title: Dynamic obstruction of the left main coronary artery ostium by a papillary fibroelastoma.
abstract: BACKGROUND
  Benign tumours of the heart are usually detected as incidental findings during echocardiography. Most cases are intracardiac tumours, with myxoma being the most frequent entity. We present images of a patient with acute myocardial infarction and a concomitant extracardiac benign tumour in the aortic root.
  
  
  METHODS
  Transesophageal echocardiography, coronary computed tomography angiography, cardiac surgery and histology of the excised tumour were performed.
  
  
  RESULTS
  A mobile mass was found in the aortic root obstructing the left main coronary artery ostium during diastole. Coronary CT angiography indicated severe coronary artery disease and the patient underwent bypass surgery and excision of the tumour. The excised tumour was identified as papillary fibroelastoma.
  
  
  CONCLUSIONS
  Papillary fibroelastoma is the second most benign tumour of the heart. More than other tumours it is prone to embolization. Extracardiac location as in our case is very rare but dangerous since embolization may occur spontaneously or associated with catheterization.
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. Electronic address: napp.christian@mh-hannover.de.
authors.forename: L Christian
authors.initials: LC
authors.lastname: Napp
authors.forename: Hassina
authors.initials: H
authors.lastname: Baraki
authors.forename: Ingo
authors.initials: I
authors.lastname: Kutschka
authors.forename: Martin
authors.initials: M
authors.lastname: Bredt
authors.forename: Michael-Ulrich
authors.initials: MU
authors.lastname: Brehm
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.forename: Udo
authors.initials: U
authors.lastname: Bavendiek
mesh_terms: D001706:Biopsy; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005350:Fibroma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006338:Heart Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Myocardial infarction; Papillary fibroelastoma; Sinus of valsalva; Transesophageal echocardiography