Mobile Papillary Fibroelastoma Leading to Severe Chest Pain via Left Main Occlusion

Ariana Y. Ramirez; Kevin M. Kashuba-Shanahan; Joseph A. Cavallaro; Emilio Fentanes

doi:10.1016/j.jaccas.2025.103535

Mobile Papillary Fibroelastoma Leading to Severe Chest Pain via Left Main Occlusion

Ariana Y. Ramirez^*, Kevin M. Kashuba-Shanahan, Joseph A. Cavallaro, Emilio Fentanes

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Papillary fibroelastomas (PFEs) are common cardiac tumors. They are usually asymptomatic and identified incidentally. Case Summary: A 63-year-old woman presented with angina. Myocardial perfusion imaging was positive for anterior ischemia. Cardiac computed tomographic angiography (CCTA) showed no coronary atherosclerosis and a PFE within the left coronary cusp causing left main coronary artery (LMCA) occlusion during systole and early diastole. Surgical removal of the PFE resulted in symptom resolution. Discussion: Though benign, PFEs can cause coronary obstruction, usually involving the right coronary ostium. The use of CCTA is important for the localization, characterization, and visualization of PFE mobility throughout the cardiac cycle. This is a rare case of angina caused by LMCA obstruction by a mobile PFE.

Original language	English
Article number	103535
Journal	JACC: Case Reports
Volume	30
Issue number	16
DOIs	https://doi.org/10.1016/j.jaccas.2025.103535
State	Published - 25 Jun 2025
Externally published	Yes

Keywords

angina
cardiac tumor
chest pain
left main occlusion
papillary fibroelastoma

Access to Document

10.1016/j.jaccas.2025.103535

Cite this

@article{2da526aa49644cbf9d9bbaf218015220,

title = "Mobile Papillary Fibroelastoma Leading to Severe Chest Pain via Left Main Occlusion",

abstract = "Background: Papillary fibroelastomas (PFEs) are common cardiac tumors. They are usually asymptomatic and identified incidentally. Case Summary: A 63-year-old woman presented with angina. Myocardial perfusion imaging was positive for anterior ischemia. Cardiac computed tomographic angiography (CCTA) showed no coronary atherosclerosis and a PFE within the left coronary cusp causing left main coronary artery (LMCA) occlusion during systole and early diastole. Surgical removal of the PFE resulted in symptom resolution. Discussion: Though benign, PFEs can cause coronary obstruction, usually involving the right coronary ostium. The use of CCTA is important for the localization, characterization, and visualization of PFE mobility throughout the cardiac cycle. This is a rare case of angina caused by LMCA obstruction by a mobile PFE.",

keywords = "angina, cardiac tumor, chest pain, left main occlusion, papillary fibroelastoma",

author = "Ramirez, {Ariana Y.} and Kashuba-Shanahan, {Kevin M.} and Cavallaro, {Joseph A.} and Emilio Fentanes",

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T1 - Mobile Papillary Fibroelastoma Leading to Severe Chest Pain via Left Main Occlusion

AU - Ramirez, Ariana Y.

AU - Kashuba-Shanahan, Kevin M.

AU - Cavallaro, Joseph A.

AU - Fentanes, Emilio

PY - 2025/6/25

Y1 - 2025/6/25

N2 - Background: Papillary fibroelastomas (PFEs) are common cardiac tumors. They are usually asymptomatic and identified incidentally. Case Summary: A 63-year-old woman presented with angina. Myocardial perfusion imaging was positive for anterior ischemia. Cardiac computed tomographic angiography (CCTA) showed no coronary atherosclerosis and a PFE within the left coronary cusp causing left main coronary artery (LMCA) occlusion during systole and early diastole. Surgical removal of the PFE resulted in symptom resolution. Discussion: Though benign, PFEs can cause coronary obstruction, usually involving the right coronary ostium. The use of CCTA is important for the localization, characterization, and visualization of PFE mobility throughout the cardiac cycle. This is a rare case of angina caused by LMCA obstruction by a mobile PFE.

AB - Background: Papillary fibroelastomas (PFEs) are common cardiac tumors. They are usually asymptomatic and identified incidentally. Case Summary: A 63-year-old woman presented with angina. Myocardial perfusion imaging was positive for anterior ischemia. Cardiac computed tomographic angiography (CCTA) showed no coronary atherosclerosis and a PFE within the left coronary cusp causing left main coronary artery (LMCA) occlusion during systole and early diastole. Surgical removal of the PFE resulted in symptom resolution. Discussion: Though benign, PFEs can cause coronary obstruction, usually involving the right coronary ostium. The use of CCTA is important for the localization, characterization, and visualization of PFE mobility throughout the cardiac cycle. This is a rare case of angina caused by LMCA obstruction by a mobile PFE.

KW - angina

KW - cardiac tumor

KW - chest pain

KW - left main occlusion

KW - papillary fibroelastoma

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