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Papillary fibroelastoma is an uncommon cardiac tumour. It is usually attached to the chordae tendineae or to the papillary muscles, while the involvement of the valves or the LVOT is rarely seen. The diagnosis is often due to incidental finding because the tumor is often asymptomatic, even though structural cardiac damages or dramatic embolization may occur. We present the case of a 66 year old woman affected by arterial hypertension and dyslipidemia. During a routine cardiologic visit a transthoracic echocardiogram unexpectedly revealed the presence of a extremely mobile peduncolate mass (11x5mm) with a homogenous speckle pattern, apparently settled on the aortic side of the right cusp of the aortic valve. No further pathological elements were detected. A diagnosis of suspected fibroelastoma was made and the patient was transferred to the cardiac surgery department. On admission clinical examination and vital signs were unremarkable. No symptoms suggestive of TIA or amaurosis were reported by the patient, hence the tumor was considered as an asymptomatic incidental finding. Since the mass did not seem to be firmly attached, based on the high risk of embolization and the possibility of coronary ostia impingement with the manipulation of the catheters, the Heart Team decided to omit a pre-interventional coronary angiography. A coronary CT scan excluded significant coronary artery disease and the patient was offered a surgical resection of the mass. After anterior mini-sternotomy, during extracorporeal circulation, the ascending aorta was opened with a transversal incision and the aortic valve was exposed. A pedunculated tumour of 1.5x2 cm implanted in the edge of the right cusp was observed and completely excised with a valve-sparing resection. Macroscopically, the tumour looked whitish and filamentous, suggestive of fibroelastoma. At the end of the procedure transesophageal echocardiography guaranteed the competence of the aortic valve was preserved. The patient recovered successfully and was discharged one week after the intervention. The control transthoracic echocardiography excluded tumoral residual and the histological examination confirmed the diagnosis of fibroelastoma. The patient was discharged after an uneventful course. This report singularly shows a rare case of aortic location of an asymptomatic fibroelastoma treated with an early surgical approach in order to avoid embolic complications. Multimodality imaging provides clear and exemplary information about this rare entity. Nowadays, the optimal management of challenging cases requires a multidisciplinary team with a discrete familiarity with the common imaging techniques, which play a pivotal role in the diagnostic, pre-procedural and interventional setting. Abstract P640 Figure. Multimodality imaging: fibroelastoma

P640 Multimodality imaging of an asymptomatic aortic fibroelastoma successfully treated with a surgical valve-sparing technique