Evaluation of Mitral Apparatus Blood Cyst: A Case Report and Review of Literature

Abstract

Intracardiac blood cysts (ICBC) are cardiac pseudoneoplasm commonly seen in infants below two months of age. ICBC typically resolve spontaneously; however, they can sometimes persist in adults and can cause detrimental consequences. A 47-year-old female presented to our facility with complaints of chest pain and was found to have an incidental subvalvular chordal mitral apparatus echolucent mass on transthoracic echocardiogram (TTE). A stress echocardiography was performed, which revealed transient left ventricle outflow tract (LVOT) obstruction in the absence of anginal symptoms. A cardiac magnetic resonance imaging (MRI) showed no evidence of increased mass enhancement confirming the diagnosis of a benign blood cyst of mitral apparatus. The cyst was treated conservatively with carvedilol to prevent worsening of exertional LVOT obstruction. A follow-up study done at six months showed stable exertional hemodynamics. There is no general consensus while managing ICBC. In asymptomatic, non-surgical patients stress echocardiography can offer valuable information by assessing the hemodynamic implications resulting from the cyst.

Blood cyst of the mitral valve – is it common? Case report

“…Most authors suggest a conservative approach in asymptomatic patients with minor cysts. 3,10,11 In their opinion, surgical resection should be considered if symptoms occur or if the cysts lead to any cardiac dysfunction. Paşaoglu et al suggested surgical removal of cardiac blood cysts at the time of diagnosis, even if the patient is asymptomatic.…”

“…9 They are often asymptomatic but few cases resulting in embolization and valvular dysfunctions have been reported. [10][11] Blood cysts involving heart valves were fi rst reported by Elsässer in 1844. 12 These cysts are usually blood-fi lled nodules measuring 1-2 mm, which are commonly associated with the atrioventricular valves, but they have also been reported as attached to the semilunar valves.…”

Blood Cyst of the Mitral Valve Diagnosed in an Adult after Systemic Thrombolysis

“…Transesophageal echocardiogram seems more accurate than CT scan, but false negatives can occur when masses are located in the left ventricle due to difficulty for visualizing the ventricular apex [14]. In the compilation of cases by Dencker, only 2 out of 11 cases had a cardiac MRI for supporting the diagnosis [6]; nevertheless, this modality has been relevant for confirming (rather than discarding) the echocardiographic finding [1,8,15]. Lamentably, there are still administrative barriers that impede access to advance image modalities in developing countries.…”

“…Currently, there are no treatment guidelines for blood cysts because of the low incidence, but the majority of symptomatic patients have undergone surgery for ruling out malignancy and preventing stroke [16]. β-blocking, antiaggregation, or anticoagulation remain controversial [15]. The prognosis is benign as congenital cysts tend to resolve spontaneously, but in fewer cases, valvular disease or obstruction of the ventricular outflow tracts can be present [9].…”

BLOOD CYSTS OF THE CARDIAC VALVES IN ADULTS Review and analysis of published cases

“…Symptoms related to the presence of MV BCs, in the absence of any other intracardiac abnormality, included predominantly palpitations, chest discomfort and exertional dyspnea. In 3 patients BCs caused severe left ventricular outflow tract (LVOT) obstruction 5,11,50 , 2 patients presented with hemiparesis 4,43 , 2 with syncopal episodes 32,50 , 2 had a stroke 15,18 , 2 a myocardial infarction 9,21 and in one the BC caused severe MV regurgitation 23 . Except for the first 2 BCs cases described, diagnosed either by cineangiography 3 or M-mode echocardiogram 5 , in all other cases transthoracic 2-D echo was used for evidencing the presence of a MV mass (Fig.…”