Surgery to preserve the spleen with cardiac involvement in hydatid cyst diseases

Abstract

Background: Despite the fact that hydatid illness affects several organs in the body most commonly seen in the liver (50-70%) and lungs (20-30%), intracardiac hydatid cyst localization occurring in only 0.02 - 2% of cases of Cardiac involvement can occur as a result of systemic or pulmonary circulation. The left ventricle is the most often affected location (75%), followed by the right ventricle (15%), the interventricular septum (5-9%), the left atrium (8%), the pericardium (8%), the pulmonary artery (7%), and the right atrium (3 -4%). on the other hand, splenic hydatid accounts for only 0.8-4% of all human echinococcosis cases. Splenectomy was the standard surgical treatment for splenic hydatid until recently. Since 1980, there has been a growing trend toward using conservative treatment options to treat such pathology. Aim of the study: In a single institutional study, we wanted to assess our experience with open splenic-preserving surgery for splenic hydatid and it is crucial to detect cardiac involvement early and provide surgical intervention as soon as possible. Patient and methods: In retrospective research, ten patients with splenic hydatid were operated on in our medical center between August 2013 and January 2018. In 7 cases, the spleen was affected alone, in 3 cases, the liver and spleen were both afflicted, and one of them also showed intraperitoneal cyst affection. Ultrasonography was used to confirm the diagnosis. It required computed tomography (CT) and magnetic resonance imaging (MRI) in some circumstances. All patients got a chest X-ray to rule out pulmonary hydatid. The most important diagnostic method includes serologic testing cardiac imaging by echo-cardiography, CT and MR imaging to detect cardiac involvement in hydatid diseases. The surgical procedure was used as an open one. Isolation of the field, aspiration of cystic fluid and injection of 1% cetrimide solution, re-aspiration, endocystectomy, and suturing of cystic margins over the intracystic tube drain. All surgeries were performed with albendazole (15 mg/kg/day) as a pre-and post-operative treatment. Results: There were no major intraoperative or postoperative problems. There was no need for a second procedure. 3-5 days in the hospital after a (1-3) year follow-up, there was no recurrence. Three patients, however, failed to follow up after two years and as for cardiac hydatid cysts, it can induce deadly consequences such as rupture and embolization, surgical resections combined with medicinal therapy are the best therapeutic option. Conclusion: Our experience with splenic hydatid motivates us to employ splenic-preserving surgery rather than splenectomy if appropriate. Cardiac hydatid cyst illness can occasionally produce a fistula between the coronary and pulmonary arteries. Therefore, to provide best possible treatment cardiac cyst must be investigated in endemic countries as early as possible.