A rare location for cardiac hydatid cyst in the interventricular septum | |
DOI: 10.5606/e-cvsi.2014.115 | |
Funda Yıldırım, 1 Barış Tuncer, 1 Adnan Taner Kurdal, 1 Tülün Öztürk, 2 İhsan İşkesen1 | |
1Departments of Cardiovascular Surgery, Medical Faculty of Celal Bayar University, Manisa, Turkey 2Departments of Anesthesiology and Reanimation, Medical Faculty of Celal Bayar University, Manisa, Turkey |
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Keywords: Cardiac hydatid cyst; interventricular septum; operative view | |
Hydatid cyst is an endemic disease seen in different regions of the world due to the Echinococcus granulosus tapeworm. The lung and
liver are the most affected organs. Cardiac involvement is 0.5% to 2% of patients with hydatid disease and the interventricülar location is
seen more rarely. A 17-year-old female patient with systemic hydatid cyst disease was consulted to our clinic. The patient presented with
dyspnea, exertional dysrhythmia, and chest pain. Transthoracic echocardiography and cardiac magnetic resonance imaging showed the
location of the interventricular septal hydatid cyst. The patient underwent elective surgery and discharged without any complications. |
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Hydatid cyst is an endemic disease seen in different
regions of the world due to the Echinococcus granulosus
tapeworm. The lung and liver are the most affected
organs. Among patients who have hydatidosis,
hepatic cysts occur in 70% and pulmonary cysts in
20%, but cardiac cysts are reported 0.5% to 2% of
patients with hydatid disease and the interventricular
location is seen rarely.[1] Cardiac hydatid cysts
may rupture and cause cardiac tamponade, fatal
arrhythmias or systemic infection.[2] The diagnosis
of cardiac hydatid cyst is made through transthoracic
echocardiography. Computed tomography (CT) and
magnetic resonance imaging (MRI) are the other
diagnostic tools. The treatment of cardiac hydatid
cysts is surgery. |
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CASE PRESANTATION
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A 17-year-old female patient with systemic hydatid cyst
disease was consulted to us with cardiac interventricular
septal cyst. The patient had an intracranial cyst
operation approximately one month ago. Imaging
studies showed two small renal cysts. There were no
cysts in the liver and lung. The patient had complaints
of dyspnea, effort-related dysrhythmia and chest
pain for approximately three months. We planned
the cardiac cyst surgery electively 54 days after the
intracranial cyst operation. On physical examination, systolic murmur was heard over the left second intercostal interval. The electrocardiogram showed right bundle branch block and the routine laboratory tests were normal. Transthoracic echocardiography showed 5x4.3 cm sized cystic lesion located in the interventricular septum (Figure 1). Before the operation, cardiac MRI imaging was obtained to identify the cyst dimensions in the septal anatomy. The cardiac MRI was reported as the compression signs to the both of the ventricles (Figure 2). Figure 1. Transthoracic echocardiographic image of the septal cyst. Figure 2: Cardiac magnetic resonance image of the septal cyst. The operation was performed through median sternotomy. After opening the pericardium, the structure of cyst was palpable over the septal area. The cardiopulmonary bypass was instituted with ascending-aortic, bicaval cannulation and antegrade cardioplegia. The polyvinylpyrrolidone iodine-soaked sponges were placed into the pericardial cavity to prevent contamination. The incision was parallel to the interventricular septum. The cyst was reached by performing some dissection on the right ventricular side of the interventricular septum without opening any cardiac chamber and avoiding to damage to the left anterior descending coronary artery. The cyst content was aspirated and hypertonic solution was injected into the cyst. The germinal membranes were removed. The cavity was washed with hypertonic solution and iodinated solution, closed by capitonnage sutures, and then filled with Tisseel (Tisseel lyo 4 mlt, two component fibrin sealant, Baxter Healthcare Ltd. Caxton Way, Thetford, Norfolk, UK IP24 3SE PL 00116/0321). The sides of myotomy were closed primarily by using Teflon felts (Figure 3, 4). After the operation, there was no problem in the intensive care unit. The patient was discharged at the first postoperative week. The right bundle branch block was disappeared at the postoperative electrocardiographic records. The patient is still on albendazole treatment. |
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Hydatid cyst disease is endemic in Turkey.[3] It is often
asymptomatic at early stages. Clinical suspicion is
important for the definite diagnosis. As it may affect
multiple organs and systems, full body screening
should be done. Cardiac involvement is 0.5-2%
of the hydatid cyst patients. The interventricular septum is affected from the 4% of the cardiac cyst
cases. Cardiac hydatid cysts can rupture and cause
cardiac tamponade, fatal arrhythmias or systemic
infection.[3] Angina secondary to coronary artery
compression, anaphylactic reaction and profound
circulatory collapse may follow intracavitary rupture,[4]
therefore treatment is surgery. Removal of the cyst
improves myocardial compliance and myocardial
perfusion.[4] It also corrects cardiac deformation and
strengthens myocardial contraction.[4] It has been
reported that electrical activity and contractile
function can be restored by removal of interventricular
septal hydatid cyst.[5] Improved electrical activity was
also observed in our case report, as the right bundle
branch block disappeared after the removal of the hydatid cyst. We performed cardiac operation 54 days
after the cranial cyst operation, therefore there was
no risk of intracranial bleeding due to heparinization.
In addition, serological markers against Echinococcus
granulosus was negative. It decreases the risk of
systemic dissemination due to the two major surgical
procedures for this patient. |
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The cardiac cysts are rare and may present with
various clinical findings. Clinical suspicion is the
critical issue for the definite diagnosis. Due to
the possible risks of systemic distribution, cardiac
cysts should be treated surgically. During surgery,
perioperative measures should be taken to prevent
systemic dissemination.
Declaration of conflicting interests
Funding |
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1) Shehatha J, Alward M, Saxena P, Konstantinov IE. Surgical
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E, Engin E, et al. Large cardiac hydatid cyst in the
interventricular septum. Tex Heart Inst J 2011;38:719-22.
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