Case Report
A 73-year-old woman, hypertensive and diabetic, came to ER with typical
angina symptoms. The patient had undergone PTCA with DES on the anterior
descending and first diagonal coronary arteries, following acute
myocardial infarction, 3 years before. Subsequently, one and a half
years later a further coronary artery examination, performed after a
chest pain episode with positive ECG, showed a good success of the
previous PTCA’s. No other coronary lesions were found and nothing was
detected in the ascending aorta. At the current admission the ECG showed
ST depression in II-III-aVF that spontaneously resolved and there was no
significant HS troponin enzymatic release. At a routine TTE the presence
of a mass in the upper part of the right coronary sinus just above the
right coronary ostium was noted. A TEE was quickly performed confirming
the presence of a mobile mass of about 1x1.5 cm in diameter with
irregular profile (Figure 1A). A CT scan was then performed confirming
the location, aspect and size of the mass (Figure 1B). Although the
patient remained asymptomatic, the mobility of the mass associated with
the previous episode of chest pain made us put an indication to urgent
surgery.
After a median sternotomy the extracorporeal circulation was started by
cannulation of the ascending aorta and left atrium. After aortic
clamping, longitudinal aortic root exposure was obtained. A transparent
gelatinous mass was found, implanted by a small peduncle in the upper
part of the right coronary sinus slightly laterally to the coronary
ostium, which appeared partially covered by the mass itself (Figure 2A).
The tumor was excised at the base, without the need to remove part of
the aortic root (Figure 2B). The total CPB time was 32 min and the cross
clamp 16 min. The postoperative course was uncomplicated and the patient
discharged home on the seventh POD. Before discharge a new coronary
artery angiography showed an unchanged finding. The histopathological
examination confirmed that the mass was a papillary fibroelastoma
without thrombotic component (Figures 2C).