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An asymptomatic 46 year old man was referred for family screening because of a diagnosis of hypertrophic cardiomyopathy in his father. Cardiovascular examination and the ECG were normal. Transthoracic echocardiogram showed a mobile mass on the non-coronary cusp of the aortic valve and no features of hypertrophic cardiomyopathy. Transoesophageal echocardiography confirmed a discreet 0.5 cm mobile mass attached to the non-coronary cusp by a stalk and no aortic regurgitation (left image, short axis; right image, long axis). In view of the potential risk of embolism either of the mass or associated thrombus, elective surgical removal was undertaken. The tumour was shaved off the underside of the leaflet and the base of the lesion coagulated with diathermy, leaving the leaflet intact. The patient made an uneventful recovery and follow-up echocardiography confirmed normal aortic valve function. Diagnosis of papillary fibroelastoma was suggested by the appearance of macroscopic frond-like structures arising from the tumour when it was emersed in saline. This was confirmed by histological examination.
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