HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Koçak, H. Articles by Becit, N. Search for Related Content PubMed PubMed Citation Articles by Koçak, H. Articles by Becit, N.

Ann Thorac Surg 2000;70:1002-1003
© 2000 The Society of Thoracic Surgeons

---

Correspondence

Cardiac and pericardiac echinococcosis

Ahmet Özyaziciolu, MD^a, Hikmet Koçak, MD^a, Necip Becit, MD^a

^a Department of Cardiovascular Surgery, Atatürtk Universty School of Medicine, 25240 Erzurum, Turkey

To the Editor

We read with interest the article by Birinciolu and colleagues, in the November 1999 issue of The Annals [1].

Echinococcosis disease is endemic on the Asian Continent. It is also endemic to East Anatolia [2]. Between 1992 and 1998 3 patients underwent evaluation and treatment for cardiac echinococcosis at the Department of Cardiovascular Surgery at Atatürk University Hospital in Erzurum, Turkey. Enucleation, aspiration and pericystectomy are among the specific surgical procedures for cardiac hydatids. Each operation has two phases: 1 removal of the cyst and 2 dealing with the residual cavity. When I read the article [1], I understood that the aspiration technique was generally preferred in the process of removing the cyst. With this technique it can be comprehended that there is a relationship between the cyst and the intracardiac compartment. My first question is: Have Birinciolu and associates preferred the aspiration technique only for this reason?

As cardiac cysts are usually more in number and free from myocardium than those in the pulmonary cysts (Fig 1), we believe that the total enucleation must be used for all cardiac intact cysts. In the enucleation technique (Fig 2) if the cyst is deeply situated, the myocardium is incised where the cyst is nearest to the surface if the opening in the pericyst is small. Abrupt protrusion of the cyst may occur. For solid structures, scissors are used. When the cyst is from one–third to one–half exposed in this way, the hand is gently pushed beneath the cyst and the remaining part of it is separated from the pericyst by careful finger dissection, until the cyst lies in the palm of the surgeon’s hand. On occasion, both hands are required to lift out a large cyst. The use of the scissor and spoon, as described above makes enucleation of an intact cyst much easier and safer. We haven’t witnessed any surgical rupture in the 3 cases in which we have used the enucleation technique. If this occurs, the cavity should be filled for 5 minutes with sodium chloride 10%, which provides reliable decontamination. Birinciolu and associates have used pericardial, polytetrafluoroethylene and dacron patch in order to repair the residual cavity or the other myocardial defects. In 1 of our cases, to fill the residual cyst cavity, we used biologic glue which was previously used for a surgical treatment in the multiple ventricular septal defect or in the acute aortic dissection [3]. The cyst pouch was stuck together with biologic glue. However, the mouth of the pouch was supported with suture. There was no problem postoperatively. We think that the biologic glue is quite appropriate for closing the cyst space.

View larger version (118K): [in this window] [in a new window]   Fig 1. Multiple hydatid cardiac cysts were removed by enucleation.

View larger version (28K): [in this window] [in a new window]   Fig 2. Techniques of cystectomy

References

1. Birinciolu C.L., Bardakci H., Küçüker A., et al. A clinical dilemma:cardiac and pericardiac echinococcosis. Ann Thorac Surg 1999;68:1290-1294.[Abstract/Free Full Text]
2. Yekeler I., Koçak H., Aydin N.E., et al. A case of cardiac hydatid cyst localized in the lungs bilaterally and on anterior wall of right ventricle. Thorac Cardiovasc Surg 1993;41:261-263.[Medline]
3. Leca F., Karam J., Vouhe P.R., et al. Surgical treatment of multiple ventricular septal defects using a biologic glue. J Thorac Cardiovasc Surg 1994;107:96-102.[Abstract/Free Full Text]
4. Morris D.L., Dykes P.W., Marriner S., et al. Albendazole-objective evidence of response in human hytadid disease. JAMA 1985;253:2053-2057.[Abstract]

This article has been cited by other articles:

				M Ceviz, N Becit, and H Kocak Infected cardiac hydatid cyst Heart, November 1, 2001; 86(5): e13 - 13. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Koçak, H. Articles by Becit, N. Search for Related Content PubMed PubMed Citation Articles by Koçak, H. Articles by Becit, N.