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Congenital blood cysts of the heart valves
Insights
Congenital blood cysts are common in fetal and infant heart valves, particularly the tricuspid and mitral valves. These benign findings likely have no clinical significance and may arise from ventricular endothelial infoldings.
Area of Science:
- Cardiovascular Pathology
- Fetal and Pediatric Cardiology
Background:
- Congenital blood cysts frequently occur on fetal and infant heart valves, primarily the tricuspid and mitral valves.
- Previous research suggested a link between these cysts and asphyxia, a hypothesis this study addresses.
Purpose of the Study:
- To investigate the prevalence and characteristics of congenital blood cysts in heart valves of fetuses and infants.
- To elucidate the histological structure and potential formation mechanism of these cysts.
- To determine the clinical significance and associations of congenital blood cysts.
Main Methods:
- Autopsy examination of 38 fetal and infant hearts (up to 2 years old).
- Histological analysis using light microscopy (paraffin and plastic embedding) and scanning electron microscopy.
- Detailed examination of cyst morphology, size, and number per valve.
Main Results:
- Blood cysts were identified in 47% of cases (18 out of 38), ranging from 26 weeks gestation to 11 months.
- Cyst diameters varied from microscopic to 3 mm, with up to 20 cysts per valve.
- Microscopic examination revealed endothelium-lined channels connecting cyst lumens to ventricles, suggesting formation from endothelial infoldings.
Conclusions:
- Congenital blood cysts are a common, likely incidental finding in neonates with diverse causes of death.
- The study found no association with asphyxia, refuting prior claims.
- Blood cysts may persist and potentially enlarge, forming giant cysts of the heart valves.
Abstract:
Congenital blood cysts of the heart valves are found most commonly on the tricuspid and mitral valves of fetuses and infants. Hearts available following 38 random autopsies of fetuses and infants 2 years of age or younger were examined. Blood cysts were found in 18 cases (47 per cent) in which ages ranged from 26 weeks of gestation to 11 months. The cysts varied in diameter, from microscopic to 3 mm. Affected valves had from one to 20 cysts. Light microscopic examination of serially sectioned paraffin-embedded tissue and plastic-embedded tissue and scanning electron microscopic examination revealed connections between the cyst lumens and ventricles via small endothelium-lined channels. The cyst structure suggested formation from ventricular endothelial infoldings in the valve leaflet base, which bulged into the atrium because of the pressure gradient present during valve closure. Blood cysts are a common finding in neonates dying of various causes and probably have no clinical significance. There is no association with asphyxia as previously described. Blood cysts may persist and enlarge to form giant cysts of the heart valves.