Multimodality Imaging in the Diagnosis of Coexisting Left Atrial Myxoma and Aortic Valve Papillary Fibroelastoma

We present the case of a 77-year-old Cambodian woman with a 3-day history of dyspnea on exertion. Physical examination revealed a murmur of mitral regurgitation and decompensated heart failure. The ECG was remarkable for atrial fibrillation with rapid ventricular response. Transthoracic echocardiography showed severe left atrial dilation, a large (5×8 cm) mobile mass attached to the anterior left atrial wall, and several small, mobile aortic masses on the noncoronary cusp of the aortic valve (Figure 1 and online-only Data Supplement Movie I).Figure 1. Transthoracic echocardiogram shows small, mobile aortic masses on noncoronary cusp of aortic valve (blue arrow) and large mobile mass attached to the anterior left atrial wall (red arrow). LV indicates left ventricle; LA, left atrium; AO, aorta.Three-dimensional transesophageal echocardiography showed a large multilobular mass being displaced by the central jet of moderate to severe mitral regurgitation during systole and prolapse of the mass through the mitral valve during diastole (Figures 2 and 3 and online-only Data Supplement Movies II and III). The atrial mass was attached with a stalk to the anterior atrial wall and appeared lobulated and deformable, consistent with the …