Morphologic aspects and morphogenesis of blood cysts on canine cardiac valves

We investigated retrospectively the morphologic aspects of blood cysts of the atrioventricular valve in eight Beagle dogs and clarified the morphogenesis of the lesions. Study of serial sections revealed that the cysts communicate with the blood vessels; however, they showed no connection with the valve surface. Immunohistochemically, the thin endothelium of the lesions showed positive staining for factor VIII-related antigen. Histologic studies of a variety of sizes of blood cysts revealed four basic stages of blood cyst formation: 1) initially, the involved blood vessel undergoes only a slight enlargement that is not grossly detectable; 2) next, the vessel becomes moderately or markedly dilated and contains a large number of erythrocytes. The changes of this stage are macroscopically detectable; and 3) then, blood flow is arrested partly in the cystic lesion, followed by degeneration and necrosis of the cyst. At this third stage, fibrous tissue or dense collagenous connective tissue is usually seen surrounding the cyst; 4) and finally, metaplastic bone is formed within the lesion. Colloidal carbon infusion into the valves of normal canine hearts revealed the presence of an extensive, dense arrangement of blood vessels in the septal leaflet of the tricuspid valve, which usually is the recognized site to develop blood cysts.