A clinical dilemma: cardiac and pericardiac echinococcosis

Pericardial hydatid cyst: A comprehensive case report on diagnosis and multidisciplinary intervention in a young patient

Pericardial hydatid cysts, although rare, present unique diagnostic challenges and require a multidisciplinary approach for effective management. This parasitic infection, caused by Echinococcus granulosus larvae, typically affects the liver and lungs but can manifest in the pericardium, leading to potentially life-threatening complications if untreated. The 22-year-old female's escalating dyspnea posed diagnostic challenges despite inconclusive echocardiography. Employing a multidisciplinary strategy, including preoperative albendazole therapy and surgical excision, effectively managed the condition. This case highlights the intricate diagnostic nature of pericardial hydatid cysts, emphasizing the importance of heightened clinical awareness, especially in endemic regions. The detailed clinical trajectory, imaging methodologies, and therapeutic interventions contribute significant insights to the medical community. The study aims to deepen comprehension and guide clinicians in refined diagnostic and treatment approaches for pericardial hydatid cysts, ultimately improving patient outcomes. It underscores the imperative for continued research in this niche to enhance medical understanding and optimize clinical practices.

Mediastinal and pericardial hydatidosis: A case report with review of the literature

Hydatidosis is an echinococcosis caused by the development of Echinococcus granulosus larvae in humans. The lung is the second most frequent site after the liver. The primary mediastinal and pericardial localisations are extremely rare. Ultrasound and CT scans play an important role in the diagnosis of this disease.We report the case of an 11-year-old female patient from a rural environment with a history of dogs contact, whose symptomatology consisted of chest pain, dyspnoea, all evolving in a febrile context. The imagery showed the existence of multiple mediastinal and pericardial collections. This patient was rapidly managed with albendazole (ABZ) and scanography revealed an excellent therapeutic response. Primary mediastinal and pericardial hydatidosis is a very uncommon disease. It can be unfortunately revealed at the stage of vital prognosis complications. Ultrasound and computerized tomography (CT) are helpful for localizing and defining the morphologic features of hydatid cysts. It should be kept in mind, especially in patients from endemic areas.

Pediatric hydatid cyst with ventricular aneurysm and surgical treatment with dor procedure, case report

BACKGROUND

Cardiac involvement of hydatid cyst disease (HCD) is a rare presentation but may lead to life-threatening complications such as cyst rupture and should be treated surgically.

METHODS

A 10-year-old male patient with cranial and complicated cardiac HCD lesions that caused lower extremity peripheral arterial occlusion and aneurysmatic dilatation in the left ventricular apex is presented.

RESULTS

Although the patient was in the pediatric age group, the Dor procedure was successfully applied to preserve the ventricular geometry. The Dor procedure for a ventricular aneurysm caused by a cardiac hydatid cyst (CHC) was rarely applied in the pediatric age group.

CONCLUSION

In conclusion, this case differs from other CHCs previously reported in the literature due to the advanced stage of the disease, atypical clinical presentation, and rare complications despite the young age of the case. The surgical method used in treating the patient makes the subject more interesting.

Case Report: Sudden death related to unrecognized cardiac hydatid cyst

Echinococcosis, also known as hydatid disease, is a common parasitic human infestation found in sheep-breeding areas. It is caused by the larvae stage of Echinococcus granulosus, and cysts develop mostly in the lungs and the liver. Cardiac involvement is unusual and silent until acute complications or a fatal outcome occurs. Herein, we report an autopsy case of a young healthy adult who died suddenly. The autopsy revealed an external bulging on the right heart ventricle outlet with a fluid-filled cystic cavity discovered on sectioning. Dissection of other organs did not reveal other cyst locations. Histological examination ascertained the diagnosis of hydatid cyst, and death was attributed to cardiac arrhythmias. Pathologists should keep in mind that hydatid cysts can develop anywhere in the body. Solitary cardiac cyst is rare and can simulate a “silent bomb”. Unfortunately, sudden death remains the frequent manner of revelation of this disease in endemic areas.

A Pericardial Hydatid Cyst Masquerading as Acute Inferolateral Myocardial Infarction

A case of pericardial hydatid cyst adjacent to the inferoposterial wall of the left ventricle is reported. Significant ST segment elevations in leads D2, D3, aVF, V5, and V6 on surface electrocardiography and sudden onset of severe chest pain mimicked acute inferolateral myocardial infarction. However, cardiac catheterization and coronary angiography showed normal coronary arteries and normal left ventricular cavity. The ST segment elevation in the inferolateral leads disappeared a few days after surgical resection of the cyst. Cardiac hydatid cyst should be considered in the differential diagnosis of patients with angina-like chest pain in endemic areas.

[Hydatidosis simulating a cardiac tumour with pulmonary metastases]

BACKGROUND

The presence of multiple symptomatic pulmonary nodules and one cardiac tumour in a child requires urgent diagnosis and treatment. Until a few decades ago, the diagnosis of a cardiac tumour was difficult and was based on a high index of suspicion from indirect signs, and required angiocardiography for confirmation. Echocardiography and other imaging techniques have also helped in the detection of cardiac neoplasms. However, it is not always easy to make the correct diagnosis.

CLINICAL CASE

The case is presented of a 12 year-old boy with pulmonary symptoms, and diagnosed with a cardiac tumour with lung metastases. The presence of numerous pulmonary nodules was confirmed in our hospital. The echocardiogram detected a solid cardiac nodule in the right ventricle. Magnetic resonance imaging confirmed the findings and the diagnosis. Puncture-aspiration of a lung nodule gave the diagnosis of hydatidosis. He underwent open-heart surgery with cardiac cyst resection and treated with anthelmintics. The lung cysts were then excised, and he recovered uneventfully.

DISCUSSION

This child had multiple pulmonary nodules and a solid cardiac nodule, and was suspected of having a cardiac tumour with pulmonary metastases. However, given the clinical history, background and morphology of pulmonary nodules, another possible aetiology for consideration is echinococcosis. The clinical picture of cardiac hydatidosis and its complications is highly variable. The clinical history is essential in these cases, as well as having a high index of suspicion.

CONCLUSION

Hydatidosis should be included in the differential diagnosis of a solid, echogenic, cardiac nodule. The treatment for cardiopulmonary hydatid cysts is surgical, followed by anthelmintics.

Thrombotic cardiac apex hydatid cyst

Hydatid cyst (HC) is an endemic infestation in the cattle-breading countries such as in Iran. The involvement of heart by HC is rare; however, nesting of larva in the left ventricular apex with subsequent rupture to the systemic circulation and thrombus formation in the remaining cyst cavity is an exceedingly rare phenomenon. A 45-year-old man referred to our emergency cardiac room with chest pain and a transthoracic echocardiography (TTE) that showed a cardiac apex cystic lesion. The differential diagnosis of a cystic tumor, a HC, or aneurysm in the apex of the left ventricular walls was considered and evaluated by TTE and magnetic resonance imaging. However, the thrombotic HC was confirmed at the surgery. The cyst with its thrombotic component was excised surgically by on-pump cardiac surgery. The postoperative period was uneventful and the patient was discharged to home and treated with a full course of Albendazole therapy for 4 weeks. Six-month follow-up with TTE revealed complete healing of the apex defect without recurrence of the cyst.

Right ventricular hydatid cyst ruptured to pericardium

Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

A Case of Isolated Cardiac Hydatid Cyst that Mimics Lymphoproliferative Malignancy

Cardiac cystic echinococcosis is a rare parasitic infestation caused by Echinococcus granulosus larvae and it composes 0.5-2% of all human cystic echinococcosis cases. The left ventricle is the most common affected area followed by right ventricle, interventricular septum, left atrium, right atrium, and interatrial septum. The diagnosis is difficult because of nonspecific clinical and radiographic findings. We present a case of isolated apical cardiac cystic echinococcosis mimicking lymphoproliferative disease.

Hydatid cyst of the pericardium: a case report

Pericardial hydatid cystis a rare condition; its clinical presentation is variable. It can reveal straightaway at the stage of life threatening complications. We report the case of a 17 years old female Arab patient, who complained of a sudden onset dyspnea, clinical examination was poor; the diagnosis was suspected by echocardiography and confirmed by the CT scan and hydatid serology. Furthermore, no other location was noted. Surgical treatmentwas proposed. The modern cross-sectional imaging especially CT scan and MRI revolutionized the diagnosis of this rare hydatid location.

[Cardiac and renal hydatid disease--contribution of imaging: report of a case]

L’échinococcose cardiaque est rare, elle représente 0.2 à 2% des cas d'hydatidose. Elle siège essentiellement au niveau du ventricule gauche. La localisation péricardique est exceptionnelle. L’échocardiographie et la tomodensitométrie jouent un rôle primordial et sont généralement suffisantes pour poser le diagnostic de cette affection. Nous rapportons une observation d'une association de deux localisations peu courantes d'hydatidose rénale et péricardique partiellement rompu et l'intérêt de l'imagerie dans le diagnostic de ces lésions kystiques.

Heart echinococcosis: current problems and surgical treatment

We present some historical, epidemiological, statistical data for heart echinococcosis and concomitant lesions of different organs. The diagnosis of heart echinococcosis is based on revealing of the cyst and its identification with echinococcus. The value of different diagnostic methods is shown. A surgical procedure in patients with heart echinococcosis depends on the localization of the cysts (manipulations under cardiopulmonary bypass or off-pump procedure). We present some additional techniques for prophylaxis of recurrence.

Cardiac echinococcosis

Objective

Cardiac echinococcosis is an extremely rare disease, seen worldwide. Some clinical characteristics are unknown, and treatment modalities are unclear.

Methods

41 patients diagnosed with cardiac or pericardial echinococcosis underwent surgery. We evaluated the patients echocardiographically in 8 different categories: cardiac echinococcosis lesions located within the heart, imaging appearance of each lesion, activity of the cysts, mode of cardiac echinococcosis, and number of cardiac lesions per patient. The surgical technique was reevaluated according to the intraoperative echocardiographic findings, especially according to the mode of the lesion.

Results

The hydatid cysts were located in the ventricular wall in 34 cases, the right atrium in 2, the noncoronary sinus Valsalva of the aorta in 1, between the aorta and the pulmonary bifurcation in 1, and in the pericardium alone in 4 cases. In 1 case, septal rupture occurred and the patient died. Relapse was seen in 1 patient who was operated on due to multiple ventricular and pericardial cysts; this patient underwent a second operation 6 years and 8 months after the initial surgery.

Conclusion

Recent echocardiographic developments and application of intraoperative echocardiography enables a detailed classification for extirpation, and allows successful treatment.

A giant hydatid cyst in the interventricular septum with papillary muscle involvement

We present here a 44-year-old male patient with hydatid disease who was referred to our hospital due to dyspnea and chest pain for the last 2 month before admission. Using echocardiography and contrast-enhanced computed tomography the heart hydatid was diagnosed. However, hydatid disease of the interventricular septum is rare; particularly, the involvement of mitral apparatus with mitral regurgitation (MR) is an exceptionally rare presentation. Early diagnosis and an integrated treatment strategy are crucial. Surgical excision was performed and the patient had an uneventful recovery and follow-up at 3 months.

Cardiac hydatid disease: literature review

Hydatid disease is endemic to various regions of the world, with an incidence of 0.4 per 100,000 persons. Isolated cardiac involvement is rare and occurs in only 0.02%-2% of cases. As the majority of cases are asymptomatic, can present catastrophically, and lead to high mortality, it has become increasingly important to identify the disease in an early stage and treat it with surgical excision. This review aims to familiarize the readers with the varied presentations, early diagnosis, and management of cardiac hydatid disease.

[Tamponade reveals an intra-pericardial hydatid cyst - a case report]

INTRODUCTION

Hydatid disease is a parasitic infection caused by the development of the larval form of the Teania of Echinococcus granulosus. It is endemic in many regions of the world such as the Mediterranean basin. Location without pericardial cardiac involvement is extremely rare. In this case study, we will elaborate the case of an intra-pericardial hydatidosis disease without cardiac location revealed by a tamponade.

OBSERVATION

AA is a 60-year-old man with no pathological history and who was admitted for a tamponade assessment. Indeed, the cardiovascular examination showed a muffling of the heart sound and signs of a right heart failure. Besides, the ECG shows a microvoltage, and the chest radiography shows cardiomegaly. Moreover, the transthoracic echocardiogram confirmed the presence of an abundant pericardial effusion along with signs of a tamponade. It also reifies the presence of, at the intra-pericardial level, a multiple vesicular formation giving a cluster of grapes highly suggestive of an intra-pericardial hydatid disease. An emergency surgical drainage allowed removing about two liters of suspicious fluid along with cysts and white membranous. The pathological examination of the membranous confirmed the diagnosis of a pericardial hydatid cyst. The performance of a chest CT and an abdominal ultrasound's scan to identify other locations shows no further anomalies. The patient was put under medical treatment (Albendazole(®)) and is showing a good clinical improvement.

CONCLUSION

The intra-pericardial hydatid disease is another cause of tamponade not to fail despite its rareness, as it is endemic to North African countries.

Heart echinococcus cyst as an incidental finding: early detection might be life-saving

We present a 46-year-old female smoker who was admitted to the emergency department of our hospital due to cough with blood-tinged sputum for the last four days before admission. Using echocardiography and Multi-Detector Computed Tomography (MDCT) heart Echinococcosis was diagnosed. Echinococcosis is a severe health issue in some geographical regions of the world. Hydatid infection of the heart is rare and the clinical presentation is usually insidious but there is always the lethal hazard of cyst perforation. Early diagnosis and an integrated treatment strategy are crucial. The results of surgical treatment of heart echinococcosis are better than the conservative strategy only. Extraction of the cyst combined with chemotherapy peri or post operative aiming to decrease the recurrences, consists the lege artis method of encountering this medical entity. Surgical excision was performed and the patient had an uneventful recovery and follow up at six and twelve months.

Combined medical and surgical treatment of intracardiac hydatid cysts in 11 patients

OBJECTIVES

Echinococcosis is a human parasitic disease common in sheep-rearing regions, which is caused by the larval stage of Echinococcus granolosus and can involve any heart region. We report 11 cases of cardiac hydatidosis who were treated medically and surgically.

PATIENTS AND METHODS

Eleven patients diagnosed with cardiac echinococcosis were referred to the Cardiac Surgery Department of Shahid Madani Hospital from 1992 to 2004. Symptoms included dyspnea, palpitation, limb ischemia, fever, weight loss, hemiplegia, and loss of consciousness. Patients underwent surgical removal of the cyst followed by medical treatment until the titer of echinococcus hemaglutination test came to normal.

RESULTS

Hospital stay and recovery time were uneventful in nine patients. One patient died due to acute renal failure before hospital discharge (9%) and another patient experienced cerebral hydatidosis 12 months after surgery (probably due to cyst embolism). The other nine patients had no complications during five years of follow-up.

CONCLUSION

Surgical excision using cardiopulmonary bypass combined with medical therapy provides the most optimal treatment for cardiac echinococcosis.

Surgical treatment of an Echinococcus cyst of the interventricular septum complicated by septic endocarditis, complete atrioventricular block, and rupture into the Valsalva sinus

A 40-year-old man was emergently hospitalized because of high fever, a transient ischemic attack, and complete atrioventricular block. The diagnosis was endocarditis, cyst of the interventricular septum (IVS), and complete atrioventricular block. A temporary pacemaker was introduced, and the patient underwent surgery that included IVS cystectomy, ventricular septum plication, and aortic valve replacement. A permanent pacemaker was implanted during the early postoperative period. The patient was discharged from the medical center on day 9 after primary surgery. At the 4-month postoperative follow-up, the patient was found to be in normal condition. Patients with high temperature, heart rhythm and conduction disorders, and dyspnea of unknown etiology might be harboring Echinococcus despite the absence of primary liver or lung damage. Urgent surgical treatment is necessary even on suspicion of complicated hydatid damage to the heart.

Surgical approach to the management of cardiovascular echinococcosis

OBJECTIVE

Echinococcosis is a serious health problem in some regions of the world. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important.

METHODS

We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years.

RESULTS

The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence.

CONCLUSIONS

Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk.

Cardiac tamponade via a fistula to the pericardium from a hydatid cyst: case report and review of the literature

Although echinococcus is endemic in many sheep-raising areas of the world, cardiac involvement is rare. Cysts usually reach the heart by means of the coronary circulation, but other routes have been proposed. Pericardial tamponade due to a hydatid cyst has not yet been described in the literature. We present the case of a 46-year-old woman who presented to the Emergency Department with complaints of chest pain and mild dyspnea. Her medical history was positive for a liver hydatid cyst operation 26 years earlier. She was tachypneic, tachycardic, and hypotensive. Pleural and pericardial effusions were detected on transthoracic echocardiography. When she worsened clinically, pericardiocentesis was performed and she promptly improved. A fistula was detected between the liver and pericardium on computed tomography (CT) scan of the torso. Serologic test (agglutination) for Echinococcus granulosus was positive in a 1/32 dilution. A final diagnosis of mediastinal hydatic cyst was made, and a 4-week course of albendazol was given. Then the cyst was surgically excised, and the patient recovered without complications.

Echocardiography Findings in 16 Cases of Cardiac Echinococcosis: Proposal for a New Classification System

BACKGROUND

Echocardiography is a reliable method for diagnosing cardiac echinococcosis (CE). Currently, there is no echocardiographic classification system for CE, but such a scheme would facilitate diagnosis. This article presents echocardiographic data for 16 cases with CE and outlines a method for echocardiographic classification of CE based on the World Health Organization's ultrasonographic classification of cystic echinococcosis.

METHODS

We assessed the echocardiographic features of hydatid cysts in 16 patients with CE (9 women and 7 men; mean age, 41 +/- 18.3 years), all of whom underwent cardiac surgery. The proposed classification system identifies 3 types of CE lesions: active (unilocular or multilocular and echolucent, showing double-layered cyst wall and hydatid sand); transitional (shrunken as a result of reduced intracystic pressure, and showing water lily sign); and inactive (completely degenerated contents creating the ball-of-wool sign). Preoperative echocardiographic findings (lesion location, imaging appearance [unilocular/multilocular, solid/semisolid], echocardiographic classification/type, number of lesions) were compared with computed tomographic, intraoperative echocardiographic, surgical, and parasitological findings.

RESULTS

Preoperative echocardiography revealed 18 hydatid cysts (10 myocardial, 7 pericardial, 1 on the ascending aorta). In all, 10 lesions appeared multilocular, 6 unilocular, and 2 solid. A total of 11 were active, 5 transitional, and 2 inactive. Computed tomography identified 20 lesions total, therefore, two were missed on echocardiography. The preoperative echocardiographic findings correlated well with intraoperative echocardiographic, surgical, and parasitological findings.

CONCLUSION

The 3 types of CE lesions defined in this proposed classification system feature distinct echocardiographic characteristics. This new system is reliable and practical, and could assist with diagnosis and rapid treatment of CE.

Isolated pericardial hydatid cyst in an asymptomatic patient: a remark on its radiologic diagnosis

Cardiac hydatid cyst disease is uncommon, representing approximately 0.2% to 2% of all cyst-related cases. Cardiac hydatid cysts are found mostly within the myocardium. Most cardiac hydatid cysts are located in the interventricular septum or in the left ventricular wall. Only few cases of pericardial location have been reported; isolated pericardial hydatid cysts are especially extremely rare. Patients with a cardiac hydatid cyst are usually asymptomatic. We present the case of an asymptomatic patient with isolated pericardial hydatid cyst disease and discuss the role of chest X-rays in the incidental diagnosis of this condition.

Complete Atrioventricular Block due to a Hydatid Cyst Located in the Interventricular Septum: A Case Report

We report a case of complete atrioventricular block and tricuspid valve insufficiency due to a cardiac hydatid cyst located in the interventricular septum that occurred in a 19-year-old male patient. Surgery was carried out with the help of cardiopulmonary bypass. The cyst was excised, and the interventricular septum was closed with an autologous pericardial patch treated with glutaraldehyde. The tricuspid valve insufficiency was repaired with annuloplasty. A dual-chamber epicardial pacemaker was implanted. The postoperative course was uneventful, and the patient was doing well 6 months after discharge. This is the first report of a cardiac hydatidosis case for which the repair of the interventicular septum, tricuspid annulopasty, and permanent pacemaker implantation were performed during the same operation.

Left atrial mobile hydatid cyst mimicking left atrial myxoma and mitral stenosis and causing heart failure and arrhythmia

Cardiac hydatid cysts are very rare in hydatid cyst disease. We report herein a case of hydatid cyst mimicking left atrial myxoma. A 78-year-old woman was admitted to our hospital with complaint of dyspnea and signs pulmonary edema and mitral stenosis. Echocardiography showed left atrial mobile, mostly solid mass with wall calcifications moving towards the orifice of the mitral valve. We also found loculated giant hepatic and right pulmonary cysts. We aimed to report this case because of mimicking mitral stenosis and left atrial myxoma and causing heart failure.

Pericardial hydatid cyst presenting with cardiac tamponade

Cases of cardiac hydatid cyst disease are uncommon, occurring in approximately 0.5% to 2% of patients with hydatid disease. Most cardiac hydatid cysts are located in the left ventricle and interventricular septum. Cardiac involvement may have serious consequences. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 10-year-old girl with cardiac tamponade secondary to a pericardial hydatid cyst is described.

Complex Reconstruction of Hydatid Cyst-Destructed Left Ventricle: A Case Report

OBJECTIVE

Echinococcus cyst in the heart as a life threatening condition has a rare incidence of only 0.5% to 2%.

MATERIAL AND METHODS

We have described the case of a 23-year-old patient with an echinococcus cyst localized in the inferoseptal and posterior wall of the left ventricle. In a random x-ray examination, a pathological formation in the left ventricle was found in a completely asymptomatic patient. Using a transthoracic echocardiography, the existence of a multilocular echinococcus cyst in the left ventricle was confirmed. The cyst, with a diameter of 8 cm, was located at the distal third of the septum toward the posterior wall. The diagnosis was confirmed with transesophageal echocardiography, computerized tomography, and magnetic resonance imaging. We excluded the existence of other noncardiac localizations of the echinoccosis. The patient had normal angiography. After 3 and a half years of unsuccessful treatment with benzimidazole, the patient was enrolled for a surgical treatment. After a medial sternotomy, during extracorporeal circulation, we performed warm-blood cardioplegy and approached complete excision of the cyst. The multilocular cyst was opened at the apex. We punctured the cyst and aspirated the dense co-liquated cystic mass, instillating hypertonic solution for prevention of cyst dissemination. The pericystic sheath was resected down to an intact myocardium. The septal defect was closed with 2 circular sutures.

RESULTS

The patient underwent the operation without any complications, and the patient's functions were stable following the intervention. Patient follow-up at 3 years showed no signs of relapse of the disease.

CONCLUSION

The surgical treatment is inevitable even when the location and approach technique are highly troublesome.

Left ventricular hydatid cyst presenting with acute ischemic stroke: case report

Cardiac hydatid cysts are rarely seen. The presentation of an acute stroke secondary to embolization from a cardiac hydatid cyst is also rare. We report a young boy with left ventricular hydatid cyst who presented with acute ischemic stroke.

Cardiac hydatid cysts: surgical treatment and results

From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were diagnosed as a component of multi-organ echinococcosis and three of them underwent operation before. They were examined serologically and echocardiographically. Cardiac hydatidosis were diagnosed in right ventricle (in three cases), left ventricle (in one case), and interventricular septum (in two cases). Sternotomy was the approach used and all patients were operated on using cardiopulmonary bypass. Intraoperative rupture did not occur. There was no operative mortality, the only morbidity was complete atrioventricular block necessitating VVD pacemaker implantation in the patient with hydatid cyst involving the basal interventricular septum. All patients were followed by medical treatment with albendazole (400 mg/day) and no recurrences were reported in the late follow-up.

Acute Abdominal Aorta Embolism Caused by Rupture of a Cardiac Hydatid Cyst

We report a case of an abdominal aortic embolism due to rupture of a cardiac hydatid cyst. This report emphasizes the diagnostic, preventative, and treatment options for hydatid cyst embolism of abdominal aorta. Echocardiography should be routinely performed in all patients with hydatid disease for possible involvement of the heart. This enables early diagnosis and treatment of cardiac echinococcus before life-threatening complications occur.

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.

Cardiac involvement of hydatid disease

OBJECTIVES

Echinococcosis is a serious health issue occurring in some geographical region of the world. Cardiac involvement is rare and early diagnosis and prompt surgical intervention are critical.

SUBJECTS AND METHODS

Six patients with cardiac hydatid cysts underwent surgical treatment in our institution between April, 1996 and March, 2002. Five of the patients were female and one was male. Average age was 40+/-5 years with a range of 19 to 72 years. Cysts were located in the right ventricular outflow tract in two patients, the left ventricular outflow tract in one, the right atrial in one, the right ventricular in one and the right atrioventricular groove in one. Five patients were operated on using standard cardiopulmonary bypass techniques, and one was operated on without cardiopulmonary bypass.

RESULTS

In the perioperative and the early postoperative period, no cardiac problems was observed. On control echocardiography, a ventricular septal defect was detected in one patient in the late postoperative period. The ventricular septal defect was repaired using standard cardiopulmonary bypass and was closed with a teflon patch. Patients were followed up for a mean period of 3.4+/-2.5 years. No mortality or recurrence was observed during the follow-up period.

CONCLUSIONS

When hydatid cyst is diagnosed, the possibility of cardiac involvement should also be investigated. The treatment of cardiac hydatid cyst is surgical extraction of the cyst. Results of surgery are generally satisfactory.

Off-pump technique for the treatment of ventricular myocardial echinococcosis

BACKGROUND

This study was planned to investigate the off-pump operability of ventricular myocardial Echinococcosis, which has no close relation with the cardiac chambers.

METHODS

Twenty patients with cardiac echinococcosis, and 2 patients with isolated pericardial echinococcosis were operated on. Hydatid cysts were located in the ventricular wall in 17 patients and 10 of these 17 patients were operated without cardiopulmonary bypass. We present these 10 patients in this report. We used transesophageal echocardiography (TEE) and peroperative surface echocardiography (PSE) to determine the relation of cysts with cardiac chambers. The cysts were aspirated for diagnosis and to facilitate the dissection. Cyst cavities were left open in all cases.

RESULTS

We did not observe any early complication and in long-term follow-up only one patient underwent reoperation 68 months after her first operation due to reoccurrence.

CONCLUSIONS

Ventricular myocardial echinococcosis without relation with the cardiac chambers can be operated without using cardiopulmonary bypass with the aid of TEE, PSE, and controlled cyst fluid aspiration.

Cardiac hydatid cyst and pulmonary hydatidosis in a child

Hydatidosis in the lungs is unusual, and a cardiac localization occurs rarely. We report a child with cardiac hydatid cyst that developed during albendazole treatment for preceding multiple pulmonary hydatid lesions. The cardiac lesion was treated by surgical excision, and the pulmonary cysts improved with a combination of praziquantel and albendazole therapy.

Cardiac hydatid disease: report of two cases

Cardiac involvement in hydatid disease is rare, occurring in less than 2% of cases of hydatid infection. It can occur as part of a widespread systemic infection or as an isolated event. It may be asymptomatic for a long period before presenting with a myriad of non-specific symptoms. Imaging plays an important role in the diagnosis, surgical planning and follow up of cases. Current treatment involves attempted surgical resection (cystopericystectomy) with long-term follow-up chemotherapy (Albendazole). Both the disease and its surgical treatment carry a high complication rate, including rupture leading to anaphylaxis and death.

[Cardiac echinococcosis]

Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve, left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiographic examination revealed a round tumour (5.8 x 4 cm) in the right ventricular free wall and two smaller cysts behind that tumour. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

Surgical treatment of echinococcal cysts of the heart: report of 3 cases

Three patients diagnosed with hydatid cysts of the heart underwent surgical treatment. The cysts were enucleated and the cavities were closed in 2 cases by plication and obliteration. In one case, the cystic cavity was closed with biologic glue. The outcome was satisfactory in all 3 patients. Postoperative treatment with albendazole is recommended.