Cardiac Hydatid Disease Research Articles

Cardiac hydatidosis complicated by vascular involvement: a case report

BackgroundHydatid disease is a parasitic infection which is endemic in multiple regions across the globe including Indian subcontinent. Although it commonly affects the liver and other solid organs, isolated involvement of the heart is relatively uncommon. Cardiac hydatidosis can be confidently diagnosed on echocardiography, but cross-sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) provides accurate information about its location, extent, and multiplicity. Multiple case studies of cardiac hydatid disease have been reported in the literature. However, cardiac hydatidosis with extension into pulmonary vasculature has not been reported commonly. This case report highlights this rare association, with stress upon the altered surgical management.Case presentationA 50-year-old patient presented with atypical chest pain to the cardiology department of a tertiary care hospital where he underwent multiple blood tests as well as electrocardiography (ECG) and echocardiography as part of the routine examination. Echocardiography revealed a large, multicystic mass invading the posterolateral wall of left ventricle (LV) with no internal vascularity and was provisionally diagnosed as hydatid disease. Subsequent CT study confirmed a large multicystic lesion with the presence of another smaller lesion invading the left atrial appendage (LAA). In order to evaluate the vascular and mediastinal invasion, cardiac MRI was then performed which revealed invasion of right pulmonary artery (PA), right superior pulmonary vein (PV) as well as compression of superior vena cava (SVC) by the smaller lesion. A final diagnosis of cardiac hydatidosis with invasion into right PA and right superior PV was made. Treatment plan for the patient changed, who then underwent an additional reconstruction of right PA and right superior PV after cyst removal.ConclusionsCardiac hydatid disease is a rare but potentially lethal condition, which tends to show slow growth and local invasion. The diversity of findings in such rare cases makes individual surgical approach extremely valuable with preoperative radiological imaging becoming indispensable for correct localization and appropriate planning. Our case report highlights rare association of cardiac hydatidosis with invasion of both pulmonary artery and vein, which eventually altered the surgical management of patient.

Cardiac hydatid disease; a systematic review

Background and objectivesHuman cystic echinococcosis (CE), is a common health problem in low- and middle-income countries. Cardiac involvement is a relatively rare manifestation of Echinococcus infection. This study aims to summarize the evidence regarding the features of cardiac CE.MethodsCase series of the patients with cardiac CE, were included in this study. Non-English papers, case reports, reviews, letters, , commentaries, and conference abstracts were not included. A systematic search was conducted in PubMed and EMBASE databases and the risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.ResultsOut of 3985 results of the searches, finally 37 studies were included in this systematic review. Based on available evidence, cardiac involvement is an uncommon but serious presentation of CE which presents with some non-specific signs and symptoms. Dyspnea, chest pain, and palpitation are the most common symptoms of the disease and normal sinus rhythm is the most common Electrocardiogram (ECG) feature. The disease is not associated with high mortality in case of timely diagnosis and appropriate management.DiscussionConsecutive and complete inclusion of participants, statistical analysis, and appropriate reporting of the demographics were the sources of bias in the included studies. The exclusion of non-English papers was a limitation during the review process.FundingThe research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380).RegistrationThis study was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42022381204).

Precordial pain induced by the isolated cardiac hydatid cyst in interventricular septum: a case report

BackgroundHuman hydatid disease occurs after infection with Echinococcus granulosus, mainly involves liver and lung, while hydatid involves heart is infrequent. A great majority of hydatid diseases could be asymptomatic, and incidentally found through examination. Here, we reported a woman who suffered an isolated cardiac hydatid cyst located at the interventricular septum.Case presentationA 48-year-old woman presented intermittent chest pain was admitted to the hospital. Imaging examination revealed a cyst located at the interventricular septum near the right ventricular apex. Considering medical history, radiological findings and serological results, cardiac hydatid disease was suspected. The cyst was successfully removed, while pathological biopsy confirmed the diagnosis of infection of Echinococcus granulosus. Postoperative course was uneventful, the patient was discharged from hospital without complications.ConclusionFor symptomatic cardiac hydatid cyst, surgical resection is necessary to avoid progression of disease. During surgical procedure, appropriate methods to reduce the potential risk of hydatid cyst metastasis are essential. Besides surgery, combined with regular drug therapy is an effective strategy to prevent reappearance.

Cardiac Hydatid Disease with Palpitations as the Only Presenting Complaint: The Egg in the Nest.

Isolated cardiac hydatid disease is rare and accounts for only 0.5-2% of cases among infected patients.Cardiac hydatidosis may present with a wide variety of clinical manifestations ranging from no symptoms to sudden death; palpitations may be the only complaint.Surgical excision is the treatment of choice for cardiac hydatid disease to avoid high-risk complications.

A Scientometric Analysis on Cardiac Echinococcosis

Cardiac echinococcosis is a rare but mortal disease. The primary goal of this study was to quantitatively examine, using bibliometrics tools, the publications and assess the hot issues and new directions in cardiac echinococcosis research from 1970 to December 2021. We only included "journal articles" and "reviews" in the study. The keywords "cardiac echinococcosis", "cardiac hydatid disease’ or "echinococcal heart disease" were used for the search. The search covered the years 1970 through December 2021. The data was extracted from the Web of Science database. Vosviewer software was used for network mapping. The research findings, which were based on the search strategy used, showed that between 1970 and 2022, there were 425 articles and reviews on cardiac echinococcosis that had been indexed in the Wos database. Most of the papers were from Türkiye (n=152). India (n=29), Iran (n=29), Tunisia (n=26) and France (n=22) were the other top publishing countries. The first publication was published in 1991. Although the number of publications increased after 1996, it emphasizes an irregular distribution. The publications were cited 3900 times in total and 9.18 times per publication, and the mean H-index was 28. There was an increase in the number of citations after 1995. There were 151 publications from Türkiye, and these publications were cited 1,327 times total, 8.79 per publication, and the mean H index was 18. The number of publications was not at the expected rate. The findings of our study may be helpful to researchers researching cardiac echinococcosis.

Recurrent cardiac hydatid cysts ruptured intraoperatively during anesthetic induction for open-heart surgery

Introduction: Cardiac localization of hydatid disease is rare (<3%) even in endemic countries. Affection characterized by a long functional tolerance and a large clinical and paraclinical polymorphism. Serious cardiac hydatitosis because of the risk of rupture requiring urgent surgery. The diagnosis is based on serology and echocardiography. The aim of this work is to show one of the fatal complications of this condition which arose intraoperatively during anesthetic induction. Methods: We report the observation of a 37-year-old woman operated on in 2010 for a cardiac hydatid cyst presenting a recurrence of cardiac hydatid disease with two left intraauricular cysts expressed by palpitations with dyspnea. Preoperatively: dyspnea stage II of the NYHA. Chest x-ray: CTI at 0.58. ECG: RSR. Echocardiography: Two largest left atrial cysts: 47/40 mm compress the origin of the right pulmonary vein, 2nd cyst of 36/28 mm. The existence of another small caliber lateral cyst. Positive hydatid serology. The patient developed an anaphylactic shock of unexplained cause, which required the assistive CPB facility. Intraoperative exploration: The two ruptured cysts in the left atrium with multiple left intraatrial daughter vesicles. Gesture: Removal of daughter vesicles with sterilization with hypertonic saline. Results: The postoperative consequences were favorable despite a prolonged stay in intensive care following a picture of acute respiratory distress syndrome. Conclusion: Intracardiac rupture is a very serious complication and can produce dramatic pictures with sudden death. It can be responsible for allergic reaction, systemic embolism, pulmonary embolism and systemic metastases. Keywords: Hydatid Cyst; Heart; Relapsing; Rupture; Surgery; Anaphylactic Shock; Cardiopulmonary Bypass; Prevention

Cardiac hydatid cyst presenting as ventricular arrhythmia: a case report

BackgroundHydatid disease caused by Echinococcus granulosus commonly involves the liver followed by lungs. Cardiac involvement is a rare occurrence and presents a challenging scenario.Case presentationOur case describes a middle-aged gentleman who presented to the emergency room with an episode of sudden loss of consciousness resulting from ventricular tachycardia. After successful cardiac resuscitation, the patient underwent imaging that showed a lesion compatible with hydatid cyst. Surgical treatment with pharmacologic coverage was provided which resulted in good clinical outcome.ConclusionsThe case highlights rare occurrence of isolated cardiac hydatid disease presenting as cardiac arrhythmia in contrast to its common routine outpatient presentation involving the liver and lungs. Good knowledge of the unusual presentations and its epidemiology is essential to the proper management of such patients.

Cardiac hydatid disease: An unusual pathology in an st-elevation myocardial infarction patient

Hydatid disease, is an infection caused by the larval stage (metacestode) of the cestode Echinococcus granulosus. In humans it may result in a wide spectrum of clinical manifestations ranging from asymptomatic infection to severe, even fatal disease. Echinococcal cysts are found in the liver in approximately 70 % of cases, and the lungs in approximately 25 % of cases. Cardiac hydatid disease is seen in 0.5–5% of total hydatid disease patients, the present case highlights the unusual presentation of Hydatid cyst in a different clinical scenario.

Surgical Management and Outcomes of Cardiac and Great Vessels Echinococcosis: A 16-Year Experience

Cardiac involvement is an uncommon presentation of hydatid disease. In this study, we aim to analyze the experience of surgical treatment of cardiac and great vessels echinococcosis in our cardiovascular and thoracic surgery department. Through a 16-year period, from 2000 to 2015, 27 patients underwent surgery for cardiac and great vessels hydatid disease. The clinical, operative, and postoperative data were analyzed through this retrospective and descriptive study. Most of our patients came from a rural area. The most common symptom was chest pain. The diagnosis was mainly made by transthoracic echocardiography, which has shown the right ventricle as the most frequent location of the disease. All patients receivedsurgical treatment under cardiopulmonary bypass, and only six surgeries were performed without cross-clamping the aorta. Inhospital mortality rate was 7.4%. Cardiac hydatidosis is a rare but potentially serious condition whose treatment is mainly surgical even for asymptomatic patients owing to its possible fatal complications. The surgery outcomes are usually satisfactory. Follow-up examinations are highly recommended to detect recurrences.

Papillary Muscle Hydatid of Heart: A Rare Case of Disseminated Hydatidosis in A Young Female with Multisystemic Involvement

Hydatid disease, a zoonosis, most commonly caused by the parasite Echinococcus granulosus, involving the cardiac and brain is rare accounting for 0.5-2% and 2-5% respectively. The disseminated hydatid disease is associated with poor prognosis. A 35-year-old, female, from rural background presented cardiac OPD, PGIMER, Chandigarh in 2016 for vague discomfort in the chest and right hypochondrium. Her past medical records revealed neurosurgical intervention for the right frontal cerebral cystic lesion with negative hydatid serology, which was proven to be hydatid cyst on histopathological examination in the year 2011. Increase in the intensity of the above-mentioned chest discomfort. Echocardiography was advised which revealed a cystic lesion in the left ventricle, subsequent cardiac MR examination revealed cystic lesion in anterolateral papillary muscle of the left ventricle and the contrast examination of the abdomen revealed disseminated hydatid disease in abdomen with raised hydatid serology titers at present. Patient requested medical management over surgical intervention, and she was on tablet Albendazole 400mg every 12 Hrs. After 3-4months patient succumbed due to the anaphylaxis resulted from ruptured mesenteric hydatid cyst. Presence of isolated cerebral or cardiac hydatid disease should warrant the physicians to evaluate systematically and follow up the patient frequently with the available cross sectional imaging, which may aid in early detection and holistic management of the patient. Irregular follow up visits or non-intentional negligence of the meticulous evaluation of the subjects with hydatid disease in organs other than liver and lungs, can predispose to the disseminated disease and early mortality as witnessed in the present case.

Cardiac hydatid disease; misleading presentations, a case series

IntrodcutionCardiac echinococcosis is a zoonotic parasitic infection that necessitates a high index of suspicion in endemic areas. The purpose of this study is to introduce different clinical scenarios of four cases in two major cardiac centers. MethodsA retrospective, case series study, conducted in three centers for the last two years. Addressing each case separately in regard to presentation and management. ResultsFour cases have been reported, three patients were female 75% and one patient was male 25%. Age ranged from 27 to 32 years. All the patients 100% had dyspnea as their main first presentation, one patient (25%) presented as pulmonary embolism with three attacks of hemoptysis. One patient (25%) had an attack of convulsion 25%. Different segments of the heart were involved, Left ventricle was involved in 50%, Right ventricle in 25%, combined pulmonary and pericardial involvement in another 25%. Median Sternotomy with the cardioplegic arrest was performed in three patients 75% and Posterolateral thoracotomy was the approach in one case 25%. ConclusionCardiac Hydatid cyst is a sparse yet potentially perilous clinical entity. Early surgical intervention is the modality of choice might halt unfavorable consequences.

Hidatidosis cardíaca: tratamiento quirúrgico para recidiva de quiste hidatídico en ventrículo izquierdo

Introduction : Cardiac hydatid cyst is a rare disease caused by Echinococcus granulosus arrival of the coronary circulation. Materials and Method : 52 years old man with a history of cardiac hydatid cyst operated 27 years ago, heart failure and coronary artery disease. He presented with a history of one year of progressive dyspnoea. Study with chest radiography, echocardiography and computed tomography showed an image compatible with cardiac hydatid disease recurrence in relation to the left ventricle, pulmonary artery and anterior descending artery. Ejection fraction of the left ventricle was approximately 30%. No evidence of extracardiac hydatid disease was found and surgical treatment was decided. Addressed by median sternotomy and extracorporeal circulation, a multiloculated myocardial hydatid cyst, with hundreds of daughter vesicles of different size was found. Pericystectomy of the hydatid cyst was performed without incident. The patient presented postoperative bleeding which required early reoperation. Posteriorly, was discharged without complications. Discussion: Hydatid disease is an endemic zoonosis in Chile. Heart location is infrecuent and correspond to 0.5 to 2% of the cases, usually associated with the presence of extracardiac cysts. The most common location is the free wall of the left ventricle at intramyocardial level. Medical treatment is often inadequate and surgical resection is recommended.

Cardiac Hydatidosis

Cardiac hydatid disease is rare, occurring in about 2 % of the patients, the disease usually involves the myocardium and is associated with a wide spectrum of presentations, hence the patients may be asymptomatic or may present with a serious condition like severe valvular dysfunction, congestive heart failure, pulmonary embolism or conductive disturbances. Full histories, a proper examination of the chest, ECG, CXR, Echocardiography, cardiac catheterization, CT scan of the chest and immunoblot tests are essential diagnostic tools. Fifteen patients diagnosed preoperatively as having cardiac hydatid cysts were involved in this retrospective study. There was neither sex predilection nor any age limit for the disease. Any part of the heart could be involved, but the Left ventricle was the commonest site. Many patients included in the study were associated with extracardiac involvement especially the liver. Removal of the cyst(s) surgically stays the treatment of choice.

Magnetic resonance imaging characteristics of cardiac hydatid cyst

PurposeThe purpose of this article is to describe the magnetic resonance imaging (MRI) features of cardiac hydatid disease and show the specific findings in the diagnosis of hydatic cysts. Materials and methodsA retrospective review of cardiac MRI records between 2015 and 2017, 7 patients (3 males, 4 females; age range: 14–74) were identified with the histologic diagnosis of cardiac hydatid disease. Cardiac MRI examinations were performed in order to investigate the cardiac cystic-solid lesion obtained via previous echocardiography (ECG) and thorax computed tomography. 1.5 Tesla magnetic field power generation capacity was used and the images were acquired with ECG trigger. ResultsThere is variation in signal characteristics of cysts on T1-weighted and T2-weighted images. Early contrast enhancement was not observed in the any of lesions on contrast-enhanced series. In all lesions examined, peripheral contrast enhancement was observed in the late contrast enhanced series, independent from the internal structure and signal intensity. ConclusionsMRI reveals the exact anatomic location and nature of the cyst structures. Peripheral enhancement of non-enhancing lesion is very valuable for diagnosis of cardiac hydatids on MRI.

The Unconventional Phenomenon of Cardiac Echinococcosis:A Case Report

Hydatid Disease or Echinococcosis is regarded as a major zoonotic infection in India as well as worldwide. It is estimated that Echinococcosis approximately affects 1 million people at one point of time and the incidence is 0.4 in 1,00,000. Cardiac involvement is seen in only 0.02% to 2% of the cases reported. This case assumes importance in this context due to its rarity and because cardiac hydatid disease may be totally asymptomatic or may present with sudden death in up to 20% of the cases without any pre-existing symptoms. Precordial pain is by far regarded as the most common presenting complaint in symptomatic cases. Pain may mimic angina due to coronary artery disease in cases where the cyst compresses the coronary arteries. Presently we would like to report the case of a 28-year-old housewife who presented to our OPD with symptoms of shortness of breath, pedal oedema and progressive abdominal distension. Detailed evaluation revealed evidence of a large multilocular cyst in the left ventricular cavity. Further imaging studies also revealed similar cysts at other locations. Serological tests also showed evidence of hydatid disease suggesting the possibility of a multivisceral hydatid disease. She was put on oral medications and successfully underwent cyst excision at a later date. In relation to the present case, we would also like to shed some light regarding the common symptoms, diagnostic approach and further treatment options available for this extreme rare condition.

New World’s old disease: cardiac hydatid disease and surgical principles

SummaryBackground:Hydatid cyst is a parasitic disease caused by infection with the Echinococcus granulosus tapeworm larva. It is a major public health problem in endemic regions. Cardiac involvement of the disease is rare.Methods:Between 1985 and 2015, 12 patients were admitted to our clinic with a possible diagnosis of cardiac hydatid disease. Of these patients, six (50%) were male and six (50%) were female. Mean age of the patients was 42.6 years.Results:The most common location of cardiac hydatid disease was left sided (six patients, 50%). Five (41.7%) patients had cysts located in the right heart, whereas one (8.3%) had a cyst in the interventricular septum. Eleven (91.7%) of the patients were operated on via median sternotomy and the remaining one was operated on via a left anterolateral thoracotomy. Ten (83.3%) of the patients were operated on using cardiopulmonary bypass under moderate hypothermia, whereas the remaining two (16.7%) had off-pump surgery. There was no surgical mortality in our series. All patients were discharged with medical therapy (mebendazole or albendazole) for the duration of six months. No recurrences were observed in their follow ups.Conclusion:Although cardiac hydatid disease is rare, its prevalence seems to have increased in the last decade. Any patient with suspected cardiac symptoms suggesting mass lesions should be considered for a differential diagnosis of cardiac hydatid disease, especially in developing countries. Definitive treatment is removal of the cyst, combined with medical therapy.

Les kystes hydatiques cardiaques à propos de 17 cas opérés

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period. MethodsBetween May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25±13years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest. ResultsOur study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n=2). Morbidity was marked by conduction abnormalities (n=2), bleeding and hematoma of the residual cavity that required surgical treatment (n=3). Eleven patients were followed with a mean period of 40.5±19.4 months. At follow-up, neither late deaths nor recurrence have occurred. ConclusionCardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.

Surgical Management of Cardiopericardial Hydatid Disease: A Tunisian Center Experience

Introduction: Cardiac hydatid disease is a rare, but it is potentially a life-threatening pathology. It has fatal complications such as valvular dysfunction, free wall rupture, embolism, anaphylactic reactions, conduction disturbances, or congestive heart failure. Methods: We report 12 cases of cardiopericardial hydatid disease that underwent operation in our institution between January 1998 and December 2014, and we review our results. The mean age was 31.83 years and it ranges of 11 to 65 years. Male to female ratio was 1. The diagnosis of hydatid disease was confirmed by transthoracic echocardiography in all patients. The cyst was located in the left ventricular free wall in 5 cases, the right ventricular free wall in 1 case, the interventricular septum in 3 cases, the interatrial septum in 2 cases, and the pericardium in 1 case. Three patients had multiple organ hydatidosis: in the interatrial septum and the two lungs in one case; in the left ventricle, the left lung, the liver, and the peritoneum in 1 case; and in the left ventricle, the left lung, the liver and the breasts in 1 case. All of our patients underwent surgery. The patients with cardiac cysts were operated under sternotomy and standard cardiopulmonary bypass with antegrade cardioplegia and aortic cross-clamping. The patient with pericardial hydatidosis was operated under posterolateral thoracotomy and without cardiopulmonary bypass. Results: The postoperative period was uneventful in all our patients. We didn’t have any cardiac hydatidosis recurrence in the follow-up of our patients. Only one patient was operated two years after cardiac surgery for recurrence of pulmonary cysts. Conclusion: Surgery should be recommended in all cases of cardiopericardial hydatid disease in order to avoid their complications.

Surgical treatment and outcome of cardiac cystic echinococcosis.

Cardiac cystic echinococcosis (CE), or hydatid cyst is exceptionally uncommon. We review the experience of surgical treatment of cardiac CE. Twenty-six patients (11 females; mean age, 28.9 ± 7.6 years) with cardiac CE undergoing surgical treatment from February 1978 to April 2013 were reviewed. The operative methods mainly included puncture-aspiration cystectomy, intact endocyst enucleation and total cyst resection. Cardiac CE was located in the myocardium in 16 cases, pericardium in 8 and both myocardium and pericardium in 2. There were 21 cases with solitary hydatid cyst including at the left ventricle in 7, right ventricle in 5, right atrium in 2, interventricular septum in 1 and at the pericardium in 6; 5 cases were with multiple cysts. There was no operative mortality. All patients received albendazole postoperatively. The mean follow-up time was 68 ± 21 months (range 7-195 months) except for 4 who were lost to follow-up. There were three recurrences and one late death. Cardiac cystic echinococcosis (CE) remains a very infrequent zoonotic infection. Presenting symptoms of cardiac hydatid disease are variable depending on the size, number and location of the cyst. Echocardiography, corroborated with computed tomography or magnetic resonance imaging, affords the best diagnostic and follow-up confirmation. Surgical treatment is associated with a low morbidity and mortality, and the selection of proper technique is very important to completely remove the hydatid cyst and prevent recurrence. Postoperative oral antiparasitic therapy is necessary for a definitive cure.

Mediastinal mass and hydatid disease

### Learning Point for Clinicians This case serves to highlight that cardiac and mediastinal hydatid disease can occur without overt liver or lung involvement, and that echinococcosis of the mediastinum may mimic many other diseases. A 50-year-old female presented with a non-productive cough. She was a non-smoker and reported no other symptoms. Her past medical history was unremarkable, and her general, cardiac and respiratory examination within normal limits. The patient’s chest radiograph revealed a broadened, lobulated cardiac silhouette and widening of the superior mediastinum (Figure 1a). Her routine investigations showed a normal biochemistry, blood counts and arterial blood gas analysis. Pulmonary function testing yielded normal lung volumes and airflow. Figure 1. The chest radiograph (a) of the patient showed a lobulated cardiac silhouette and widening of the superior mediastinum. The coronal (b) and axial view (c) of the chest CT confirmed extensive mediastinal masses …