Cardiovascular Journal of Africa: Vol 28 No 5 (September/October 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017

AFRICA

307

single cyst with a wall, daughter cysts surrounded by a capsule

with peripheral calcifications, and membrane detachment.

MRI is the most reliable diagnostic modality for CHD; it

depicts the exact anatomical location, and the nature of internal

and external structures. A typical finding on T2-weighted

images is a hypo-intense peripheral ring, representing the peri-

cyst. More specific signs include calcification of the cyst wall,

presence of daughter cysts, and membrane detachment.

CT best shows wall calcification, whereas MRI depicts the

exact anatomical location.

In our clinical practice, we use

either CT or MRI prior to surgery to devise a surgical plan

and decide accordingly whether to carry out on- or off-pump

surgery (Fig. 5).

Estimates on the average increase in cyst diameter vary

from about one to 1.5 cm per year.

The disease may be silent

for years or cause fatal complications, such as rupture of the

HC, resulting in anaphylaxis. Whatever the location, surgical

removal of the cyst is the definitive treatment for potentially life-

threatening complications, such as rupture, cardiac tamponade

or pulmonary/systemic embolisation.

Most surgeons prefer median sternotomy but on selected and

well-defined lesions, left anterolateral thoracotomy may also be

used. We performed one operation through left anterolateral

thoracotomy in our series. In patients with superficially localised

or pericardial CHD, the off-pump technique can be used,

as in two of our patients. Using the CPB technique may be

mandatory or sometimes beneficial; cross-clamping of the aorta

and pulmonary artery may prevent dissemination of the parasite

to the systemic or pulmonary circulation, thereby preventing

possible pulmonary emboli. After cannulation, our surgical

approach is to puncture and aspirate the cyst contents, sterilise

with 10% saline solution and close the cavity with purse-string

sutures.

After surgery, close follow up of the patients is important to

detect any recurrence or dissemination to other organs. Despite

successful surgery, supplemental medical therapy should be

administered in case of possible cyst rupture and dissemination

of daughter cysts during the operation and to prevent recurrence

of the cysts.

We recommend albendazole 400 mg twice a day for

a period of six months.

We searched the literature in the PubMed database using the

words ‘cardiac hydatid cyst’ and the number of reports is shown

in Fig. 6. As can be seen, the number of reports has increased

dramatically over the last decade or two. This may be explained

by more accurate diagnosis using either echocardiographic or

radiological (CT or MRI) studies, and the increased numbers

of open-heart surgery cases since the late 1950s. However, we

should keep in mind that, as people travel more and immigrants

disperse all over the world, an endemic disease will not remain

endemic. Therefore a disease that we thought belonged to the

Old World will also be seen in the New World.

Conclusion

Although CHD is an extremely rare disease, its prevalence

seems to have increased in the last decade. Any patient with

suspected cardiac symptoms suggestive of mass lesions should

be considered for a differential diagnosis of CHD, especially

in developing countries. Definitive treatment is removal of

the cyst combined with medical therapy. Surgery performed

by experienced practitioners provides excellent results when

combined with postoperative medical therapy. We will probably

see more cases, not only in endemic regions, but also in developed

countries in the near future due to the migration of populations.

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Fig. 6.

Number of cardiac hydatid cyst reports on PubMed

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Fig. 5.

Magnetic resonance (A) and computerised tomogra-

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the left ventricular free wall.