Transesophageal Echocardiographic Detection of Papillary Fibroelastoma in the Pulmonary Artery

A 57-yr-old man presented for excision of a pulmonary artery (PA) mass after a 5-mo history of productive cough and wheezing. Computerized tomography scan revealed a large, stable, eccentric, filling defect within the main and left PA. Positron emission tomography demonstrated a single, intensely hypermetabolic focus in the PA region. Preoperative transthoracic echocardiography showed no abnormalities. After the induction of anesthesia, transesophageal echocardiography (TEE) examination was performed, revealing normal left ventricular systolic function and mild enlargement of the right ventricle. The main PA was dilated, with a mass extending from the main PA into the left main PA (Fig. 1). Close inspection of the pulmonary valve (PV) revealed a previously undetected small mobile lesion, independent of the PA mass, and not associated with PV restriction (Fig. 2 and video loop (available at www.anesthesia-analgesia. org). After cardiopulmonary bypass, a longitudinal incision along the PA exposed both the PA mass and the PV lesion. The PA mass nearly occluded the main PA and extended into the left main PA. Partial resection of the mass was performed, and a freestyle graft was used to repair the PA. Pathology examination indicated a spindle cell sarcoma. The PV lesion was