Cardiac papillary fibroelastoma has an intrinsic dynamics, which is seldom witnessed. A sea anemone shape response is observed when immersed in normal saline immediately after surgical resection.

Cardiac papillary fibroelastoma (CPF) may arise on any endocardial lined surface and its etiology is mostly associated with injured endocardium. A 83-year-old female patient arrived at our attention after a transient ischemic attack. The transthoracic echocardiography revealed a hyperechogenic mobile structure in the muscular septum, protruding in the left ventricular outflow tract (Fig. 1A), without aortic regurgitation. Computed tomography angiography clearly confirmed it (Fig. 1B).

Fig. 1

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Through an upper ministernotomy and under cardioplegic arrest, the lesion was resected from the muscular septum. On gross appearance, it offered the morphology of a soft rounded mass, while its dynamics changed when immersed in saline solution. It then assumed the ‘sea anemone’ shape (characteristic non-vascularized ramifications, with an accumulation of collagen fibres endothelium-covered; Fig. 1C, D and video 1 of the supplementary data). After regular discharge of the patient, histopathology confirmed CPF. This dynamic behaviour of CPF may account for its ability to embolize. Written informed consent from the patient was obtained preoperatively for the publication of this case.