Echocardiographic diagnosis of papillary fibroelastoma in the aortic valve following successful cardioversion for acute atrial fibrillation

Cardiac papillary fibroelastomas are rare, benign tumors that involve the valvular endocardium. They are clinically important because of their propensity to embolize. A 58-year-old woman presented with complaints of palpitation, dizziness, dyspnea, and weariness, all of which she had not experienced before. Electrocardiographic findings of atrial fibrillation and her hemodynamic instability led to the application of electrical cardioversion, after which the patient restored to normal sinus rhythm. Following clinical improvement, transthoracic echocardiography was performed, in which parasternal short-axis views showed a mobile mass in the free edge of the right aortic coronary cuspid. Transesophageal echocardiographic findings were compatible with a diagnosis of papillary fibroelastoma. Fifteen days after cardioversion, a subsequent echocardiographic examination showed no change in the size of the mass. Although the patient was free of any clinical complaints, surgical removal of the mass was decided due to the potential risk for embolism.