Multimodality imaging in the diagnosis of coexisting left atrial myxoma and aortic valve papillary fibroelastoma.

We present the case of a 77-year-old Cambodian woman with a 3-day history of dyspnea on exertion. Physical examination revealed a murmur of mitral regurgitation and decompensated heart failure. The ECG was remarkable for atrial fibrillation with rapid ventricular response. Transthoracic echocardiography showed severe left atrial dilation, a large (5 8 cm) mobile mass attached to the anterior left atrial wall, and several small, mobile aortic masses on the noncoronary cusp of the aortic valve (Figure 1 and online-only Data Supplement Movie I). Three-dimensional transesophageal echocardiography showed a large multilobular mass being displaced by the central jet of moderate to severe mitral regurgitation during systole and prolapse of the mass through the mitral valve during diastole (Figures 2 and 3 and online-only Data Supplement Movies II and III). The atrial mass was attached with a stalk to the anterior atrial wall and appeared lobulated and deformable, consistent with the appearance of a myxoma (online-only Data Supplement Movie IV). The aortic valve masses had multiple frondlike projections, which had an appearance like a sea anemone, with stippling at the edges that arose from the noncoronary aortic valve leaflet (online-