Multimodality Images of a Giant Blood Cyst Originating From the Bicuspid Aortic Valve
A 22-year-old male patient was admitted to our institution because of repeated chest pain and syncope. Physical examination was unremarkable except for a systolic murmur on cardiac auscultation. Transesophageal echocardiogram showed a large, very mobile cystic mass (21×17 mm) attaching to the bicuspid aortic valve, which caused severe left ventricular outflow tract obstruction with normal ventricular size and function (Figure 1A and 1B and Movies I and II in the online-only Data Supplement). Additional cardiac MRI revealed there was a cyst-like mass attached on the aortic valve (Figure 1C through 1E and Movie III in the online-only Data Supplement). Finally, a bluish blood-filled cyst (23×17 mm) originating from the bicuspid aortic valve with a broad base was confirmed during surgical operation (Figure 2A and 2B). Surgical resection of the cyst with concurrent aortic valve replacement was done for this patient. Additional histological examination confirmed that the cystic cavity was surrounded by a fibromyxoid wall with an internal lining of endothelial cells (Figure 2C). The patient was discharged uneventfully 7 days after surgery.
Cardiac cyst originated from bicuspid aortic valve is an extremely rare type of cardiac mass. It may cause obstruction of the left ventricular outflow tract (and lead to progressive damage of the valve leaflet itself. Multimodality imaging including echocardiography and cardiac MRI plays an essential role in perioperative evaluation for this rare condition.
Sources of Funding
This study was supported by grants from the National Natural Science Foundation of China (No. 81370413 and 81300155).
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.114.012465/-/DC1.
- © 2014 American Heart Association, Inc.