Complete heart block caused by cardiac echinococcosis and successfully treated with albendazole

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.

Simultaneous hydatid cysts of both the right atrium and right ventricle

Hydatid disease in both chambers of the heart is very rare. Mobile right atrial and right ventricular hydatid cysts were diagnosed incidentally in the etiologic work up for a transient ischemic attack in a 77-year-old man with a history of a hepatic hydatid cyst operation. Transthoracic echocardiography was very successful in the diagnosis of both hydatid cysts. Transesophagial echocardiography and computed tomography confirmed the diagnosis. Both right atrial and right ventricular hydatid cysts were removed under cardiopulmonary bypass to prevent morbidities and potentially fatal complications.

Complex Reconstruction of Hydatid Cyst-Destructed Left Ventricle: A Case Report

OBJECTIVE

Echinococcus cyst in the heart as a life threatening condition has a rare incidence of only 0.5% to 2%.

MATERIAL AND METHODS

We have described the case of a 23-year-old patient with an echinococcus cyst localized in the inferoseptal and posterior wall of the left ventricle. In a random x-ray examination, a pathological formation in the left ventricle was found in a completely asymptomatic patient. Using a transthoracic echocardiography, the existence of a multilocular echinococcus cyst in the left ventricle was confirmed. The cyst, with a diameter of 8 cm, was located at the distal third of the septum toward the posterior wall. The diagnosis was confirmed with transesophageal echocardiography, computerized tomography, and magnetic resonance imaging. We excluded the existence of other noncardiac localizations of the echinoccosis. The patient had normal angiography. After 3 and a half years of unsuccessful treatment with benzimidazole, the patient was enrolled for a surgical treatment. After a medial sternotomy, during extracorporeal circulation, we performed warm-blood cardioplegy and approached complete excision of the cyst. The multilocular cyst was opened at the apex. We punctured the cyst and aspirated the dense co-liquated cystic mass, instillating hypertonic solution for prevention of cyst dissemination. The pericystic sheath was resected down to an intact myocardium. The septal defect was closed with 2 circular sutures.

RESULTS

The patient underwent the operation without any complications, and the patient's functions were stable following the intervention. Patient follow-up at 3 years showed no signs of relapse of the disease.

CONCLUSION

The surgical treatment is inevitable even when the location and approach technique are highly troublesome.

Role of transesophageal echocardiography in diagnosis and management of cardiac hydatid cyst: report of three cases and review of the literature

Although diagnostic value of transthoracic echocardiography in cardiac echinococcus is well established, the role of transesophageal echocardiography in both the diagnosis and the management of this entity is not well known. We present 3 unusual cases of cardiac hydatid cyst in which transesophageal echocardiography was used. A review of the literature on the subject is also presented.

Multiple hydatid cysts of epicardium and pericardium

We report a case of multiple hydatid cysts of epicardium and pericardium with rupture and dissemination. The diagnosis was established by hemagglutinin test, echocardiography and computed tomography and confirmed by histological examination. Entirely, 12 cysts of epi- and pericardium and 1700 ml of pericardial fluid were removed during operation on the beating heart.

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

In cardiac echinococcosis, a hydatid cyst most frequently forms either solely in the heart or in the pericardium, but there are several reports of cysts forming in the liver or lung or in both. In two cases reported here, both patients developed cysts in new sites after one or more previous surgeries for hydatid cyst removal. In Case 1, the patient first underwent spleenectomy and resection of multiple cysts with no evidence of a cyst in the heart; 3 years later, there was no sign of Echinococcus in the liver, but a large inframyocardial cyst had damaged the left ventricle. In Case 2, the patient first underwent surgery to remove cysts from the pericardium, 2 years later from the anterior wall of the left ventricle, and, finally, 8 months after this second operation, from the left atrium also with no evidence of cyst formation anywhere else in the heart at the time of surgery. These cases emphasize the need for thorough and frequent reevaluation to detect new hydatid cyst formation in the heart and elsewhere caused by the Echinococcus organism.

A clinical dilemma: cardiac and pericardiac echinococcosis

BACKGROUND

Cardiac and pericardial echinococcosis as a life-threatening disease may present with a clear picture most of the time, however it may also become a clinical puzzle.

METHODS

In the period between 1977 and 1998, 14 patients were operated on with the diagnosis of cardiac and pericardial echinococcosis. Nine patients were operated on with standard cardiopulmonary bypass (CPB) techniques, and the remaining 5 patients were operated on without CPB. Transesophageal echocardiography (TEE) or intraoperative surface echocardiography were used to plan and perform the operation for the late cases.

RESULTS

One patient died during the postoperative period due to the rupture of interventricular septum. All other patients survived the perioperative period, received mebendazole treatment, and exhibited no recurrence during the follow-up.

CONCLUSIONS

The definitive treatment is the surgical extraction of the cyst. Because the clinical picture may vary according to the number, size, and location of cysts, as well as complications, cardiac echinococcosis should be remembered and included in the differential diagnosis to achieve the treatment. Intraoperative surface echocardiography is of paramount value for diagnosis and planning the management of a successful surgery.

Echocardiographically diagnosed cardiac echinococcus complicated by embolic intraventricular thrombus

A young woman had cerebral embolism caused by an unusual complication of an asymptomatic cardiac hydatid cyst. The diagnosis of the cyst by means of echocardiography was confirmed by surgery as well as nuclear magnetic resonance, computed tomography, and serologic tests. Transesophageal echocardiography revealed a thrombus in the left ventricle that was situated aside the cyst. It was thought to be the source of an embolus. Surgical removal of the cyst was successful. Cerebral damage was reduced by administration of heparin.