Circulation. 2006;113:e401-e402
doi: 10.1161/CIRCULATIONAHA.105.565036
(Circulation. 2006;113:e401-e402.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Bubble in the Heart
A Rare Cause of Mitral Regurgitation
Hans Joachim Nesser, MD, FESC;
Girish Dwivedi, MD, DM;
Klaus Davogg, MD;
Bruno Schneeweiss, MD;
Choi-Keung Ng, MD;
Roxy Senior, MD, DM, FRCP, FESC
From Public Hospital Elisabethinen Linz (H.J.N.), Academic Teaching Hospital of the University of Innsbruck and Vienna, Innsbruck and Vienna, Austria; Department of Cardiovascular Medicine (G.D., R.S.), Northwick Park Hospital, Harrow, Middlesex, England; Kirchdorf Hospital (K.D., B.S.), Linz, Austria; and General Hospital Wels (C.-K.N.), Linz, Austria.
Correspondence to Dr Roxy Senior, MD, DM, FRCP, FESC, FACC, Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK. E-mail roxy.senior{at}virgin.net
A 50-year-old male patient was referred after an episode of collapse in the early hours after partying all night. At the time of presentation, findings from the general physical, neurological, and cardiovascular examinations were unremarkable other than a grade III/IV holosystolic murmur in the mitral area radiating to the axilla. No abnormality was observed on chest x-ray films and ECGs. He had twice undergone echocardiography before the current admission and was known to have a cardiac murmur related to mitral valve prolapse and mitral regurgitation. Two-dimensional (Figure 1) and color Doppler (Figure 2) echocardiography demonstrated a flail posterior mitral valve leaflet and significant mitral regurgitation. There was suspicion of an echogenic structure in the left ventricular cavity on the color Doppler images. The other valvular structures were normal. There was no evidence of any obstruction observed during left ventricular inflow and outflow. For further evaluation of the suspicious mass, contrast echocardiography was performed. This clearly showed a cystic mass attached to the ventricular aspect anterior of the mitral valve (Figure 3). Surgical excision with repair of the mitral valve was performed successfully (Figure 4). Histological examination confirmed the mass to be a giant blood cyst of the mitral valve.
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Figure 3. Contrast-enhanced, 2-dimensional transthoracic echocardiogram clearly demonstrating a mass (arrow).
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Figure 4. Intraoperative photograph confirming the presence of a cystic mass attached to the anterior mitral valve leaflet.
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Blood cysts are congenital cysts that are found on the endocardium, particularly along the lines of closure of the heart valves. Commonly identified in neonates and children, in most cases they regress spontaneously, but there have been cases of their persistence into adulthood. They are often asymptomatic but may be associated with a variety of presentations, such as embolization, obstruction, and regurgitation. Consensus is lacking with respect to the optimal management of blood cysts and has ranged from surgical excision to serial monitoring, with resection reserved for only symptomatic cysts. The low echogenicity of the cyst could have precluded diagnosis on routine 2-dimensional and color Doppler echocardiography. However, imaging improvement of the tissue-blood interface by contrast echocardiography enables easy identification of such structures.
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Acknowledgments
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Disclosures
None.
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Footnotes
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The online-only Data Supplement can be found at http://circ.ahajournals.org/cgi/content/full/113/10/e401/DC1.
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Issue Highlights
Circulation 2006 113: 1271.
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