Transient Loss of Vision as the Presenting Symptom of Papillary Fibroelastoma of Aortic Valve

Cardiac papillary fibroelastomas are benign endocardial papillomas. They may arise from atrial or ventricular endocardium but most commonly are located in cardiac valves. Their papillary structure, with loose, friable projections, results in a high tendency for embolism. Tumor fragments often embolize to the coronary, systemic, or cerebral arterial systems. Thus, acute myocardial infarction, cerebrovascular accident, or peripheral arterial occlusion have resulted from these tumors. Retinal artery embolism is a rare complication of papillary fibroelastoma, and only five such patients have been reported in the English-language literature. We describe a 64-year-old woman who presented with transient painless loss of vision and was found to have a large papillary fibroelastoma on the right coronary cusp of the aortic valve by transesophageal echocardiography. The tumor was successfully removed at surgery.