Recurrent Right Coronary Artery Occlusion Caused by Cardiac Fibroelastoma Attached to the Aortic Valve

A 60-year-old church minister was referred to our department for a stress-perfusion cardiac MRI with a clinical presentation of central chest pain 6 weeks previously with a positive troponin result and dynamic inferoposterior ST elevation on ECG. The patient was a nonsmoker, nondiabetic, otherwise fit and well gentleman on no regular medications. Emergency angiography at the time of his initial presentation revealed unobstructed coronary arteries, by which time the ECG changes had returned to normal. Troponin was very mildly elevated (131 ng/L; normal range, 0–13ng/L) and the patient was given a likely clinical diagnosis of severe coronary spasm. He had no further symptoms until he returned for the outpatient cardiac MRI (CMR).The CMR was initially unremarkable with normal volumes, function, and wall thickness. T2 images were normal, identifying no acute myocardial edema. The patient had a normal response to adenosine infusion (140 μg/kg body weight per min for 3 minutes) with an appropriate increase in his heart rate and symptoms of chest tightness and flushing that are typical for adenosine; 3 standard short-axis slices were acquired during the first passage of a …