Blood cysts of the mitral valve
Our Literature search has documented a total of 50 articles considered
eligible for analysis and reporting a total of 54 patients; 36 (72%)
are reports of a single case3-38, 12 (24%) images in
cardiovascular disease39-50, 1 a case series reporting
5 patients (2%)51 and 1 a letter to the Editor
(2%)52, all published from 1960 to 2021 (Table 1 and
2).
Patient characteristics : There were 29 males (55%) and 25
females (45%) with an age ranging from18 to 87 years (mean, 48±18
years). The majority of patients was asymptomatic and the cyst was
disclosed at routine controls for other pathologies. 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) obstruction5,11,50, 2 patients
presented with hemiparesis4,43, 2 with syncopal
episodes32,50, 2 had a stroke15,18,
2 a myocardial infarction9,21 and in one the BC caused
severe MV regurgitation23. Except for the first 2 BCs
cases described, diagnosed either by cineangiography3or M-mode echocardiogram5, in all other cases
transthoracic 2-D echo was used for evidencing the presence of a MV mass
(Fig. 1). The diagnosis was confirmed by supplemental transesophageal
echo in many cases and more recently by multimodality imaging, including
angio-computed tomography, nuclear magnetic resonance, contrast
real-time echocardiography and 3-D
echo23,34,36,38,44,45,49,51.
Surgical data : Cyst removal was performed in 37 patients
(70%) while in 16 (30%) medical treatment and serial follow-up was
recommended; in one patient aortic valve and ascending aorta replacement
were performed leaving in place a small BC on the
MV20. Surgery was generally performed through a
standard median sternotomy while in 3 cases a minimally invasive,
endoscopic technique was used27,36,45. Two patients
had previous open heart operations and required repeat
sternotomies22,42, while one had a previous liver
transplantation10. The BC was approached through a
trans-aortic incision in 7 cases, through the left atrium in 6,
trans-septal in 4, while in 20 cases it was not specified. Beside cyst
removal, 27 patients (73%) had associated procedures: mitral valve
replacement (MVR) in 12, mitral valve repair (MVr) in 9, coronary artery
bypass grafting in 3 and combined MVR and aortic valve replacement in 1.
In addition, in 2 patients, with associated cor triatriatum,resection of the intraatrial band was performed14,24.
No operative deaths are reported.