Images in cardiovascular medicine. Hydatid cyst of the interventricular septum

Pharmacology of sclerotherapy

Sclerotherapy is the therapeutic use of sclerosants in the controlled destruction of undesired target tissues. Sclerosants have been used in vascular and nonvascular settings, both as primary and adjunctive therapy. Effective sclerotherapy requires a conceptual understanding of key questions about the process being treated, including the method of delivery, the presence of flow, and the required contact time to initiate sclerosis. However, beyond technique and delivery, practical and safe application of sclerotherapy requires an understanding of the uses, limitations, dosing, and side effects of sclerosants used during interventional radiology procedures. Agents discussed here include detergents and surfactants [ethanol, Sotradecol(®) (Bioniche Pharma, Pointe Claire, Quebec and Angiodynamics, Latham, NY), ethanolamine oleate], hypertonics (saline, glucose), and a review of several other types that are used less frequently.

Hydatid cyst of the right atrium: a rare presentation

Hydatid cyst of the heart is an uncommon lesion. Reported is the case of a 24-year-old female patient admitted with a history of chest pain and hemoptysis, and a mass lesion in the right atrium. Investigations and intraoperative intervention revealed the mass to be a hydatid cyst located in the right atrium, along with hydatid cysts of the liver and both lungs. The right atrial mass was successfully removed under cardiopulmonary bypass.

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.

Cardiac Hydatid Cyst Rupture as Cause of Death

Echinococcosis is a frequent parasitic human infection in sheep-farming areas. It is caused by the larval or the cyst stage of a tapeworm, mainly Echinococcus granulosis. Humans can be infected by ingesting tapeworm eggs, from which cysts will be developed mostly in the liver and the lung. Cardiac involvement of echinococcosis is rare and its clinical evolution is silent till the complication stage. A young adult died suddenly. The autopsy showed a ruptured hydatid cyst hollowed on the right side of the interventricular septum, protruding in the ventricle. The left pulmonary artery contained white-colored fragments of a membrane, similar to the one found in the right ventricle, associated to small vesicles. All these elements were obstructing this vessel, extending to small pulmonary arterial branches. Dissection of the other organs did not show other locations. Microscopic examinations ascertained the diagnosis of echinococcosis. Death was imputed to a right ventricular hydatid cyst rupture with pulmonary artery embolism.

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.

Spontaneous intramural atrial hematoma presenting as a left atrial mass

We describe an unusual case of spontaneously occurring intramural atrial hematoma with no communication with either atrium. The diagnosis of left atrial mass was made from transthoracic echocardiography. Subsequent examination with transesophageal echocardiography confirmed a large mass essentially filling the whole left atrium but failed to provide an etiologic diagnosis, which was eventually made at surgery.

[Cardiac hydatid cyst in a child]

Cardiac hydatid cyst is an uncommon disease, especially in children. The interventricular septum region is the most frequent localization. The cysts usually involve other organs making the etiologic diagnosis easier. Our young patient presented a single hydatid cyst. The etiologic diagnosis was difficult due to the negativity of the serologic tests and there were no other organs affected. Surgical ablation of the cyst was performed and histopathological analysis achieved.