Background 
Cystic echinococcosis (CE) can affect the heart and the vena cava but few cases are reported.


Methods 
A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995–2009) is reported.


Results 
Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4–93 months). One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE) and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications.


Conclusions 
Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.

/pdf/management-and-outcome-of-cardiac-and-endovascular-cystic-2d1lx6ge0g.pdf

Management and outcome of cardiac and endovascular cystic echinococcosis.

OBJECTIVES: Cardiac cystic echinococcosis (CE), or hydatid cyst is exceptionally uncommon. We review the experience of surgical treatment of cardiac CE. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

/pdf/surgical-treatment-and-outcome-of-cardiac-cystic-2nq6f2z0p4.pdf

Surgical treatment and outcome of cardiac cystic echinococcosis.

Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose. Today, our cardiac surgical center occupies an entire 6-floor building. We have 12 cardiac surgeons, 10 surgical residents, a formal 6-year surgical residency program, a pediatric cardiac unit, an annual caseload of 1,600, and plans to double our productivity in 2 years.

The tribulations of establishing sophisticated surgical programs in a developing country are offset by the variety of clinicopathologic conditions that are encountered, and even more so by the psychological rewards of overcoming adversity and serving a population in need. This account may prove to be insightful for Western-trained physicians who seek to develop specialized medical care in emerging societies.

Reflections on a heart surgery career with insights for Western-trained medical specialists in developing countries.

Hydatid cyst of the heart is a rare but potentially fatal disease. There have been reports of the occurrence of such cysts, but we present here a unique experience of mistaken identity of a right ventricular intramyocardial hydatid cyst for a mediastinal hydatid cyst, leading to a dangerous intraoperative procedure.

Intramyocardial hydatid cyst: a mistaken identity and its successful removal on a beating heart.

Hydatid cyst of the heart is a rare but potentially fatal disease. There have been reports of the occurrence of such cysts, but we present here a unique experience of mistaken identity of a right ventricular intramyocardial hydatid cyst for a mediastinal hydatid cyst, leading to a dangerous intraoperative procedure.  2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. 1. Case history A 19-year-old female presented with severe retrosternal chest pain that had lasted for two months with a recent onset of dyspnoea, palpitation, syncope and low-grade fever. There was no history of rearing pet animals. On clinical evaluation, the heart rate, rhythm, systemic pres- sure and jugular venous pressure were normal. Heart sounds were normal, and there was no murmur. Bilateral breath sounds were normal. The abdomen was normal on clinical evaluation. Her haematological parameters, coagulation profile and routine renal and hepatic biochemical blood parameters were within normal limits. The ECG was normal except for showing T-wave inversion in limb leads oriented to the inferior chest wall. The chest X-ray showed a clear bulge on the left border of the cardiac silhouette just below its apex (Fig. 1), with normal lung fields. A computed tomography (CT)-scan revealed a large, multiloculated cystic lesion, suggestive of a hydatid cyst, in the mediastinum just below the heart and displacing it upwards, causing external compression of the right ventri- cle and right atrium extending deep into the mediastinum, with normal lung fields and liver. Ultrasound evaluation of the abdominal organs was normal. Echocardiography showed a large extracardiac mass containing multiloculated cysts, compressing the right atrium and the right ventricu- lar inflow, and causing a pressure gradient of 8 mmHg across the tricuspid valve. The heart valves were normal with normal ventricular function, and there was no enlarge- ment of the cardiac chambers. Serological evaluation sup- ported the diagnosis of a hydatid cyst, with indirect haemagglutination and Western blot tests being positive. With the plan of enucleating the mediastinal hydatid cyst, a median sternotomy was carried out. A large cyst of 6 cm × 12 cm with a thick wall was found to be situated on the central tendon of the diaphragm, extending deep into the mediastinum and also to the right of the heart. The cyst was opened, and numerous daughter cysts were evacuated (Fig. 2). At the time of retrieval of the last few daughter cysts, the diaphragmatic surface of the right ventricle ruptured, with severe bleeding that was managed success- fully with control by fingers and suturing of the ventricle with Teflon felts. On careful inspection, it was then realised that the main cyst wall was separable from the diaphragm but not from the undersurface of the heart, where thinned- out and stretched myocardial fibres were found in the bed of the cyst wall. The cyst wall on the diaphragm was separated and excised, but the part of the cyst wall incorporated into the wall of right ventricle was left behind. Cetrimide 1% was used as the topical scolicidal agent in the surrounding operative field. The sternum was closed after placing the chest drains. There were no postoperative events. A postoperative ECG and echocardiogram ruled out myocardial ischaemia and ventricular dysfunction. The patient received oral alben- dazole (400 mg) twice daily continuously from two weeks prior to the operation until six months after surgery. A histopathological study of the specimen confirmed it to be a hydatid cyst. Echocardiographic evaluation during the follow-up period of three years revealed no evidence of recurrence of hydatids, and ventricular function remained normal.

Case report - Cardiac general Intramyocardial hydatid cyst: a mistaken identity and its successful removal on a beating heart

Cardiac echinococcosis is a rare affliction of the heart encountered in areas where the tapeworm Echinococcus is endemic. During the 15 years to September 2005, 19 consecutive patients (11 female; mean age, 25.6 ± 12.8 years) with cardiac echinococcosis were operated on at Damascus University. Diagnosis was mainly established by 2D-echocardiography. Twelve patients also had extracardiac hydatidosis. All patients were operated on using cardiopulmonary bypass and cardioplegia. Intact cysts were generally enucleated, ruptured cysts were exteriorized, and interventricular septal cysts were managed by controlled puncture and aspiration. There was no operative mortality. All patients were placed on mebendazole postoperatively for periods appropriate to the extent of their hydatidosis. There were 4 known late deaths due to systemic extension of the disease. Cardiac echinococcus is a serious disease that should be managed surgically without delay. Enucleation of intact cysts under cardiopulmonary bypass and cardi...

Surgical experience with cardiac echinococcosis.

Results: The follow-up period for PSD in our study was 12 months, during which we encountered 3 cases of recurrence, all of them in the group (B). In our study, we found that the percentage of males with pilonidal sinuses was more than females, and, also females suffered from lower rates of complications and no recurrence. Our study included patients with different occupations; PSD was found to be more common in particular jobs such as jeep drivers, workers who sit for more than six hours per day, and students.

Evaluation of Post-operative Use of Depilating Creams on Incidence of Recurrence after Surgical Treatment of Chronic Pilonidal Sinus

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Surgical experience with cardiac echinococcosis.

Evaluation of Post-operative Use of Depilating Creams on Incidence of Recurrence after Surgical Treatment of Chronic Pilonidal Sinus