Abstract
BACKGROUND: Papillary fibroelastomas (PFEs) are benign primary cardiac tumors. The occurrence of multiple PFEs on a single valve is exceedingly rare. CASE SUMMARY: A 72-year-old woman with coronary artery disease and prior right coronary stenting was scheduled for robotic minimally invasive direct coronary artery bypass graft. Intraoperative transesophageal echocardiography revealed multiple mobile masses on the aortic valve. The operation was aborted to inform the patient of the intraoperative findings. Two days later, coronary artery bypass grafting and valvular mass excisions were performed. Pathology confirmed 7 PFEs, and postoperative recovery was uncomplicated. Plans were made for continued coronary artery disease management and annual echocardiographic follow-up. DISCUSSION: This case underscores the importance of intraoperative echocardiography in detecting rare tumors and outlines the management considerations in PFE patients. TAKE-HOME MESSAGES: Unexpected findings on intraoperative transesophageal echocardiography can alter surgical plans. Asymptomatic PFEs can be missed on transthoracic echocardiography and discovered incidentally.