Circulation. 2004;110:e324-e325
doi: 10.1161/01.CIR.0000143101.78864.60
(Circulation. 2004;110:e324-e325.)
© 2004 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Heart Within a Heart
Contrast 3-Dimensional Echocardiography Imaging of a Tricuspid Valve Blood Cyst
Jonathan Timperley, MBChB, MRCP;
Colin Forfar, MD, PhD, FRCP;
Harald Becher, MD, PhD;
Ravi Pillai, FRCS(Ed), FRCS
From the Department of Cardiology, The John Radcliffe Hospital, Oxford, UK.
Correspondence to Dr J. Timperley, Department of Cardiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom. E-mail jon.timperley{at}orh.nhs.uk
An 80-year-old woman was referred with non-sustained palpitations, intermittent presyncope, and atypical chest pain. Examination revealed a loud "plopping" first heart sound and presystolic thrill at the lower left sternal edge. Echocardiography showed a large cystic lesion attached to the septal leaflet of the tricuspid valve, dilatation of the right heart chambers, and moderate tricuspid regurgitation (Figure 1). Three-dimensional contrast echocardiography confirmed the mobile cyst and revealed small lesions within it (Figure 2a); during systole, the cyst became deformable within the ventricle, resulting in a "heart" shape (Figure 2b). The following day, her clinical findings had changed, with loss of the "plopping" first heart sound, a new systolic murmur at the left sternal edge, and loss of the presystolic thrill. Echocardiography confirmed cyst migration into the right ventricular outflow tract with partial obstruction (Figure 3).
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Figure 1. Echocardiographic modified apical 4-chamber view showing well circumscribed thin-walled cyst with echolucent core attached to the septal leaflet of the tricuspid valve. RA indicates right atrium; RV right ventricle.
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Figure 2. A, Contrast 3-dimensional echocardiogram showing cyst with small lesions on the interior surface and no contrast enhancement within the cyst. RA indicates right atrium; LA left atrium. B, Contrast 3-dimensional echocardiogram cut longitudinally through the right side of the heart alone at 90° to A showing the deformation of the cyst during systole that formed a "heart" shape in the right ventricular apex.
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Figure 3. Echocardiographic modified parasternal short-axis view showing cyst within the right ventricular outflow tract. RV indicates right ventricle; PV pulmonary valve.
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Emergency resection on cardiopulmonary bypass revealed a blood-filled cyst with small interior cysts that was attached to the tricuspid valve. Histological examination confirmed a simple blood-filled cyst. The patient had an uncomplicated recovery.
Blood -filled cysts are typically small and asymptomatic and are most commonly found in infants. In most cases, they regress spontaneously and are rare in adults, but they occasionally obstruct, as in this case.
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