A 59-year-old woman, who had a history of acute coronary syndrome (ACS) but without obstructive coronary lesions 2 years previously, presented with vertigo. MRI revealed a left cerebellar embolism. TEE detected a mobile aortic valve tumor, suggesting a papillary fibroelastoma (PFE). Reviewing previous echocardiograms, it was discovered that the tumor was present at the time of the ACS event. At surgery, the PFE was present on the right coronary cusp. When the aortic valve was opened, it was found that the tumor was obstructing the right coronary artery (RCA) ostium. ACS was probably caused by PFE's dynamic obstruction of the RCA ostium.
Keywords: acute coronary syndrome; aortic valve; cardiac papillary fibroelastoma; embolism.