Hydatid cyst in the right ventricular outflow tract: Successful surgical outcome of a rare entity

Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review and Meta-analysis

Background

Right ventricular outflow tract obstruction (RVOTO) is a cause of hemodynamic instability that can occur in several situations, including cardiac surgery, lung transplantation, and thoracic surgery, and in critically ill patients. The timely diagnosis of RVOTO is important because it requires specific considerations, including the adverse effects of positive inotropes, and depending on the etiology, the requirement for urgent surgical intervention.

Methods

The objective of this systematic review and meta-analysis was to determine the prevalence of RVOTO in adult patients, and the distribution of all reported cases by etiology.

Results

Of 233 available reports, there were 229 case reports or series, and 4 retrospective cohort studies, with one study also reporting a prospective cohort. Of 291 reported cases of RVOTO, 61 (21%) were congenital, 56 (19%) were iatrogenic, and 174 (60%) were neither congenital nor iatrogenic (including intracardiac tumour). The mechanism of RVOTO was an intrinsic obstruction in 169 cases (58%), and an extrinsic obstruction in 122 cases (42%). A mechanical obstruction causing RVOTO was present in 262 cases (90%), and 29 cases of dynamic RVOTO (10%) were reported. In the 5 included cohorts, with a total of 1122 patients, the overall prevalence was estimated to be 4.0% (1%-9%).

Conclusions

RVOTO, though rare, remains clinically important, and therefore, multicentre studies are warranted to better understand the prevalence, causes, and consequences of RVOTO.

Intracardiac hydatid cyst located in right ventricular outflow tract: a rare site

Intracardiac hydatid cyst is relatively uncommon and involvement of right ventricular outflow tract is extremely rare. We report a rare case of intracardiac hydatid cyst involving the right ventricular outflow tract and do a review of literature.

Excision of innumerable hydatid cysts from the myocardium of the left ventricle via the left thoracotomy along with myoplasty on beating heart

Cardiac hydatid cyst is a rare disease with frequency of less than 2%. The left ventricle is the most common site. Symptoms depend upon site of involvement ranging from asymptomatic to acute coronary syndrome, arrhythmias, valvular lesions, etc. It is a surgical emergency, therefore early diagnosis and surgical treatment is required even in asymptomatic patients. Surgical excision on beating heart along with preparedness with cardiopulmonary bypass and fibrillator via left anterolateral thoracotomy can be done successfully, followed by medical treatment with albendazole. Increased awareness and high degree of suspicion among cardiac physicians in the endemic area is essential for early diagnosis. Echocardiography remains the gold standard for diagnosis and follow-up of patient.

Usefulness of bubble study in echocardiographic diagnosis of contained rupture of hydatid cyst in the right ventricular outflow tract

We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac-like structure in the right ventricular outflow tract (RVOT) containing a heterogenous echogenic mass. This sac-like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst. Bubble echoes were noted within the sac-like structure but did not penetrate the inner wall of the cyst which contained echogenic material, indicating that the rupture was confined only to the outer layers. At surgery, a 0.5 cm communication was noted between the cyst and the RVOT and pathology confirmed the diagnosis of hydatid cyst.

Surgical treatment and outcome of cardiac cystic echinococcosis

OBJECTIVES

Cardiac cystic echinococcosis (CE), or hydatid cyst is exceptionally uncommon. We review the experience of surgical treatment of cardiac CE.

METHODS

Twenty-six patients (11 females; mean age, 28.9 ± 7.6 years) with cardiac CE undergoing surgical treatment from February 1978 to April 2013 were reviewed. The operative methods mainly included puncture-aspiration cystectomy, intact endocyst enucleation and total cyst resection.

RESULTS

Cardiac CE was located in the myocardium in 16 cases, pericardium in 8 and both myocardium and pericardium in 2. There were 21 cases with solitary hydatid cyst including at the left ventricle in 7, right ventricle in 5, right atrium in 2, interventricular septum in 1 and at the pericardium in 6; 5 cases were with multiple cysts. There was no operative mortality. All patients received albendazole postoperatively. The mean follow-up time was 68 ± 21 months (range 7-195 months) except for 4 who were lost to follow-up. There were three recurrences and one late death.

CONCLUSIONS

Cardiac cystic echinococcosis (CE) remains a very infrequent zoonotic infection. Presenting symptoms of cardiac hydatid disease are variable depending on the size, number and location of the cyst. Echocardiography, corroborated with computed tomography or magnetic resonance imaging, affords the best diagnostic and follow-up confirmation. Surgical treatment is associated with a low morbidity and mortality, and the selection of proper technique is very important to completely remove the hydatid cyst and prevent recurrence. Postoperative oral antiparasitic therapy is necessary for a definitive cure.