Emoji-like structure in the right atrium: identified as blood cyst and removed by interventional venous drainage cannula.

Abstract

Intracardiac blood cysts are thin-walled, blood-filled and round-shaped malformations, commonly located to the endocardium of semilunar or atrioventricular valves. Blood cysts with a diameter of a few millimetres are a frequent finding in neonates and infants 2 years of age or younger,1 but in adults they are rare. On echocardiography, blood cysts have usually a round or oval shape, about the half are pedunculated or mobile, their size varies in adults, but cysts up to a diameter of 40 mm have been reported, and usually the trapped blood within the cyst appears echo-free.2,3 The aetiology of acquired blood cysts in adults remains unknown. Furthermore, the management of adult patients with a blood cyst is controversial. We present a 56-year-old male patient in whom a mobile blood cyst in the right atrium was found by transesophageal echocardiography as part of preoperative diagnostic investigation in pocket infection of a cardiac contractility modulation device. The patient had a history with multiple lead implantations since 28 years due to AV block and dilatative cardiomyopathy. The blood cyst has been successfully removed by a venous drainage cannula (AngioVac system). In this case, the evolution of blood cyst is compatible with a possible mechanical injury of endocardium due to multiple insertions and high number of leads in the right heart. To the best of our knowledge, here we report for the first time on the removal of a blood cyst using a large venous drainage cannula (22 french size).