LAUSR

Fibroelastomas are themost common tumors involving themitral valve apparatus and may be single or multiple, originate from the septum of the left ventricle (LV) in proximity to the valve, and be associated with LV outflow obstruction and systolic anterior motion. We present images of an aberrant chordae to the anterior leaflet of themitral valve that simulated a fibroelastoma. A 39-year-old female with Noonan syndrome, a genetic disorder associated with cardiac valvular malformations, and a history of mild pulmonary stenosis, was found on a follow-up transthoracic echocardiogram (TTE) to have a 12 × 8-mm mobile mass attached to the anterior leaflet of the mitral valve associated with trace mitral regurgitation (MR) (Figure 1). A transesophageal echocardiogram (TEE) revealed that the mass was attached to the tip of the anterior leaflet (Figure 2). Although the patient was asymptomatic, in view of the size of the lesion and the potential for thromboembolism, surgical excision was recommended. Following a mediansternotomy and institution of cardiopulmonary bypass (CPB) with aortic and bicaval cannulation, the aorta was crossclamped and the heart arrested with antegrade, cold crystalloid cardioplegia. The mitral valve was exposed through a posterolateral left atriotomy. The entire mitral valve was thickened, andwhatwas thought to be a tumorwas actually an aberrant chordae attached to the free edge of the anterior leaflet (Figure 3A-C). Since the marginal chordae to the anterior leaflet was preserved, only the tip of the anterior leaflet and the aberrant chordaewereexcised. The leaflet was repaired with a 5-0 prolene suture. An intraoperative saline injection test demonstrated mild central MR and a #30-mm Carpentier Edwards Physio Ring (Edwards Lifesciences Inc., Irvine, CA) was inserted. However, following discontinuation of CPB, a TEE demonstratedmoderateMRdue to prolapse of the P3 segment. The heartwas rearrested and neochordae were inserted to resuspend that portion of the leaflet. However, the MR persisted and so the anterior leaflet was excised and the valve replaced with a #27-mm St. Jude mechanical prosthesis (St. JudeMedical, St. Paul, MN). The patient was weaned off CPBwithout difficulty andhad anuneventful postoperative course. The