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Two adherent blood cysts in subvalvular apparatus of the mitral valve causing severe left ventricular outflow tract obstruction.

ABSTRACT: Blood cysts in the heart are often incidentally found during post-mortem examinations in infants, and usually do not cause clinical symptoms. They almost always regress spontaneously, and only a few cases of embolization or valvular dysfunction have been reported previously. We report a 62-year-old man who presented with chest discomfort and dyspnea on exertion for several years, and was found to have a dynamic murmur in left ventricular outflow tract (LVOT) on physical examination. His echocardiogram demonstrated two large blood cysts attached to the subvalvular apparatus of mitral valve, causing significant LVOT obstruction and mild to moderate mitral regurgitation. The cysts were surgically excised and pathology confirmed simple blood cysts. <Learning objective: To the best of our knowledge, this is the first reported case of twin blood cysts with severe left ventricular outflow tract obstruction in an adult, since most of these cysts either regress spontaneously in childhood or remain asymptomatic in adults.>.

SUBMITTER: Bagheri A

PROVIDER: S-EPMC6149619 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Two adherent blood cysts in subvalvular apparatus of the mitral valve causing severe left ventricular outflow tract obstruction.

Bagheri Abdolhamid A Ansariaval Zahra Z Khani Mohammad M Shekarkhar Shadi S Baghayi Ramin R Sharifi Tahmineh T

Journal of cardiology cases 20180607 2

Blood cysts in the heart are often incidentally found during post-mortem examinations in infants, and usually do not cause clinical symptoms. They almost always regress spontaneously, and only a few cases of embolization or valvular dysfunction have been reported previously. We report a 62-year-old man who presented with chest discomfort and dyspnea on exertion for several years, and was found to have a dynamic murmur in left ventricular outflow tract (LVOT) on physical examination. His echocard ...[more]

PMID: 30279916

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Project description:BackgroundLeft ventricular outflow tract (LVOT) obstruction is a leading cause of mortality and exclusion from transcatheter mitral valve replacement (TMVR). Intentional laceration of the anterior mitral valve leaflet to prevent LVOT obstruction (LAMPOON) is a transcatheter mimic of surgical chord-sparing leaflet resection.ObjectivesThe purpose of this prospective multicenter trial was to study LAMPOON with transseptal (Edwards Lifesciences, Irvine, California) TMVR in annuloplasty rings or native mitral annular calcification (MAC).MethodsSubjects at high or extreme surgical risk and prohibitive risk of LVOT obstruction from TMVR were included. Eligibility was modified midtrial to exclude subjects with threatened LVOT obstruction from a Sapien 3 valve fabric skirt. The primary endpoint was procedure survival with successful LAMPOON, with successful TMVR, without reintervention, and with LVOT gradient <30 mm Hg ("optimal") or <50 mm Hg ("acceptable"). Secondary endpoints included 30-day mortality and major adverse cardiovascular events. There was universal source-data verification and independent monitoring. All endpoints were independently adjudicated. Central laboratories analyzed echocardiogram and CT images.ResultsBetween June 2017 and June 2018, 30 subjects were enrolled equally between the MAC and ring arms. LAMPOON traversal and midline laceration was successful in 100%. Procedure survival was 100%, and 30-day survival was 93%. Primary success was achieved in 73%, driven by additional procedures for paravalvular leak (10%) and high-skirt neo-LVOT gradients observed before a protocol amendment. There were no strokes.ConclusionsLAMPOON was feasible in native and annuloplasty ring anatomies in patients who were otherwise ineligible for treatment, with acceptable safety. LAMPOON was effective in preventing LVOT obstruction from TMVR. Despite LAMPOON, TMVR using Sapien 3 in annuloplasty rings and MAC still exhibits important limitations. (NHLBI DIR LAMPOON Study: Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Implantation; NCT03015194).

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Two adherent blood cysts in subvalvular apparatus of the mitral valve causing severe left ventricular outflow tract obstruction.

Publications

Two adherent blood cysts in subvalvular apparatus of the mitral valve causing severe left ventricular outflow tract obstruction.

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