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.
Capella G, Zolezzi F, Villani R, et al. 1986. Right cardiac echinococcosis with coronary compression. Description of a clinical case [in Italian]. G Ital Cardiol 16:696-701.nGoksel S, Kural T, Ergin A, et al. 1991. Hydatid cyst of the interventricular septum. Diagnosis by cross-sectional echocardiography and computed tomography, treatment of mebendazole. Jpn Heart J 32:741-4.nOliver JM, Sotillo JF, Dominquez FJ, et al. 1988. Two-dimensional echocardiographyc features of echinococosis of the heart and great blood vessels. Circulation 78:327-37.nDesnos M, Brochet E, Cristofini P, et al. 1987. Polyvisceral echinococcosis with cardiac involvement imaged by two dimensional echocardiography, computed tomography and magnetic resonance imaging. Am J Car diol 59:383-4.nBirincioglu L, Bardakci H, Kucuker SA, et al. 1999. A clinical dilemma: cardiac and pericardiac echinococcosis. Ann Thorac Surg 68:1290-9.nDe Paulis R, Seddio F, Colagrande L, Polisca P, Chiariello L. 1999. Cardiac echinococcosis causing coronary artery disease. Ann Thorac Surg 67:1791-3.nAupetit JF, Ritz B, Ferrini M, Coppin M, Champsaur G. 1997. Hydatid cyst of the interventricular septum. Circulation 95:2325-6.nMechmeche R, Bousnina A, Ismail B. 1983. Use of coronary angiography in the diagnosis of hydatid cysts of the heart [in French]. Arch Mal Coeur Vaiss 76:305-12.nOzdemir M, Diker E, Aydosdu S, et al. 1997. Complete heart block caused by cardiac echinococcosis and successful treatment with albendazole. Heart 77:84-5.nTejada JG, Saaverda J, Molina L, et al. 2001. Hydatid disease of the interventricular septum causing pericardial effusion. Ann Thorac Surg 71:2034-5.n