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Cardiovascular Images

Tissue Characterization of a Suspected Aortic Valve Fibroelastoma With Cardiac Magnetic Resonance Imaging

Cosima Jahnke, MD; Ashraf Hamdan, MD; Eckart Fleck, MD and Ingo Paetsch, MD

From the Department of Internal Medicine/Cardiology, German Heart Institute, Berlin, Germany.

Correspondence to Cosima Jahnke, MD, Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail jahnke@dhzb.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Apreviously healthy 29-year-old woman complaining of atypical chest pain was referred to our hospital. No cardiovascular risk factors were present. Resting ECG demonstrated normal sinus rhythm, and an exercise ECG during full workload was inconspicuous. Routine transthoracic echocardiography revealed a small lesion protruding from the aortic side of the aortic valve (Figure 1, Data Supplement Movie I) that was suggestive of a primary cardiac valve tumor. In such a case, differential diagnosis consists of tumor, thrombus, or vegetation and usually relies on clinical presentation or localization of the structure alone. Consequently, cardiac magnetic resonance (CMR) imaging was attempted for tissue characterization.

View larger version (115K):   Figure 1. A, Transthoracic echocardiography detected a small, globular mass (7x7 mm, arrow) attached to the right coronary cusp of the aortic valve (left: parasternal long-axis view; right: parasternal short-axis view). B, Similarly, CMR cine imaging demonstrated a hypointense mass (arrow) and was used for the assessment of its relative standstill period during the cardiac cycle (left: 3-chamber view; right: short-axis view of the aortic valve). LA indicates left atrium; LV, left ventricle; RA, right atrium; and RV, right ventricle.

 
On T1- and T2-weighted CMR images, a structure with homogeneous signal intensity identical to fibrous valve tissue was detected; fat suppression ruled out the presence of fatty lesion components (Figure 2). During dynamic, contrast-enhanced first-pass perfusion imaging, no increase in signal intensity was noted (Data Supplement Movie III), whereas on delayed-enhancement imaging, a distinct signal intensity increase was documented (Figure 2). . . . [Full Text of this Article]