Jmedj dec-2012.pdf

Hydatid Cyst of the Left Ventricle of the Heart
Bahi Hiyasat, 1*Ashraf Abu Alsamen, 2 Omar Oudat, 2 Marwan Nimri 2
Abstract
The present study involves a 47-year-old male patient from Jordan that presented with a history of progressive shortness of breath and chest tightness. Cardiac hydatidosis was diagnosed based on typical radiological findings and a positive serology test. Intra-operatively, there was a mass of a hydatid cyst located in the left ventricle and interventricular septum with no other organs involved. The patient was treated by a surgical excision and albendazole without any complications. Keywords: Albendazole, Hydatid cyst, Left ventricle, Surgery.
(J Med J 2012; Vol. 46 (4):381- 384) Received
Accepted
Introduction
Laboratory blood tests showed no abnormality in A hydatid cyst or cystic echinococcosis is caused the blood-cell count, and liver or kidney function by the larval stage of the tapeworm Echinococcus granulosus. Dogs and other canines expel the adult tapeworm eggs in their feces and humans become infected after ingestion of the eggs. distortion of cardiac borders (figure 1). The EKG Clinical presentations vary as these cysts might was normal sinus rhythm with diffuse T wave be found anywhere in the body causing different changes. A two dimensional Echocardiography signs and symptoms.1, 2 Liver (65%) and lungs (2D Echo) showed a normal left ventricle and a (25%) are the most common sites to be infected. Hydatidosis is a noteworthy health problem in many regions and especially the Middle East.3, 4 A dynamic chest computed tomography (CT) that was done on February 2008 (figure 2) revealed Case Report
multiple low-attenuation non-enhancing (cystic) lesions of different sizes arising from the A 47-year-old patient was referred to our myocardium of the left ventricle and the Cardiology Clinic at the Queen Alia Heart interventricular septum. One of them rises from the left atrium. The largest one measured 95 × 60 breathlessness for the last 2 years. The symptoms were aggravated in the last 6 months to the calcifications in their wall and some showed degree that it interfered with his daily activities. small cystic lesions inside. There were no lung lesions, no pleural effusion and no lymph node enlargement. 1. Cardiac Surgery Department, Queen Alia Heart Institute, King Hussein Medical Center, Amman, Jordan.
2. Cardiology Department, Queen Alia Heart Institute, King Hussein Medical Center, Amman, Jordan.
* Correspondence should be addressed to:
Bahi Hiyasat
P. O. Box: 3262, Amman 11953, Jordan.
E-mail: bahihiy@hotmail.com
2012 DAR Publishers⁄ University of Jordan. All Rights Reserved.
Hydatid Cyst of the Left Ventricle of the Heart… Bahi Hiyasat et al. A transesophageal echocardiogram (TEE) revealed a large non-homogenous mass with multiple cystic lesions inside arising from the apex site. The patient missed the follow up and came back
one year later, after which his chest (figure 3),
abdomen, and pelvic CT scan (done on
02/01/2009) showed a huge pericardial cystic
lesion with a court wheel appearance Figure (2): Dynamic Chest CT scan done 2008.
compressing the right ventricle to the right. The
cyst was bulging interiorly through the left chest
wall. Another cyst was located subcarinal and
inferior to the left atrium. There was a pleural
effusion with a subsegmental collapsed
consolidation with the enlargement of multiple
anterior mediastinal left pericardial lymph nodes.
Other organs were normal.
Treatment was done by the complete surgical
excision of the cyst where through a Figure (3): Dynamic Chest CT scan done in
midsternotomy incision and under 2009.
cardiopulmonary bypass (CPB), a left
ventriculotomy incision was performed. Before
Discussion
puncturing and to avoid embolization as well as to prevent the possible introduction of free Cardiac hydatid cysts are rare lesions accounting scolices to other cardiac structures, the cyst was for about 0.5 - 2% of all hydatidosis cases. It is covered with wet sponges to minimize the most commonly a manifestation of a systemic contamination as much as possible. A cystectomy infection. However, if the heart is involved, the was done after sterilization with a hypertonic outcome is potentially lethal.5, 6 Symptoms and saline solution and needle aspiration of the cystic signs of cardiac involvement vary according to contents. The cavity was opened, and the residual the cyst size and its location. Only 10% of contents and the germinative membrane were patients especially those with large cysts may removed. The ventriculotomy incision was have clinical manifestations. 7 Chest pain, closed linearly in the standard fashion. Medical palpitations, and dyspnea are the most common treatment was continued using Albendazole 200 associated symptoms.8 The coronary circulation is the pathway for the larvae to reach the myocardium. The most frequent chamber involved is the one with the largest blood supply which is the left ventricle accounting for 55- 60% of the cases followed by right ventricle, interventricular septum, left atrium, right atrium, interatrial septum respectively.9 Myocardium involvement may lead to life-threatening complications, including cyst rupture, tamponade, anaphylactic shock, embolism, acute coronary syndrome, infection, valvular Figure (1): Chest X-ray showing cardiomegaly
with distortion of cardiac borders.
J Med J 2012; December: Vol. 46 (4) http:⁄⁄dar.ju.edu.jo⁄jmj Hydatid Cyst of the Left Ventricle of the Heart… Bahi Hiyasat et al. A cardiac echinococcosis diagnosis is a difficult 4. Demircan A, Keles A, Kahveci FO, Tulmac M, issue; geographical areas where the disease is Ozsarac M. Cardiac tamponade via a fistula to the endemic are an alarm for the possibility of pericardium from a hydatid cyst: case report and carrying the disease during a visit. Clinical review of the literature. J Emerg Med. 2010; 38: 582–586. suspicions, cardiac imaging and serologic tests 5. Xing Y, Bawudong D, Zhang WB, Liu WY, Pan compose the principles for diagnosis. Chest x- CX, Wen H, Li CW. Multi-detector CT and MR rays and electrocardiograms can show changes imaging cardiac hydatidosis: case report and that are not particular for the disease.11 review of the literature. Int J Cardiovasc Imaging. 2011 Dec; 27 Suppl 1: 97-102. While echocardiography is considered highly 6. Canpolat U, Yorgun H, Sunman H, Aytemir K. specific and a sensitive method for diagnosis still Cardiac hydatid cyst mimicking left ventricular aneurysm and diagnosed by magnetic resonance (magnetic resonance imaging) are needed for imaging. Turk Kardiyol Dern Ars. 2011 Jan; 39(1): 7. Miralles A, Bracamonte L, Pavie A, Bors V, Serological tests including immunoglobulin echinococcosis. Surgical treatment and results. J Thorac Cardiovasc Surg 1994; 107: 184-90. (ELISA) carry a high sensitivity (94%) and 8. Moro P, Schantz PM. Echinococcosis: a review. specificity (99%) for the majority of cyst 9. Yaliniz H, Tokcan A, Salih OK, Ulus T. Surgical treatment of cardiac hydatid disease: a report of 7 The treatment of choice for a cardiac hydatid cyst cases. Tex Heart Inst J 2006; 33(3): 333–9. is early surgical resection where it is better to be 10. Alehan D, Çeliker A, Aydıngöz U. Cardiac hydatid performed with the use of a cardiopulmonary cyst in a child: diagnostic value of echocardiography and magnetic resonance bypass so as to get a better view of the cardiac imaging. Acta Paediatr Jpn 1995; 37: 645-7. structures and cysts and prevent systemic 11. Eylem Tuncer, Serpil Gezer Tas, Ilker Mataraci, embolization.11 Akar and colleagues reported a Altug Tuncer, Arzu Antal Donmez, et al. Surgical Treatment of Cardiac Hydatid Disease in 13 Atrioventricular block, ventricular arrhythmias Patients. Tex Heart Inst J. 2010; 37(2): 189–193. and myocardial tearing are some recognized 12. Kelle S, Köhler U, Thouet T, Fleck E, Nagel E. Cardiac involvement of Echinococcus granulosus evaluated by multi-contrast CMR imaging. Int J Medical therapy using benzimidazoles to prevent cyst recurrence is highly recommended. Together 13. Force L, Torres JM, Carrillo A, Busca J. Evaluation of eight serological tests in the with others, 11, 16 we used Albendazole 400 mg diagnosis of human echinococcosis and follow-up. twice daily starting one week before surgery and 14. Akar R, Eryilmaz S, Yazicioglu L, Eren NT, Durdu S, Uysalel A, et al. Surgery for cardiac References
hydatid disease: an Anatolian experience. Anadolu Kardiyol Derg 2003; 3(3): 238–44. 1. McManus DP, Zhang W, Li J, Bartley PB. 15. Djoshibaev S, Kudaiberdiev T, Maralov A, Echinococcosis. Lancet. 2003; 362: 1295-1304. 2. Molavipour A, Javan H, Moghaddam AA, Dastani Yankovskaya L. Surgical treatment of isolated M, Abbasi M, Ghahramani S. Combined medical cardiac echinococcosis: report of five cases. and surgical treatment of intracardiac hydatid cysts Anadolu Kardiyol Derg 2003; 3(2): 137–43. in 11 patients. J Card Surg. 2010 Mar; 25(2): 143-6. 16. Birincioglu CL, Tarcan O, Bardakci H, Saritas A, Tasdemir O. Off-pump technique for the treatment of ventricular myocardial echinococcosis. Ann Deligianni GV, Kounis NG. Large hydatid cyst of the left ventricle associated with syncopal attacks. Int J Cardiol. 2007; 118: e24–e26. J Med J 2012; December: Vol. 46 (4) http:⁄⁄dar.ju.edu.jo⁄jmj Hydatid Cyst of the Left Ventricle of the Heart… Bahi Hiyasat et al. ȆƦǴǬdz¦ ǂººLjȇȋ¦ ǺȈǘƦdz¦ Ȇǧ (ƨǯȂnjǸdz¦ ¦°Ȃ
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