Cardiac hydatid cyst with clinical features resembling subaortic stenosis

Surgical experience with cardiac echinococcosis

Cardiac echinococcosis is a rare affliction of the heart encountered in areas where the tapeworm Echinococcus is endemic. During the 15 years to September 2005, 19 consecutive patients (11 female; mean age, 25.6 +/- 12.8 years) with cardiac echinococcosis were operated on at Damascus University. Diagnosis was mainly established by 2D-echocardiography. Twelve patients also had extracardiac hydatidosis. All patients were operated on using cardiopulmonary bypass and cardioplegia. Intact cysts were generally enucleated, ruptured cysts were exteriorized, and interventricular septal cysts were managed by controlled puncture and aspiration. There was no operative mortality. All patients were placed on mebendazole postoperatively for periods appropriate to the extent of their hydatidosis. There were 4 known late deaths due to systemic extension of the disease. Cardiac echinococcus is a serious disease that should be managed surgically without delay. Enucleation of intact cysts under cardiopulmonary bypass and cardiac arrest is our preferred method of excision. Anthelmintic medical treatment is a valuable and necessary adjunct to surgical management.

Coronary narrowing secondary to compression by pericardial hydatid cyst

Echinococcus granulosus remains a clinical problem in undeveloped and developing countries. It commonly affects the liver and lung, but, rarely, other organs such as the heart can be involved. In this report, we describe an unusual case in which pericardial hydatid cyst mimicking acute coronary syndrome secondary to compression by pericardial hydatid cyst attached to the anterolateral wall of the left ventricle. We made diagnosis by transthoracic 2D echocardiography, and confirmed by cardiac magnetic resonance imaging and serologic tests. Because our patient refused to have an operation, albendazole therapy was given. It is important to recognize this unusual disease, because it may lead to serious complications.

Myocarditis

Viruses are the most common cause of myocarditis in economically advanced countries.

Enteroviruses and adenoviruses are the most common etiologic agents.

Viral myocarditis is a triphasic process. Phase 1 is the period of active viral replication in the myocardium during which the symptoms of myocardial damage range from none to cardiogenic shock. If the disease process continues, it enters phase 2, which is characterized by autoimmunity triggered by viral and myocardial proteins. Heart failure often appears for the first time in phase 2. Phase 3, dilated cardiomyopathy, is the end result in some patients. Diagnostic procedures and treatment should be tailored to the phase of disease.

Viral myocarditis is a significant cause of dilated cardiomyopathy, as proved by the frequent presence of viral genomic material in the myocardium, and by improvement in ventricular function by immunomodulatory therapy.

Myocarditis of any etiology usually presents with heart failure, but the second most common presentation is ventricular arrhythmia. As a result, myocarditis is one of the most common causes of sudden death in young people and others without preexisting structural heart disease.

Myocarditis can be definitively diagnosed by endomyocardial biopsy. However, it is clear that existing criteria for the histologic diagnosis need to be refined, and that a variety of molecular markers in the myocardium and the circulation can be used to establish the diagnosis.

Treatment of myocarditis has been generally disappointing. Accurate staging of the disease will undoubtedly improve treatment in the future. It is clear that immunosuppression and immunomodulation are effective in some patients, especially during phase 2, but may not be as useful in phases 1 and 3. Since myocarditis is often selflimited, bridging and recovery therapy with circulatory assistance may be effective. Prevention by immunization or receptor blocking strategies is under development.

Giant cell myocarditis is an unusually fulminant form of the disease that progresses rapidly to heart failure or sudden death. Rapid onset of disease in young people, especially those with other autoimmune manifestations, accompanied by heart failure or ventricular arrhythmias, suggests giant cell myocarditis.

Peripartum cardiomyopathy in economically developed countries is usually the result of myocarditis.

Eighteen-year experience with echinococcosus of the heart: clinical and echocardiographic features in 14 patients

We present a retrospective analysis of clinical symptoms and echocardiographic features in 14 patients having cardiac hydatic cysts and screened during the 18 last years, with surgical correlations in 13. The heart was the sole location of the cyst in six patients. The revealing symptoms were precordial pain (six patients), dyspnea (two patients). A systolic murmur of false pulmonic stenosis was present in three patients. In 13 patients, two-dimensional echocardiographic images of hydatic cysts were those of masses of liquid content with a well-contrasted capsule, which was single in eight patients and multiple in five, one of which had a honeycomb appearance. The mass was solid and calcified in one patient. The outlines of the cysts were particularly sharp on transesophageal echocardiograms (six patients). The cyst size ranged from 1.8 to 11 cm in diameter. Cysts were located in the intramyocardium in 10 patients (left ventricle in four patients, interventricular septum in four patients, right ventricle in two patients), the pericardium in three and the mediatinum in one. There were a Doppler pulmonary valve gradient in three patients. Computed tomography (eight patients) and coronary arteriography (seven patients) have no additional diagnosis value than echocardiography. Nuclear magnetic resonance imaging (three patients) was helpful in determining extracardiac extension of the cysts. Transthoracic and transesophageal two-dimensional echocardiography have a central role in diagnosing cardiac hydatic cysts.

[Hydatid cyst of the heart simulating coronary ischemia]

Cardiac echinococcosis is rare despite endemic occurrence of echinococcosis in some regions of the world. Clinical presentation can vary and may be misleading. Diagnosis is facilitated by new imaging techniques. Surgery is mandatory to avoid serious complications. We report a case of cardiac echinococcosis with pseudo, ischemic clinical and electrical presentation.

Two cases of cardiac cyst hydatid with right and left ventricular involvement

Cardiac cyst hydatic is a rare disease. Two cases with left and right ventricular involvement are presented that demonstrate the use of echocardiography in the diagnosis and during follow up of the disease.

Unusual recurrence of hydatid cysts of the heart: report of two cases and review of the clinical and surgical aspects of the disease

In cardiac echinococcosis, a hydatid cyst most frequently forms either solely in the heart or in the pericardium, but there are several reports of cysts forming in the liver or lung or in both. In two cases reported here, both patients developed cysts in new sites after one or more previous surgeries for hydatid cyst removal. In Case 1, the patient first underwent spleenectomy and resection of multiple cysts with no evidence of a cyst in the heart; 3 years later, there was no sign of Echinococcus in the liver, but a large inframyocardial cyst had damaged the left ventricle. In Case 2, the patient first underwent surgery to remove cysts from the pericardium, 2 years later from the anterior wall of the left ventricle, and, finally, 8 months after this second operation, from the left atrium also with no evidence of cyst formation anywhere else in the heart at the time of surgery. These cases emphasize the need for thorough and frequent reevaluation to detect new hydatid cyst formation in the heart and elsewhere caused by the Echinococcus organism.

[Cardiac cysts. A case of isolated cardiac hydatidosis]

In the presence of cardiac cysts we must discard a hydatid disease, even if there is no involvement of other organs. Imaging techniques are useful for guiding the initial diagnosis. The presence of daughter vesicles or multiple cysts is very characteristic. We present a patient affected by cardiac hydatid disease, in the form of multiple cardiac cysts, without extracardiac affectation, who presented pericardial chest pain. The patient was dealt with surgery to avoid the risks of a cyst rupture.

Cardiac echinococcosis--a rare echocardiographic diagnosis

A 30 year old female admitted for evaluation of left chest pain was suspected to have multiple cardiac hydatid cysts. The diagnosis was established by cross sectional echocardiography and computed tomography, supported by enzyme linked immunosorbent assay (ELISA) for echinococcosis. Medical therapy altered the echopattern of the cysts but failed to reduce cystic masses. Surgery was advocated but refused by the patient.

Primary Cardiac Hydatid Cyst

We report 3 patients with primary cardiac hydatid cysts, all of which were located on the wall of the right ventricle. In one case, an intramyocardial cyst protruded into the right ventricular chamber and in the other 2 cases, cysts protruded into the intrapericardial space. The diagnosis was confirmed by serologic tests, two-dimensional echocardiography, tomographic scanning and cardiac angiography. The patients underwent successful enucleation of the cysts with the aid of cardiopulmonary bypass. There was no morbidity or mortality and late results were satisfactory.