clarified the pathophysiological mechanism of symptoms and facilitated optimal surgical planning without the need for additional complex imaging techniques.