Unusual recurrence of hydatid cysts of the heart: report of two cases and review of the clinical and surgical aspects of the disease

A rare location of cardio hydatid cyst with multiple organ involvement: a case report

Cardiac cysts in hydatid cysts, a parasitic disease, are extremely rare, and left-atrial hydatid cysts are even more unusual. Therefore, the authors report herein a rare case of a hydatid cyst in the left atrium. According to them, this is the third documented case of left-atrial hydatid cysts.

Presentation of Case

A 25-year-old male presented at the outpatient clinic with atypical chest pain, hacking cough, dyspnoea, nausea, and vomiting for 2 months. Echocardiography showed a left-atrial unilocular, well-delineated mass. The authors also found multiple liver cysts and spleen cysts.

Discussion

The widespread distribution of the disease in our regions, the dog contact story of the patient, and the appearance on echocardiograms were strong reasons to diagnose a hydatid cyst in the left atrium, which may cause many symptoms (bundle branch conduction, arrhythmias, myocardial infarction) or unexpected death.

Conclusions

The authors aimed to report this case due to the disease's high probability of death, even asymptomatic patients with cardiac hydatid disease should all be referred for early surgery.

An Incidental Finding of Heart Echinococcosis in a Patient with Infective Endocarditis: a Case Report

Echinococcosis is a cosmopolitan zoonotic parasitic disease caused by infection with the larval stage of tapeworms from the Echinococcus genus, most commonly Echinococcus granulosus. According to WHO, more than 1 million people are affected by hydatid disease at any time.1 About 10% of the annual cases are not officially diagnosed.2 In humans, the disease is characterized by development of three-layered cysts. The cysts develop primarily in the liver and the lungs, but can also affect any other organ due to the spreading of the oncospheres. Cardiac involvement is very uncommon - only about 0.01-2% of all cases.4,5 In most cases, the cysts develop asymptomatically, but heart cysts could manifest with chest pain, dyspnea, cough, hemophtisis and can complicate with rupture. Diagnosis is based on a number of imaging techniques and positive serological tests. Treatment for cardiac localization is almost exclusively surgical. We present a case of an incidental finding of an echinococcal cyst in the left atrium (rarest possible localization of heart echinococcosis) in a patient, admitted for infective endocarditis.

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.

Giant cardiac hydatid cyst in children: case report and review of the literature

Cardiac echinococcus is a rare affliction of the heart caused by the tapeworm Echinococcus granulosus. Primary echinococcosis of the heart represents 0.5–2% of all hydatid disease cases in endemic regions. It evolves slowly, explaining its rarity in children. We report the case of a 11-year-old child affected by a giant cardiac cyst of the left ventricle (LV). The patient underwent cardiac surgery and medical treatment. A retrospective review of the current literature was realized. We found 18 cases: the mean age was 11-years old. Nine cysts were localized in the LV, four in the interventricular septum, three in the right ventricle, and two in the right atrium. All underwent surgery except six patients. Routine echocardiographic screening may be useful in endemic regions where infestation is common. Cardiac echinococcus should be diagnosed in the early and uncomplicated stages and be removed surgically even in asymptomatic patients.

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.

Heart echinococcosis: current problems and surgical treatment

We present some historical, epidemiological, statistical data for heart echinococcosis and concomitant lesions of different organs. The diagnosis of heart echinococcosis is based on revealing of the cyst and its identification with echinococcus. The value of different diagnostic methods is shown. A surgical procedure in patients with heart echinococcosis depends on the localization of the cysts (manipulations under cardiopulmonary bypass or off-pump procedure). We present some additional techniques for prophylaxis of recurrence.

Left ventricular epicardial hydatid cyst compressing the left circumflex artery

Cardiac hydatid is a rare disease with varied presentation. We report a unique case of left ventricular epicardial hydatid cyst causing left circumflex artery compression. Cardiac hydatids have to be surgically treated on diagnosis because of the high risk of catastrophic rupture. We discuss the surgical principles and the other adjuncts to avoid recurrence.