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Synchronized coronary revascularization and multiple cardiac cysthydatid operation
Levent Yilik1, Kazim Ergüneş, Ufuk Yetkin
1Izmir Ataturk Education and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey.
Insights
This case report details a rare cardiac cysthydatid in a 61-year-old man, successfully treated with synchronized surgery for both the parasitic cysts and coronary artery disease. Early diagnosis and surgical intervention are crucial for managing this potentially lethal condition.
Area of Science:
- Cardiology
- Parasitology
- Surgical Pathology
Background:
- Cardiac cysthydatid, a rare manifestation of echinococcal infection (0.5-2%), often involves the ventricles.
- Presentation can range from asymptomatic to severe symptoms like fever, dyspnea, and chest pain.
Observation:
- A 61-year-old male presented with symptoms suggestive of cardiac compromise and was diagnosed with a ruptured cysthydatid in the right atrium and multiple cysts on the left ventricle apex.
- Echocardiography identified a cystic mass in the right atrium, while coronary angiography revealed severe stenosis in the left anterior descending artery.
- Preoperative serology for cysthydatid was negative, highlighting the limitations of serological testing.
Findings:
- A synchronized surgical approach was employed, involving resection of the ruptured right atrial cyst and excision of previously undiagnosed left ventricular apex cysts.
- Coronary artery bypass grafting using the left internal mammary artery was performed concurrently.
- Histopathology confirmed the diagnosis of cardiac cysthydatid.
Implications:
- This case underscores the importance of considering cardiac cysthydatid in endemic areas, even with negative serology.
- Synchronized surgical management of cardiac cysthydatid and concurrent coronary artery disease is feasible and effective.
- Prompt diagnosis and surgical intervention are vital for preventing potentially fatal outcomes associated with cardiac cysthydatid.
Abstract:
Cardiac cysthydatid is rare pathology and is seen in 0.5 to 2% of echinococcal infections. It is found in the left ventricle most frequently and then in the right ventricle. We present a case with a ruptured cysthydatid at the right atrium's interatrial septum and multiple cysthydatids localized at the outer surface of the left ventricle's apex, which necessitated a synchronized coronary revascularization with our diagnosis and surgical procedure modalities. Our patient was a 61-year-old man with complaints of fever, dyspnea, tachycardia and chest pain, which began 2 months before admittance. An echocardiography in our clinic revealed a 4.7 x 1.7 centimeter, pediculled, going in and out to tricuspidal inflow, cystic mass adherent to the interatiral septum in the right atrium, which prompted immediate hospitalization. He was in New York Heart Association Class II. His electrocardiography (EKG) showed ischemia at inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His EKG showed ischemia at the inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His preoperative biochemical parameters were normal, and cysthydatid serology tests were negative. With these results,l we planned a synchronized surgical procedure for coronary artery disease with multiple cardiac cysthydatids. During operation, after the right atriotomy, a fragile cystic mass with a ruptured image and dimensions of 5 x 2 x 2 centimeters, originating from the interatrial septum and in a conglomerate form, was resected and extirpated. The left atrium was not involved. Then, 3 masses with dimensions of 2 x 2 centimeters, which were not diagnosed with the echocardiogram, at the epicardial surface of the left ventricle apex were excised. The defected part of the left ventricle was repaired with teflon felt supports for rupture prophylaxis. Then, a left internal mammary artery graft, which was prepared at the beginning of the operation, was anastomosed to LAD. The patient didn't have any additional problem during the postoperative period, and he was discharged at 1 week after surgery. To avoid recurrence, the patient was prescribed albendazole as a prophylaxis for the duration of 2 months. Histopathology confirmed the diagnosis of cysthydatid. Patients with cardiac cysthydatid can be asymptomatic or can cause minimal nonspecific symptoms for years. The condition can be lethal if not diagnosed and treated. The primary treatment for cysthydatid is surgery. Echocardiography is an important diagnostic method for cysthydatid. Serological tests can produce negative results if the immune responses of the patient is not sufficient, so it must be remembered in the endemic places for echinococcus.
