Multimodality Imaging-Guided Valve-Sparing Resection of an Atypical LVOT Blood Cyst in an Adult
1Department of Cardiovascular Function Diagnostics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Background:
Intracardiac blood cysts rarely persist into adulthood and may lose their typical echolucent appearance when chronically hemorrhagic and organized.
Case Summary:
A 54-year-old woman presented with exertional dyspnea. Transthoracic echocardiography revealed a mobile left ventricular outflow tract (LVOT) mass (19 × 16 mm) causing severe dynamic obstruction (peak gradient 85 mm Hg) without a classic anechoic cavity. Three-dimensional transesophageal echocardiography demonstrated subvalvular chordal attachment. Multimodality imaging, including myocardial contrast echocardiography, cardiac computed tomography, and cardiac magnetic resonance, showed no enhancement, supporting an avascular benign cyst. Valve-sparing excision with mitral valve repair was performed. Histopathology confirmed a chronically organized blood cyst, with resolution of LVOT obstruction and symptoms.
Discussion:
Atypical adult LVOT blood cysts may mimic tumors or vegetations; multimodality imaging can establish benignity and guide valve-preserving surgery.
Take-Home Message:
Integrated multimodality imaging can establish benignity and support safe valve-sparing surgery in atypical LVOT cysts.
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