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).