New World’s old disease: cardiac hydatid disease and surgical principles

Abstract

SummaryBackground:Hydatid cyst is a parasitic disease caused by infection with the Echinococcus granulosus tapeworm larva. It is a major public health problem in endemic regions. Cardiac involvement of the disease is rare.Methods:Between 1985 and 2015, 12 patients were admitted to our clinic with a possible diagnosis of cardiac hydatid disease. Of these patients, six (50%) were male and six (50%) were female. Mean age of the patients was 42.6 years.Results:The most common location of cardiac hydatid disease was left sided (six patients, 50%). Five (41.7%) patients had cysts located in the right heart, whereas one (8.3%) had a cyst in the interventricular septum. Eleven (91.7%) of the patients were operated on via median sternotomy and the remaining one was operated on via a left anterolateral thoracotomy. Ten (83.3%) of the patients were operated on using cardiopulmonary bypass under moderate hypothermia, whereas the remaining two (16.7%) had off-pump surgery. There was no surgical mortality in our series. All patients were discharged with medical therapy (mebendazole or albendazole) for the duration of six months. No recurrences were observed in their follow ups.Conclusion:Although cardiac hydatid disease is rare, its prevalence seems to have increased in the last decade. Any patient with suspected cardiac symptoms suggesting mass lesions should be considered for a differential diagnosis of cardiac hydatid disease, especially in developing countries. Definitive treatment is removal of the cyst, combined with medical therapy.

Case Report: Sudden death related to unrecognized cardiac hydatid cyst

“…Malamou-Mitsi et al 7 also have reported a case in which the cyst was found intact; they suggested that the death seemed to be due to fatal left ventricular arrhythmias. Singh et al 18 reported a case of a 57-year-old man who presented with syncope due to ventricular tachycardia, and imaging revealed a right ventricular hydatid cyst. In our case, although no allergic signs were observed, anaphylactic shock cannot be excluded from the scope of mechanisms of death beyond pulmonary embolism.…”

“…The mature worm inhabits the intestines of the dog and humans are accidental hosts in their life cycle. Hydatid cysts can develop anywhere in the human body, predominantly in the lung and the liver 3 , 4 . Cardiac involvement is very scarce, even in endemic regions, and its clinical evolution is asymptomatic until acute complications or a fatal outcome occurs.…”

Right-Sided Cardiac Hydatid Cyst Complicated With Pulmonary Embolization: A Pediatric Case Report

“…Only 10% of cardiac hydatid cyst patients are symptomatic [ 6 ]. The disease remains silent for years, due to the slow increase in cyst diameter (about one to 1.5 cm per year) [ 7 ]. Depending on its location, the enlargement of the cyst may lead to the right or left ventricular outlet obstruction, valvular insufficiency or stenosis, cardiac failure, compression of coronary arteries, arrhythmia, or atrioventricular and intraventricular blocks [ 4 ].…”

Quiste hidatídico en ventrículo derecho

“…Distintas series muestran variabilidad respecto a la frecuencia en la localización de los quistes, predominando la ubicación en el ventrículo izquierdo (47% -75%), ventrículo derecho (15% -41,7%) 7 -10 y otras ubicaciones menos frecuentes como el tabique interventricular, pericardio, arteria pulmonar y aurícula derecha. Existe una amplia gama de presentaciones clínicas, desde pacientes asintomáticos en quienes solo constituye un hallazgo 10 , hasta pacientes que presentan manifestaciones como disnea, arritmias, insuficiencia cardíaca 8,9 , signos electrocardiográficos de isquemia, alteraciones en el segmento ST y onda T 11 , dolor precordial con electrocardiografía normal 12 , fiebre 13, 14 y síncope 14,15 . El estudio diagnóstico, basado en el nivel de sospecha y la disponibilidad de recursos, puede incluir serología, electrocardiografía, estudios de imágenes como radiografía de tórax, tomografía computarizada, ecocardiograma transesofágico y transtorácico, angiografía coronaria y resonancia magnética 7 -9, 11 -13, 16 .…”