A heart within the heart - a rare congenital cause of an embolic stroke

Abstract

BACKGROUNDIntracardiac blood cysts are thin-walled cysts which are lined by cobble-stone shaped epithelium, fi lled with nonorganised blood. 1 They were fi rst reported by Elsasser in 1844 2 and are mostly congenital in origin. During autopsy, they are found on cardiac valves in approximately 50% of infants under the age of 2 months and are very rarely found after the age of 2 years. 3 Although they are typically asymptomatic, rarely they can cause complications such as valvular dysfunction, left ventricular outfl ow tract obstruction and embolic stroke, for which there are very few documented cases. 4 -6 Transthoracic and trans-oesophageal echocardiography remain useful diagnostic tools in diagnosing this rare condition. We describe the case of an 87-year-old lady who presented with an embolic stroke in whom trans-thoracic and transoesophageal echocardiography enabled us to diagnose the presence of an underlying blood cyst attached to the mitral valve which appeared to have ruptured. CASE PRESENTATIONAn 87-year-old lady was admitted to hospital after waking up with new onset left-sided arm and leg weakness. She denied any chest pain, palpitations or breathlessness.Her past medical history was only remarkable for sensori-neural deafness and previous urinary tract infections. There was no known history of cerebrovascular events or cardiac history and no known family history of cardiac conditions.Physical examination revealed that she was afebrile with a heart rate of 65 beats per min, blood pressure of 120/60 mm Hg and a respiratory rate of 14 breaths per min with oxygen saturations of 98% on air. Upon neurological examination, she had left-sided weakness with power reduced to 2/5 in her left upper limb and 3/5 in her left lower limb. Her sensation was intact and her plantars were both downgoing. She was unable to mobilise. Her cardiovascular examination was normal, with normal jugular venous pressure, no carotid bruits and normal heart sounds with no added sounds. INVESTIGATIONSLaboratory values demonstrated normal blood count, biochemistry, liver function and clotting profi le. Her fasting glucose and lipid profi le were within normal limits. Her C reactive protein was elevated at 59 mg/l. Her urine dipstick was positive for nitrites, leucocytes and protein suggesting she had a urinary tract infection. Admission ECG showed normal sinus rhythm with no ischaemic changes and her chest radiograph showed normal cardiac contours with normal pulmonary vascular markings. CT of the head showed hypo-attenuation of the periventricular white matter compatible with chronic micro-vascular disease. There was a focus of encephalo-malacia involving the right caudate nucleus, anterior to the caudo-thalamic groove, compatible with a subacute infarct. Carotid artery dopplers did not demonstrate any signifi cant stenosis. Her 24 h ECG demonstrated that she remained in sinus rhythm throughout with no arrhythmias.A diagnosis of subacute right middle cerebral artery territory infarct was made and she was initially given aspirin 300 m...

Giant Blood Cyst of the Mitral Valve in a Disseminated Tuberculosis Patient

“…2 When seen in adults, they typically present as hypoechogenic cardiac masses involving the mitral or tricuspid valve, although they have been known to affect any valve. 3 The mitral valve mass in this case was slightly different in appearance that what is classically described in the literature making the diagnosis more challenging. Our mass was multilobar and slightly heterogeneous with some areas appearing less echogenic than others, but not clearly echolucent.…”

“…They usually regress spontaneously, and rarely occur in adults . When seen in adults, they typically present as hypoechogenic cardiac masses involving the mitral or tricuspid valve, although they have been known to affect any valve …”

“…5 Case reports of cardiac blood cysts describe complications of embolic stroke, left ventricular outflow tract obstruction, and valve dysfunction. 3,6,7 In symptomatic cases, the optimal plan is surgical resection if possible. However, in an asymptomatic patient, there are no clear guidelines.…”

Incidental Left Atrial Blood Cyst in a Patient Undergoing Transcatheter Aortic Valve Replacement

“…Reported complications include LV outflow obstruction, 5 occlusion of the coronary arteries, 6 valvular stenosis or regurgitation, [9][10][11] and embolic stroke. 12 The embolic risk of rapid pacing and TAVR in a patient with an intracardiac blood cyst is unknown. To our knowledge, this is not only the f irst report of a blood cyst in the free wall of the left atrium, but also the first report in which a patient with a cardiac blood cyst successfully underwent TAVR.…”

Кров’яна Кіста Мітрального Клапана. Клінічний Випадок

“…Дехто з авторів стверджує, що кров'яні кісти -це дилатовані, ектатично змінені судини чи судинні мальформації/ангіомаса. Однак питання походження кров'яних кіст і надалі залишається дискутабельним [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. У фаховій літературі описані випадки різної локалізації кіст у дорослих: мітральний клапан [1,5,6,12], тристулковий клапан [3], клапан легеневої артерії [7], клапан аорти [8], камери серця [2,[9][10][11][12].…”