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A 44 year old woman with no prior cardiac or neurological symptoms was admitted to the intensive care unit because of acute chest pain. On physical examination there were no initial abnormal cardiac findings. However, the patient then had a cardiac arrest with documented complete heart block and unconsciousness from which she was rescued mechanically. Electrocardiography showed a discrete transitory T wave inversion in lead V2 and there were minor creatine kinase abnormalities. Transthoracic and transoesophageal echocardiography showed a spherical tumour attached to the free margin of the anterior leaflet of the mitral valve without mitral regurgitation and normal contractions in all segments of the left ventricle. Coronary angiography showed an isolated peripheral embolic occlusion of the second diagonal branch of the left anterior descending coronary artery. Because of new mild neurological symptoms (Babinski sign, nystagmus, increased tendon reflexes on both sides) computed tomography of the CNS was performed, which showed one recent and multiple small older brain infarcts. The patient recovered well from these acute events and a few days later the tumour at the mitral valve was excised successfully. It was a white villous-like mass that was attached by a stalk to the free margin of the anterior leaflet of the mitral valve resembling a sea anemone. Histopathological examination confirmed the diagnosis of cardiac papillary fibroelastoma. The patient had an uncomplicated postoperative recovery.
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