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

Abstract

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.

Cardiac hydatid cyst revealed by complete heart block

“…Interventricular septal cysts are usually asymptomatic; however, in rare instances in which cardiac echinococcal cysts involve the interventricular septum, they can cause symptoms related to obstruction of the right or left ventricular outflow tract and/or compression of the conduction pathway (AV block and syncopal attacks), as in our case. [2,[5][6][7] Recently Bennis et al [8] reported the case of a patient with a cardiac hydatid cyst located in the interventricular septum that was revealed by a complete heart block, and they removed it under CPB. In our case, the AV block persisted, and the patient's heart rate declined after removal of the cyst.…”

Association of Heart Block with Uncommon Disease States

“…[10][11][12][13] There is much evidence of septal involvement of the heart with the formation of abscess in infectious diseases such as acute bacterial endocarditis, involving the heart conduction system. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Collagen diseases and various types of vasculitis have been postulated as a cause of heart conduction disturbances, as described by Bernstein in humans in 1951 29 and also in an animal model. 30 Calcification of heart valves and valve rings has been shown to destroy the cardiac conduction system 1 and is thus associated with advanced heart block.…”

“…A variety of diseases, other than common coronary artery disease [1][2][3] and Lev-Lenègre syndrome, 4,5 are associated with cardiac conduction system abnormalities. These include acute processes, such as acute rheumatic fever, 6,7 and other disorders such as sarcoidosis, 8,9 Wegenar granulomatosis, [10][11][12][13] bacterial endocarditis with cardiac abscess formation, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] connective tissue disorder, 29,30 and neoplasms. [31][32][33][34][35][36] Cardiac conduction system abnormality has been documented by electrocardiography with calcification of heart valves and valve rings, 1,37 also following irradiation therapy to the chest, [38][39][40][41][42][43] and after spinal cord injury (SCI), [44][45]…”