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Mitral valve papillary fibroelastoma as a cause of acute coronary syndrome
  1. Mariana Gonçalves1,
  2. António Tralhão1,
  3. Marisa Trabulo1 and
  4. Márcio Madeira2
  1. 1 Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
  2. 2 Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
  1. Correspondence to Dr Mariana Gonçalves,{at}


A 37-year-old man presented with acute chest pain, an unremarkable ECG and mildly elevated cardiac troponin. Coronary CT angiography showed a calcium score of 0 together with the absence of atherosclerotic plaques and normal origin and course of the coronary arteries. Transthoracic and transoesophageal echocardiography revealed an infracentimetric round-shaped mobile mass attached to a secondary tendinous chord of the anterior mitral valve leaflet. Cardiac magnetic resonance further evidenced localised contrast uptake supporting vascular irrigation, making thrombus unlikely. After surgical excision, the patient had an uneventful postoperative course. Histopathology disclosed the typical collagenous matrix covered by a single cell layer. Although mostly benign, cardiac tumours are prone to embolisation and can thus mimic an acute coronary syndrome. Multimodality imaging has an important role in unmasking the true mechanism, revealing less common aetiologies and elucidating the possibility of curative surgical resection.

  • valvar diseases
  • cardiothoracic surgery

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  • Contributors The authors were responsible for the planning, conduct of clinical research and for providing patient’s treatment and care in the ward during patient’s admission in the hospital. MG and AT reviewed all the images, examinations and data available and wrote the manuscript. MT and MM reviewed and completed the manuscript. MM was one of patient’s surgeon.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.