Papillary fibroelastomas are rare tumors usually involvingthe cardiac valves. We present an extremely rare case ofa papillary fibroelastoma originating from the aortic wall.The patient was successfully treated with complete tumorresectionandavalve-sparingproceduretorestoretheaorticroot anatomy.CLINICAL SUMMARYA 77-year-old woman was admitted to the UniversityHospitalofSalamancawitha3-monthhistoryofprogressivedyspnea and angina pectoris on exertion. On admission,physicalexaminationlaboratoryfindingsandelectrocardio-gram did not revealed abnormalities. An echocardiogramshoweda232-cmmobilemasslocatedimmediatelyabovetheaorticvalveincontactwiththeaorticrootwall(Figure1,A).Theaorticvalvelookednormalandhadamildcentralre-gurgitation jet. A dilatation of the ascending aorta also wasnoted, and an enhanced computed tomography was indi-cated. Computed tomography images confirmed the pres-ence of a small mass inside the aortic root lumen,apparentlyattachedtotheaorticwallnexttothecommissurebetweentherightandnoncoronarysinuses(Figure1,B).Anascendingaortadiameterof50mmwasverified.Becauseofthe unpredictable risk of embolism and the patient’s symp-toms, an urgent surgical correction was indicated.A median sternotomy was performed, and standardcardiopulmonary bypass was established with cannulationof the proximal aortic arch and the right atrium. The distalascending aorta was crossclamped, and the heart wasarrested using antegradeand retrograde blood cardioplegia.The ascending aorta was resected from the sinotubularjunction to 1 cm proximal to the brachiocephalic trunk.The aortic root was then exposed, and an irregularglistening yellowish-white 2 3 2-cm mass with jellylikeappearance and small nodules on its surface was seenattached to the aortic wall of the noncoronary sinus,close to the top of the noncoronary right commissure(Figure 2, A and B). The aortic valve was tricuspid andstructurally normal.To achieve complete resection of the tumor, anarteriotomy-based triangular portion of the noncoronarysinus was excised with the mass (Figure 2, C). The wallroot was reconstructed with a bovine pericardial patchslightly larger than the aortic defect using a continuous4-0 polypropylene suture (Figure 2, D). To avoid suturingclose to the commissure, a tissue patch was fixed in partto the wall of the right coronary sinus. The top of thecommissure was then attached to the pericardial patchwith an additional stitch buttressed in the autologouspericardium. Because of moderate root dilatation andcentral aortic insufficiency, subcomissural triangles wereplicated with 3 Teflon-buttressed 2-0 Ticron stitches (Covi-dien, Mansfield, Mass). Finally, the ascendingaortawas re-placed using a 28-mm Dacron graft. Transesophagealechocardiography confirmed the competence of the aorticvalve after surgical procedure.The tumor excised was friable and had a yellowish andjellylikeappearance(Figure2,E).Whenthetumorwassub-merged in water, it acquired villous on its surface like a seaanemone (Figure 2, F). Histopathologic examination con-firmed a papillary fibroelastoma. After the operation, thepatient had an uneventful recovery and was discharged10 days after surgery. Postoperative echocardiographyshowed a well-functioning aortic valve.DISCUSSIONPapillary fibroelastomas are the second most commoncardiac tumors, although they represent only less than10%.