The main cause of hydatid cysts in human is
Echinococcus granulosus and human is the intermediate
host in its life cycle.[
4] Most of its embryos can be
eliminated by the host immune system; however, they
sometimes can survive and evolve to the cystic state.[
5]
The cysts usually grow very slowly (1 cm/year).[
5] The
larvae can reach the heart via the coronary circulation;
however, cardiac hydatid cysts are uncommon due to
the contraction ability of the heart (0.5 to 2% of the
cases).[
6] An adventitial pericystic layer was formed
around the cyst, when it is placed in the myocardium
as a reaction against it.
In addition, these cysts may cause several
symptoms according to the location. Most of the
cardiac hydatid cysts are asymptomatic. Most common
clinical manifestations are precordial chest pain and
coughing. Also fever, hemoptysis, arrhythmia, and
cardiac conduction disorders, dyspnea, syncope, acute
myocardial infarction, valvular disorders, pericarditis
can be seen. A ruptured cardiac hydatid cyst may also
cause more serious complications such as pericardial
tamponade, pulmonary or systemic embolization,
pulmonary hypertension, and anaphylactic reactions.[2]
Ulgen et al.[7] reported a case who died from recurrent
cerebral embolization of a ruptured cardiac hydatid
cyst. In our case, the patient had malaise, dizziness, and complete AV block probably due to the mass effect of
the cyst and compression of the conduction pathway of
the heart. A similar case reported by Ipek et al.[8] with
a cardiac hydatid cyst located in the interventricular
septum which was revealed by a complete heart block
which was removed under CPB. In our case, the AV
block did not recover and, therefore, a permanent
pacemaker was implanted postoperatively.
The diagnosis of cardiac echinococcosis
is mainly based on the combination of clinical
suspicion, cardiac imaging, and serological tests.
Echocardiography is the most common method
for the diagnosis of cardiac hydatid cyst. Also, CT
imaging can be used in the differential diagnosis
and can determine the size and exact location of
the cyst in the heart. Serological test results for
echinoccocosis were negative in our case; however,
histological and pathological examinations of the
intraoperative specimens confirmed the diagnosis of
a hydatid cyst.
The most favored method for the treatment of
cardiac hydatid cysts is surgical treatment under
CPB. The cyst content should be removed carefully
and it should be sterilized with hypertonic saline
solution to prevent recurrence. It has been reported
that nearly 10% of all hydatid cysts tend to recur after surgery.[9] Albendazole alone or in combination
with praziquantel can be used as prophylaxis. We
also administered oral albendazole therapy in the
postoperative period and the patient was discharged
with albendazole prescription.
In conclusion, cardiac hydatid cysts may cause
serious complications, such as anaphylactic reactions
and sudden death in case of ruptures, particularly.
It can easily be diagnosed with transthoracic
echocardiography. The surgical treatment yields
favorable results. Therefore, we recommend the
surgical treatment of this pathology as soon as possible.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect
to the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.
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