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.