Multiple cardiac papillary fibroelastoma and transient left ventricular apical ballooning syndrome in an elderly woman: case report.

An elderly Japanese woman presented with evidence of a myocardial infarction. Emergency angiography showed no significant atherosclerotic disease, but the anterior and anteroseptal walls were akinetic, with 'ballooning' of the apex. She was suspected to have transient left ventricular apical ballooning syndrome (TLVABS). Two months later, transthoracic echocardiography showed normal left ventricular wall motion and function, together with a 5-mm cardiac papillary fibroelastoma (CPF) attached to the aortic valve. Transesophageal echocardiography showed a stalked CPF on the aortic side of the left coronary cusp, and a smaller CPF on the right coronary cusp. It was hypothesized that the CPF caused the TLVABS through myocardial stunning. This may occur as a result of transient dynamic ostial occlusion by the fibroelastoma, or because of emboli from the fibroelastoma which then subsequently spontaneously lysed. This syndrome may represent an unusual manifestation of transient cardiac ischemia. Whilst TLVABS has been mainly reported in Japanese patients, more recent studies have suggested that other populations might also be affected.