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

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017 304 AFRICA
New World’s old disease: cardiac hydatid disease and
surgical principles
Omer Tanyeli, Yuksel Dereli, Ilker Mercan, Niyazi Gormus, Tahir Yuksek
Abstract
Background: 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 admit-
ted 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 cardiopulmo-
nary bypass under moderate hypothermia, whereas the remain-
ing two (16.7%) had off-pump surgery. There was no surgical
mortality in our series. All patients were discharged with medi-
cal 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.
Keywords: hydatid cyst, cardiac hydatid cyst, Echinococcus granu-
losus
Submitted 10/6/16, accepted 12/1/17
Published online 20/2/17
Cardiovasc J Afr 2017; 28: 304–308
DOI: 10.5830/CVJA-2017-006
Hydatid cyst (HC) is a parasitic disease caused by infection with
the Echinococcus granulosus tapeworm larva. It is a major public
health problem in endemic regions such as Asia, the Middle
East, the Mediterranean region, South America, New Zealand
and Australia.1
Hydatid disease may be seen in a variety of systems in the
human body, most commonly in the liver (70%) and pulmonary
region (20%). Cardiac involvement is very rare and comprises
about 0.5 to 2% of all cases.2 Although there are some reports of
different locations, and isolated surgical experiences are reported
in the literature, large series are limited. In this article, we report
our experience in surgical treatment of cardiac hydatid disease
(CHD) with specific surgical steps, and we review the literature,
which interestingly, shows an increase in reports of CHD over
the last two decades.
Methods
In the 30 years between 1985 and 2015, 12 patients were admitted
to our clinic, either from the Departments of Cardiology or
Emergency, with a possible diagnosis of cystic cardiac masses,
which were highly suspicious for CHD. Of these patients, six
(50%) were male and the remaining six (50%) were female. Mean
age of the patients was 42.6 years (ranging from 12–65 years). All
patients came from areas where the disease is endemic.
The most common presenting symptom was dyspnoea,
palpitations and chest pain resembling coronary artery disease.
Among these patients, one had symptoms of pulmonary emboli
and one was previously operated on because of HC of the left
lung, and recurrent CHD was diagnosed five years after the
first operation. She also had HCs on the right lung, liver and
spleen. All the other CHDs were diagnosed incidentally. Table
1 demonstrates the clinical and demographic features of the
patients.
Routine tests comprising full blood count, and biochemistry
and serological tests, including indirect haemagglutination (IHA)
and/or enzyme-linked immunosorbent assay (ELISA) were the
preferred diagnostic tools. Echocardiography was preferred
to define the mass lesions with their haemodynamically active
adjacent structures. Radiological tests, including plain chest
X-ray, were done on all patients, and computerised tomography
(CT) and/or magnetic resonance imaging (MRI) studies were
performed in order to exactly define the lesion, such as the nature
of the cystic lesion, location, dimensions and the relationship of
the mass with the surrounding tissue or any presence of HC in
the lungs. Routine abdominal ultrasonography was performed in
order to exclude concomitant HC in the abdomen.
After clearly defining the lesion, the patients were given
information on the disease and written informed consents were
received before the operation. All patients, except one who did
not give consent for surgery (not included in this series), were
operated on for cystectomy of CHD.
Results
The most common location of CHD was left sided (six patients,
50%). Five (41.7%) patients had CHD located in the right heart,
Department of Cardiovascular Surgery, Meram Medicine
Faculty, Necmettin Erbakan University, Konya, Turkey
Omer Tanyeli, MD,
Yuksel Dereli, MD
Ilker Mercan, MD
Niyazi Gormus, MD
Tahir Yuksek, MD