Coinciding anomalous coronary artery and papillary fibroelastoma.

Abstract

Introduction: The primary cardiac tumors are extremely rare tumors that arise from the normal tissues that make up the heart. Those tumor can be divided into Benign, mostly myxoma or malignant tumors. Fibroelastoma are rare benign tumors of the endocardium. They are usually left sided, with few cases reported of pulmonary valve papillary fibroelastoma. No case of fibroelastoma and anamolous coronary artery. Case Presentation: 61 year old female with past medical history of diabetes mellitus was complaining of chronic stable angina. Admitted after an outpatient positive treadmill EKG test (ST segment depression inferiolaterally). Final/Working Diagnosis: Left heart cath demonstrated angiographically normal coronaries with an anomalous left main coronary artery originating from the right coronary cusp with no significant disease. Management: CT angiogram similarly demonstrated an anomalous origin of the left main coronary artery from a common ostium with the right coronary artery originating from the right sinus of Valsalva. The left main coronary courses between the aorta and right pulmonary outflow tract consistent with an intra-arterial course.Echo showed an incidental finding of a mobile structures attached to the pulmonic valve, 0.7x0.7 cm in size, whose appearance was consistent with papillary fibroelastoma . CardioThoracic surgery was consulted for patient continuous angina symptoms not responsive to medical therapy and the above coronary artery findings, it was believed that she would not benefit from relocation of the left main coronary artery due to the common ostia with the right and its intra-arterial course. Patient had 2 vessel coronary artery revascularization (LIMA to LAD, reverse saphenous vein graft to ramus with endoscopic vein harvest and excision of pulmonary valve mass). The pathology report confirmed the diagnosis of papillary fibroelastoma. Disclosure Saif Ibrahim, MD – No Relevant Financial Relationships to Disclose Steven Lavine, MD – No Relevant Financial Relationships to Disclose Jean Touchan, MD – No Relevant Financial Relationships to Disclose