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Complicated removal of a hydatid cyst of the interventricular septum
F Parisi1, P Gagliardotto, G Zattera
1Università degli Studi di Torino, Italy.
Insights
A cardiac hydatid cyst in the interventricular septum was found in a patient with liver hydatid disease. Surgical removal required complex cardiac repair, highlighting the challenges of diagnosing and treating cardiac echinococcosis.
Area of Science:
- Cardiology
- Parasitology
- Surgical Pathology
Background:
- Echinococcosis, a parasitic infection, can rarely manifest with cardiac involvement.
- Hepatic hydatid cysts are more common, but concurrent cardiac cysts pose diagnostic and surgical challenges.
Observation:
- A 27-year-old woman presented with a large liver hydatid cyst, and an asymptomatic cardiac cyst in the interventricular septum was incidentally discovered.
- Advanced imaging modalities including echocardiography, CT, and MRI were used for diagnosis.
- Intraoperative findings revealed adherence of the cyst to the left posterior papillary muscle and chordae, necessitating complex cardiac repair.
Findings:
- The cardiac hydatid cyst, located in the interventricular septum, did not initially show signs of affecting the atrioventricular conduction system or valves.
- Surgical intervention was required due to cyst adherence, resulting in a ventricular septal defect and necessitating mitral valve and chordae repair.
- The patient recovered well post-surgery, with mild residual mitral regurgitation at 6-month follow-up.
Implications:
- Accurate anatomical delineation of cardiac hydatid cysts, especially within the interventricular septum, remains challenging despite advanced imaging.
- Surgical management requires meticulous planning and execution to address potential complications, including damage to vital cardiac structures.
- This case underscores the importance of considering parasitic infections in the differential diagnosis of cardiac masses and the complexities of their surgical treatment.
Abstract:
In a 27-year-old woman with a large hydatid cyst of the liver, an asymptomatic cardiac cyst located in the interventricular septum was discovered as well. The diagnosis was based upon echocardiography, computerized axial tomography and nuclear magnetic resonance. There was no evidence of damage to the atrioventricular conduction system or to the cardiac valves. At operation, however, the left posterior papillary muscle and chordae were firmly adherent to the cyst. Patch closure of the resulting ventricular septal defect, and mitral valve and chordae repair were necessary. The patient is alive and well 6 months after the operation, with mild residual mitral regurgitation. Precise anatomical delineation of the hydatid cyst localization within the heart, particularly in the interventricular septum, and its relations with the various cardiac structures is a difficult task, in spite of all the imaging techniques available. The surgical approach therefore has to be very careful and mindful of the potential complications.