Cardiac blood-filled cyst at the atrialized portion of the right ventricle in a patient with Ebstein anomaly: A case report

Abstract

Blood-filled cysts of heart valves are commonly reported as postmortem findings in infants. They are small, pinhead sized nodules that disappear by the age of 6 months.1 Such cysts, although rare in adults,2 have been identified in the tricuspid,3 mitral,4 and pulmonary valves,5 but their occurrence in the atrialized part of the ventricle in Ebstein anomaly has not been reported. We report the successful management of a large bloodfilled cyst at the atrialized portion of the right ventricle in a patient with Ebstein anomaly. Clinical summary. A 31-year-old woman reported to our cardiac clinic with a 10-year history of palpitations and dyspnea on exertion. Cardiac examination revealed a grade 2/6 systolic murmur in the tricuspid area. A chest x-ray film revealed mild cardiomegaly, and she had sinus bradycardia with a rate of 54 beats/min. The echocardiogram showed Ebstein anomaly of the tricuspid valve, a large atrial septal defect with moderate tricuspid regurgitation, and mild right ventricular dysfunction. She was in New York Heart Association class II. Regular follow-up was recommended. At 18 months of follow-up a right bundle branch block developed, and echocardiography showed a mass of 2.2 × 2.4 cm at the atrialized part of the right ventricle above the septal leaflet, which was presumed to be a thrombus or vegetation (Fig 1). Three consecutive blood cultures were negative for pathogens, and she was started on a regimen of warfarin and aspirin and was closely observed. The mass increased in size (2.8 × 2.8 cm), despite anticoagulation therapy, and type II atrioventricular dissociation developed over a period of 3 months. At operation a large (3 × 3 cm) encapsulated sessile mass (Fig 2) was found to be arising from the atrialized portion of the right ventricle just above the septal leaflet of the tricuspid valve, which was attached firmly to the underlying endothelium. The tricuspid valve leaflets were severely dysplastic and were not suitable for repair. The mass was carefully excised en toto. The tricuspid valve was excised, ventricular plication From the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India. Received for publication Feb 17, 2000; accepted for publication Feb 25, 2000. Address for reprints: Smruti Ranjan Mohanty, MCh, Institute of Cardiovascular Diseases, Madras Medical Mission, 4/A, Dr J. Jayalalitha Nagar, Mogappair, Chennai—600 050, India (E-mail: mmmbits@.vsnl.com). J Thorac Cardiovasc Surg 2000;120:422-3 Copyright © 2000 by The American Association for Thoracic Surgery 0022-5223/2000 $12.00 + 0 12/54/106969 doi:10.1067/mtc.2000.106969 CARDIAC BLOOD-FILLED CYST AT THE ATRIALIZED PORTION OF THE RIGHT VENTRICLE IN A PATIENT WITH EBSTEIN ANOMALY: A CASE REPORT