Abstract 362: Aortic Valve Hamartoma: A Rare Valvular Tumor Mimicking Infective Endocarditis

Abstract

A 46 YO female with PMH of DM2, HTN, Morbid obesity presented to hospital with chief complaint of chest pain, fever and SOB. She had recent hospitalization and was managed for abdominal wall abscess, MRSA bacteremia and diagnosed with infective endocarditis with aortic valve vegetation by TEE, and was discharged with antibiotics. With her current presentation: Temp was 100.8F, blood cultures grew Klebsiella Oxycota, and on TTE there was concern of increased size of aortic valve vegetation with super infection. Repeat TEE showed increase in size of vegetation. CT surgeon suggested AVR with mechanical valve. Biopsy results of the aortic valve came back as Lipomatous hamartoma. Patient recovered well post procedure and antibiotics were discontinued. Discussion: Prevalence of valvular hamartoma is as rare as 0.01 to 0.02% contributing to low diagnosis rates. If patient does not have symptoms of inflammation or infection and does not meet clinical diagnostic criteria, tumors should be included in the differential as medical management is not appropriate for hamartomas and other valvular tumors, which needs urgent surgery to prevent life threatening embolization. Cardiac valve lipomatous hamartomas are very rare lesions with preferential localization on the pericardium followed by endocardial surface. Most common histologic type of cardiac valve tumor is papillary fibroelastoma, myxoma, fibroma and hamartoma. Even if they are asymptomatic, surgical treatment should be considered to prevent embolization to brain and coronary circulation. To the best of our knowledge, we are reporting the second case of native aortic valve hamartoma so far.