Hydatid cyst of interventricular septum causing left anterior hemiblock.

Abstract

Case report An asymptomatic II-year-old boy attended the Cardiac Division of the Navarra Hospital in February I969, for evaluation of an abnormal cardiac shadow. Five years before admission he was studied at another cardiac centre and a diagnosis of infundibular pulmonary stenosis with a systolic gradient of 20 mmHg was verified. On auscultation, a systolic murmur and a split second sound were heard in the pulmonary area. The x-ray examination of the thorax showed an abnormal cardiac shadow (Fig. I).The electrocardiogram revealed normal sinus rhythm. An rS pattern was observed in leads II, III, and aVF with very deep S waves, shifting the mean QRS axis to the left (-6o0) (Fig. 2). A Q wave was present in leads I, VI, V2, and V3 with 1 Address for reprints: Dr. E. de los Arcos, Department of Thoracic and Cardiovascular Surgery, Hospital de Navarra, Pamplona, Spain. S wave in I and all the praecordial leads. A small r' was present in lead V4R. The QRS interval was 0 I3 sec in lead II. The electrocardiographic changes were interpreted as left anterior hemiblock associated with right bundle-branch block.Withdrawal pressure tracings during right cardiac catheterization showed infundibular pulmonary stenosis with a systolic gradient of 8o mmHg. No abnormality was observed during left arterial retrograde cardiac catheterization.Right ventriculotomy under extracorporeal circulation revealed a hydatid cyst IO cm in diameter in the interventricular septum. The cystic adventitia was opened and the cyst was removed.The postoperative electrocardiogram (Fig. 3) showed QRS interval widening to o-I6 sec. The mean QRS axis was not modified but the degree of right bundle-branch block was increased.

Coronary narrowing secondary to compression by pericardial hydatid cyst

“…The ECG may reflect the location of the cyst: T-wave changes and loss of QRS voltage can occur with left ventricular involvement. Atrioventricular conduction defects or right bundle branch block can be seen with involvement of the interventricular septum [13]. In our patient, there were Twave changes and angina pectoris that mimicked acute coronary ischemia.…”

Hydatid disease of the heart: Report of five cases and review of the literature

“…Electrocardiographic changes simulating myocardial infarction can be caused by the hydatid cyst (Vestri and Tardio, 1968) or conduction defects due to compression of the bundle of His (Heimann, 1928;Corkill, 1929;Ghanem and Darwish, 1951;de los Arcos et al, 1971).…”

“…An improvement in the prognosis of these patients follows surgery, especially since open-heart techniques allow radical treatment (Larghero, 1964;Di Bello and Menendez, 1963;Dodek et al, 1972;de los Arcos et al, 1971). CASE REPORTS CASE 1 P.A., a 25-year-old man, was admitted on 16 February 1959 to the Surgical Department of Rome University.…”

Sudden death caused by hydatid embolism

“…The frequence of cardiac echinococcosis ranges between 0.2% and 2.0% of all echinococcal cases [6]. It is more frequent in the left than the right ventricle of the heart but may be present in the interventricular septum as well [3]. The cardiac form is generally accompanied by primary infection of the liver or the lungs [9].…”

“…The clinical signs depend on the location. Compression of coronary arteries or conduction defect may occur as complications of cardiac echinococcosis [3]. The rupture of hydatid cysts to pericardial cavity or to the circulation may result in embolism or anaphylactic shock [2,4,7].…”