Sudden death due to obstruction of coronary artery ostium by aortic valve papillary fibroelastoma

Papillary fibroelastomas are rare endocardial growths that most commonly occur on the cardiac valves. Whether papillary fibroelastomas represent true neoplasms, hamartomas, or degenerative changes is debatable. Whatever their origin, papillary fibroelastomas have a characteristic gross and microscopic appearance, are usually solitary, and are almost always incidental findings at autopsy or during cardiac surgery. We report a case of sudden death caused by occlusion of the right coronary artery ostium by a papillary fibroelastoma of the aortic valve. We discuss the gross and microscopic features, differential diagnosis, and etiology and pathogenesis of this rare and interesting cardiac lesion.