Accepted Manuscript Mitral Valve Blood Cyst Detected by Multimodality Imaging F. Bonenfant, MD B. Essadiqi, MD G. Gahide, MD PHD H. Jeanmart, MD MSc P. Farand, MD MSc PII:
S0828-282X(14)00285-2
DOI:
10.1016/j.cjca.2014.04.019
Reference:
CJCA 1195
To appear in:
Canadian Journal of Cardiology
Received Date: 17 March 2014 Revised Date:
6 April 2014
Accepted Date: 18 April 2014
Please cite this article as: Bonenfant F, Essadiqi B, Gahide G, Jeanmart H, Farand P, Mitral Valve Blood Cyst Detected by Multimodality Imaging, Canadian Journal of Cardiology (2014), doi: 10.1016/ j.cjca.2014.04.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Mitral Valve Blood Cyst Detected by Multimodality Imaging
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Mitral Valve Blood Cyst
Bonenfant F, MD1; Essadiqi B, MD1; Gahide G, MD PHD2; Jeanmart H, MD MSc3 Farand P, MD MSc1
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1 – Cardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada,
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2- Department of Radiology, Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada,
3- Cardiothoracic surgery Division, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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Corresponding Author: Paul Farand, MD MSc
Centre hospitalier universitaire de Sherbrooke
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3001, 12th avenue nord
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Sherbrooke, Qc, Canada, J1H 5N4 Tel: 819-346-1110 Fax: 819-820-6806
e-mail: [email protected] April 2014
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Summary: We present unique images of a mitral valve blood cyst in a 25-year-old woman who presented with exertional dyspnea and atypical chest pain. Multimodality
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imaging includes transthoracic echocardiogram, CT scan and MRI.
Text of Manuscript:
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A 25-year-old woman was referred for exertional dyspnea, atypical chest pain and a systolic murmur. Transthoracic echocardiography (Fig.1A, Fig.1B, Video
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1) showed a round mobile hypoechoic structure attached to the anterior mitral valve leaflet on its ventricular side. CT scan (Fig.1C) showed an isodense mass measuring 16X19 mm in diameter. On cardiac magnetic resonance (Fig.1D), this non-enhancing mass was isointense on TSE-T1 (Fig.1E) and on TSE-T2
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(Fig.1F). Its attachment to the anterior valve leaflet was confirmed on cine MR (Video 2). A valvular blood cyst was suspected. The patient was referred for surgical resection by a minimally invasive approach. Pathologic examination
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confirmed the diagnosis. Following surgery, the patient reported resolution of
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dyspnea and atypical chest pain.
Since the first echocardiographic demonstration in 1983 by Hauser1, intracardiac blood cysts have been described on each of the valves and cavities2. It is a common finding in foetuses and infants, but much rarer in adulthood3. The exact physiopathology leading to their formation or regression remains uncertain4. The differential diagnosis should include myxoma, vegetation, hydatic cyst, thrombus
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and malignancy. Intracardiac blood cyst are typically asymptomatic, although valve dysfunction, left ventricular outflow tract obstruction and possibly stroke have been reported5. Two-dimension echocardiography remains the most
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convenient diagnostic method. Although there is no consensus on the management of asymptomatic mitral cysts, surgical approach seems appropriate
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EP
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SC
in patients with symptoms or valve dysfunction4.
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References: 1-Hauser AM, Rathod K, McGill J, Rosenberg BF, Gordon S, Timmis GC. Blood cyst of the papillary muscle. Clinical, echocardiographic and anatomic
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observations. Am J Cardiol 1983;51:612-3.
2-Dencker M, Jexmark T, Hansen F, Tydén P, Roijer A, Lührs C. Bileaflet blood cysts on the mitral valve in an adult. J Am Soc Echocardiogr 2009;22:1085.
the heart valves. Hum Pathol 1983;14:699-703.
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3- Zimmerman KG, Paplanus SH, Dong S, Nagle RB. Congenital blood cysts of
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4- Xie SW, Lu OL, Picard MH. Blood cyst of the mitral valve: detection by transthoracic and transesophageal echocardiography. J Am Soc Echocardiogr 1992;5:547-50.
5-Jacob JJ, Jose J, John B. Intracardiac blood-filled cysts of the heart: a rare
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EP
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cause of embolic stroke. Singapore Med J 2007;48:e125-6.
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Figure Figure 1. Mitral valve blood cyst (arrow) detected by multimodality imaging. (A) TTE A4C view (B) TTE A3C view (C) CT scan 4C view (D) MRI 4C view fixed
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cine frame (E) MRI 4C view TSE-T1 (F) MRI 4C view TSE-T2. TTE=
transthoracic echocardiography; A4C= apical four-chamber; A3C= apical three-
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resonance imaging; TSE= turbo spin echo
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chamber; CT= computed tomography; 4C= four-chamber; MRI= magnetic
Video
Video 1. Movie clip showing transthoracic echocardiogram in apical fourchamber view
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Video 2. Movie clip showing cine magnetic resonance imaging in four-chamber
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EP
view
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EP
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SC
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ACCEPTED MANUSCRIPT
S0828-282X(14)00285-2
DOI:
10.1016/j.cjca.2014.04.019
Reference:
CJCA 1195
To appear in:
Canadian Journal of Cardiology
Received Date: 17 March 2014 Revised Date:
6 April 2014
Accepted Date: 18 April 2014
Please cite this article as: Bonenfant F, Essadiqi B, Gahide G, Jeanmart H, Farand P, Mitral Valve Blood Cyst Detected by Multimodality Imaging, Canadian Journal of Cardiology (2014), doi: 10.1016/ j.cjca.2014.04.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Mitral Valve Blood Cyst Detected by Multimodality Imaging
RI PT
Mitral Valve Blood Cyst
Bonenfant F, MD1; Essadiqi B, MD1; Gahide G, MD PHD2; Jeanmart H, MD MSc3 Farand P, MD MSc1
SC
1 – Cardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada,
M AN U
2- Department of Radiology, Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada,
3- Cardiothoracic surgery Division, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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Corresponding Author: Paul Farand, MD MSc
Centre hospitalier universitaire de Sherbrooke
EP
3001, 12th avenue nord
AC C
Sherbrooke, Qc, Canada, J1H 5N4 Tel: 819-346-1110 Fax: 819-820-6806
e-mail: [email protected] April 2014
ACCEPTED MANUSCRIPT
Summary: We present unique images of a mitral valve blood cyst in a 25-year-old woman who presented with exertional dyspnea and atypical chest pain. Multimodality
RI PT
imaging includes transthoracic echocardiogram, CT scan and MRI.
Text of Manuscript:
SC
A 25-year-old woman was referred for exertional dyspnea, atypical chest pain and a systolic murmur. Transthoracic echocardiography (Fig.1A, Fig.1B, Video
M AN U
1) showed a round mobile hypoechoic structure attached to the anterior mitral valve leaflet on its ventricular side. CT scan (Fig.1C) showed an isodense mass measuring 16X19 mm in diameter. On cardiac magnetic resonance (Fig.1D), this non-enhancing mass was isointense on TSE-T1 (Fig.1E) and on TSE-T2
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(Fig.1F). Its attachment to the anterior valve leaflet was confirmed on cine MR (Video 2). A valvular blood cyst was suspected. The patient was referred for surgical resection by a minimally invasive approach. Pathologic examination
EP
confirmed the diagnosis. Following surgery, the patient reported resolution of
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dyspnea and atypical chest pain.
Since the first echocardiographic demonstration in 1983 by Hauser1, intracardiac blood cysts have been described on each of the valves and cavities2. It is a common finding in foetuses and infants, but much rarer in adulthood3. The exact physiopathology leading to their formation or regression remains uncertain4. The differential diagnosis should include myxoma, vegetation, hydatic cyst, thrombus
ACCEPTED MANUSCRIPT
and malignancy. Intracardiac blood cyst are typically asymptomatic, although valve dysfunction, left ventricular outflow tract obstruction and possibly stroke have been reported5. Two-dimension echocardiography remains the most
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convenient diagnostic method. Although there is no consensus on the management of asymptomatic mitral cysts, surgical approach seems appropriate
AC C
EP
TE D
M AN U
SC
in patients with symptoms or valve dysfunction4.
ACCEPTED MANUSCRIPT
References: 1-Hauser AM, Rathod K, McGill J, Rosenberg BF, Gordon S, Timmis GC. Blood cyst of the papillary muscle. Clinical, echocardiographic and anatomic
RI PT
observations. Am J Cardiol 1983;51:612-3.
2-Dencker M, Jexmark T, Hansen F, Tydén P, Roijer A, Lührs C. Bileaflet blood cysts on the mitral valve in an adult. J Am Soc Echocardiogr 2009;22:1085.
the heart valves. Hum Pathol 1983;14:699-703.
SC
3- Zimmerman KG, Paplanus SH, Dong S, Nagle RB. Congenital blood cysts of
M AN U
4- Xie SW, Lu OL, Picard MH. Blood cyst of the mitral valve: detection by transthoracic and transesophageal echocardiography. J Am Soc Echocardiogr 1992;5:547-50.
5-Jacob JJ, Jose J, John B. Intracardiac blood-filled cysts of the heart: a rare
AC C
EP
TE D
cause of embolic stroke. Singapore Med J 2007;48:e125-6.
ACCEPTED MANUSCRIPT
Figure Figure 1. Mitral valve blood cyst (arrow) detected by multimodality imaging. (A) TTE A4C view (B) TTE A3C view (C) CT scan 4C view (D) MRI 4C view fixed
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cine frame (E) MRI 4C view TSE-T1 (F) MRI 4C view TSE-T2. TTE=
transthoracic echocardiography; A4C= apical four-chamber; A3C= apical three-
M AN U
resonance imaging; TSE= turbo spin echo
SC
chamber; CT= computed tomography; 4C= four-chamber; MRI= magnetic
Video
Video 1. Movie clip showing transthoracic echocardiogram in apical fourchamber view
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Video 2. Movie clip showing cine magnetic resonance imaging in four-chamber
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EP
view
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EP
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SC
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