Available online 10 March 2024, 107631

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Including the hypothesis of a rare condition can be crucial for the diagnostic work-up and treatment of myocardial infarction with non-obstructive coronary arteries (MINOCA).

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An integrated imaging assessment including trans-esophageal echocardiogram (TEE) and cardiac nuclear magnetic resonance (CMR) is of paramount importance for the management of MINOCA.

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According to the available evidence surgical excision represents an effective treatment for cardiac papillary fibroelastoma (CPF).

Abstract

Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac tumors more often involving the left-sided valves and related with threatening embolic complications. We report the case of a 35-year-old woman presenting with relapsing-remitting chest pain and elevated cardiac troponins. After a negative coronary angiography, an integrated imaging assessment based on echocardiography and cardiac magnetic resonance showed a pedunculated mass on the aortic valve causing an intermittent obstructive engagement of the right coronary ostium. A tailored surgical treatment was performed and the histopathological examination of the specimen revealed mesenchymal tissue with the characteristics of CPF.

Section snippetsINTRODUCTION

Myocardial infarction with non-obstructive coronary arteries (MINOCA) defines a group of heterogeneous clinical settings which satisfy the criteria for acute myocardial infarction (AMI) diagnosis in the absence of angiographic evidence of ≥50% diameter stenosis in any major epicardial vessel [1]. Plaque disruption, coronary thromboembolism, coronary artery spasm, coronary microvascular dysfunction, and spontaneous coronary artery dissection are mentioned among the most common causes of MINOCA;

CASE REPORT

A 35-year-old woman with known mitral valve prolapse and history of migraine accessed the Emergency Department because of several episodes in the previous three days of chest pain arising at rest and followed by spontaneous relief within few minutes. The admission ECG showed sinus rhythm, isolated premature ventricular contractions (PVCs), and incomplete right bundle branch block (RBBB). Admission high sensitivity cardiac troponin I (hs-cTnI) was 5853 pg/ml. Cell blood count (CBC), serum

DISCUSSION

PCTs are rare autopsy findings, described in 0.02% of cases. CPFs are ranked as the third most common PCTs after myxomas and lipomas representing the 11.5% of all PCTs [4]. However, a recent large registry showed as the incidence of CPF is probably higher than any other PCT with one case every 1100 TTE performed in a referral base population [5]. CPFs are avascular, pedunculated and composed of collagen and elastic fibers with endothelial covering. These tumors typically localize on the left

CRediT authorship contribution statement

Martino Pepe: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing. Rocco Tritto: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing. Maria Ludovica Naccarati: Data curation, Investigation, Writing – original draft, Writing – review & editing. Simona Quarta: Data curation, Investigation. Andrea Marzullo:

Declaration of competing interest

All authors do not have any financial or personal relationships with people or organizations that could inappropriately influence their work. No funding has been allocated to this project.

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