Morphologic aspects and morphogenesis of blood cysts on canine cardiac valves

Blood cysts of the cardiac valves in adults: Review and analysis of published cases

BACKGROUND AND AIM

Blood cysts of cardiac valves are generally seen in newborns and infants and very rarely in adults. Although in most cases they are incidental findings they may be associated to severe cardiac or systemic complications. This study analyzes incidence, presentation, and treatment of valvular blood cysts in adults.

METHODS

A review of the pertinent literature through a search mainly on PubMed and Medline was performed.

RESULTS

In patients ≥18 years of age, our search disclosed 54 patients with mitral blood cysts (mean age, 48 ± 18 years), 9 with a tricuspid valve cyst (mean age, 67 ± 15 years), 3 with a blood cyst on the pulmonary valve (age 31, 43, and 44 years), and 1 aortic valve cyst in a 22-year-old man. Most patients were asymptomatic while stroke, syncope, or myocardial infarction occurred in six patients with a mitral valve cyst. Blood cysts were removed surgically in 70% of patients with a mitral cyst, in 55% with a tricuspid cyst, and in all those with a pulmonary or aortic cyst. At histology, the cyst wall was composed mainly by fibrous tissue and with the inner surface lined with typical endothelium.

CONCLUSIONS

Blood cysts of cardiac valves are rare in adults but may cause life-threatening complications, particularly when located on the mitral valve. For such reason, surgical removal appears advisable, with low-risk procedures. Widespread use of multimodality imaging techniques will most likely increase the number of valvular blood cysts diagnosed also in adults.

Research Relevant Background Lesions and Conditions: Ferrets, Dogs, Swine, Sheep, and Goats

Animal models provide a valuable tool and resource for biomedical researchers as they investigate biological processes, disease pathogenesis, novel therapies, and toxicologic studies. Interpretation of animal model data requires knowledge not only of the processes/diseases being studied but also awareness of spontaneous conditions and background lesions in the model that can influence or even confound the study results. Species, breed/stock, sex, age, anatomy, physiology, diseases (noninfectious and infectious), and neoplastic processes are model features that can impact the results as well as study interpretation. Here, we review these features in several common laboratory animal species, including ferret, dog (beagle), pig, sheep, and goats.

Cerebral and cardiac congenital malformations in neonatal West Indian manatees (Trichechus manatus)

Strandings of live new-born West Indian manatees (WIMs; Trichechus manatus) are one of the main challenges for the conservation of this species in Brazil, particularly in the northeastern states. Congenital malformations (CMs) are rare in sirenians. We identified CMs in two of 19 stranded WIMs that were rescued, rehabilitated and subjected to complete pathological examinations in Ceará and Rio Grande do Norte States between 1992 and 2017. In case 1, dilation of the cerebral lateral and fourth ventricles with abundant cerebrospinal fluid (internal hydrocephalus), was diagnosed. Furthermore, this animal developed necrotizing enterocolitis associated with pneumatosis intestinalis and aspiration pneumonia late during rehabilitation. Cardiac malformations in case 2 included: right ventricle hypoplasia with marked stenosis of the tricuspid outflow, high ventricular septal defect, segmental pulmonary artery aneurysm, mitral valve haemocyst and left ventricular hypertrophy. Herein, we provide the first description of a neural tube defect, specifically a developmental internal hydrocephalus, and multiple cardiac congenital anomalies, together with their respective clinicopathological features in manatees. Although the aetiology of the CMs remains unknown in these cases, a genetic basis is plausible given the low genetic variability in this population. These cases add to the body of knowledge on health and disease aspects of manatees and may provide scientific basis for future medical and conservation efforts on neonatal WIMs.

Incidental Histopathological Findings in Hearts of Control Beagle Dogs in Toxicity Studies

In preclinical studies of pharmaceutical agents, the beagle dog is a commonly used model for the detection of cardiotoxicity. Incidental findings, postmortem changes, and artifacts must be distinguished histopathologically from test item–related findings in the heart. In this retrospective analysis, cardiac sections from 88 control beagles (41 male, 47 female; ages 5–18 months) in preclinical studies were examined histopathologically. The most common finding was thickening of the tunica media of intramural coronary arteries, most likely a postmortem change. The second most common finding was the presence of vacuoles within Purkinje fibers. Dilated lymphatic and blood vessels at the insertion of chordae tendineae were noted more commonly in males than in females and were considered a normal anatomic feature. Mesothelial-lined papillary fronds along the epicardial surface of the atria were present in several dogs, as were small infiltrates of inflammatory cells usually within the myocardium. In summary, control beagles’ hearts frequently have incidental findings that must be differentiated from test item–related pathologic changes. Historical control data can be useful for the interpretation of incidental and test item–related findings in the beagle heart.

Histopathology of incidental findings in beagles used in toxicity studies

The purpose of our publication is to widely communicate the pictures of spontaneous findings occurring in beagles. Spontaneous arteritis occurs commonly in beagles. Frequent sites of arteritis are the heart, spleen, pancreas, epididymis and spinal cord. Morphological similarities between spontaneous and drug-induced arterial lesions may cause confusion when evaluating vascular toxicity of chemicals such as vasodilating agents. Focal and minimal inflammatory lesions are occasionally seen in the lung and may be associated with aspiration of food particles or of unknown causes. A cystic change with copious mucin production occurs occasionally in the mucosal epithelium of the gall bladder. Nesidioblastosis is seen rarely in the pancreas of beagles. C-cell complex and lymphocytic thyroiditis are common thyroid lesions. Spontaneous focal hypospermatogenesis and lobular Sertoli-cell-only seminiferous tubules occurring frequently in beagles must be distinguished from drug-induced damage of the seminiferous tubules in toxicity studies. The morphological differences of the female genital system in each cycle need to be understood; therefore, we present the normal features of the cyclic changes of the female genital organs. Further, we provide more information on spontaneous findings in beagles for exact diagnoses in toxicity studies.

Atrioventricular valvular angiectasis in Sprague-Dawley rats

Subendothelial heart valve angiectasis has been reported in cows, dogs, pigs, rats, mice, and in human fetuses and newborns. We observed a high incidence (62 in 208 animals examined) of spontaneous angiectasis on the atrioventricular (AV) valves in 10- to 40-week-old Sprague-Dawley rats. The angiectasis was observed predominately on the septal cusp of the right AV valve and located near the AV ostium in 57 of 62 animals. Of the remaining 5 valvular angiectases, 2 were present on the parietal cusp of the right AV valve and 3 were on the left AV valve. The angiectases were single or multiple, ranging from 40 to 300 microm in diameter and were characterized by light microscopy as blood-filled dilatations lined by endothelium. Spontaneously occurring abnormalities in normal laboratory animals, such as the spontaneous valvular angiectasis reported here, need to be differentiated from drug-related lesions.

Blood and serous cysts in the atrioventricular valves of the bovine heart

A survey of 30,907 slaughterhouse cattle (5,984 calves, 15,937 young adult, 8,986 cows) was carried out to determine the incidence of blood and serous cysts on atrioventricular valves. The cysts were classified by their content (blood/serous fluid), location (mitral/tricuspid valve), and size. Cyst wall samples were processed for histology, immunohistochemistry for factor VIII-related antigen, and transmission electron microscopy. The content of some cysts was studied by electrophoresis and biochemical and microbiologic methods. Older cows had a higher incidence (16.2%) than younger animals (11.5% in calves, 7.9% in steers, 6.4% in heifers), suggesting that the lesions may be acquired. Blood cysts were often present on both atrioventricular valves; serous cysts prevailed on the mitral valve. Cysts of both types were larger in older animals; serous cysts were larger than the blood cysts. Histologically, blood cysts contained fresh blood, and serous cysts were filled with a hyaline fluid devoid of cells, sterile, and biochemically similar to lymph. All the cysts were lined with endothelium, but a positive immunostaining for the factor VIII-related antigen was appreciable only in blood cysts. Ultrastructurally, the endothelium was composed of flat endothelial cells holding several cytoplasmic filaments, lying in blood cysts on a continuous and often laminated basal lamina with many cytoplasmic projections. The results support the hypothesis that cysts of the atrioventricular valves derive from the dilation of blood and lymphatic valvular vessels, do not regress with age, and are mainly the result of mechanical effects.