Ann Thorac Surg 2002;73:699-700
© 2002 The Society of Thoracic Surgeons
Correspondence
Cardiac hydatid cysts
Julian E. Losanoff, MDa,
Bruce W. Richman, MAa,
James W. Jones, MD, PhDa
a Department of Surgery, M580 Health Sciences Center, University of Missouri—Columbia, School of Medicine, One Hospital Dr, Columbia, MO 65212, USA
e-mail: jonesjw{at}health.missouri.edu
To the Editor
We read with interest the recent article by Kaplan and colleagues [1] on cardiac hydatid cysts (HC) with intracavitary expansion. The authors reported their 10-year surgical experience with 8 cardiac HC patients; another 12 patients with pericardial HCs were excluded from this study of intracardiac hydatid cysts. Ninety-eight percent of pericardial HCs originate from myocardial HC rupture into the pericardium [2]. In a few patients, it may occur secondary to lung or liver echinococcosis with pericardial extension [3]. There have been so few reports of isolated pericardial involvement [2] that it would be of particular interest to know whether any of Kaplan and associates’ 12 patients had isolated pericardial disease, or whether their management was unique.
We agree with the authors’ conclusion that the presence of viable Echinococcus is an indication for surgery, but preoperative diagnosis of live HCs remains problematic. Small, totally calcified, asymptomatic HCs in an elderly patient with negative serology for hydatid disease and no impedance of hemodynamics or cardiac blood supply has thus far been considered an indication for follow-up only [4]. Kaplan and colleagues’ patients were all symptomatic, making surgery the only option. To prevent contamination, the surrounding area was wrapped with compression gauze and the cystic fluid was aspirated. Soaking of the gauze with a scolicidal agent to prevent pericardial contamination in the event of accidental rupture is generally considered a wise precaution. Surgery for hydatid disease should utilize local scolicidals because contamination risk is high [3, 4]. Hypertonic saline probably would have been the best alternative for the patients in this group. Its cost is low and it has virtually no toxicity. The article provides few details about the HC size and location, but not all cysts can be found by intraoperative visual inspection. Some may remain hidden in the recesses at the heart base. Fatalities can follow rupture of undiagnosed HCs [5], making detailed cardiac imaging prior to surgery advisable. Intraoperative surface ultrasonography was reported effective in diagnosis and surgical planning, helping to identify cannulation sites and choose between cardiopulmonary bypass, beating heart surgery, or cross-clamping [3].
References
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Kaplan M., Demirtas M., Cimen S., Ozler A. Cardiac hydatid cysts with intracavitary expansion. Ann Thorac Surg 2001;71:1587-1590.[Abstract/Free Full Text]
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Cheng W. Hydatid cysts in the pericardium—a new case and review of the literature. Thorac Cardiovasc Surg 1982;30:56-57.[Medline]
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Birincio
lu C.L., Bardakci H., Kücüker S.A., et al. A clinical dilemma: cardiac and pericardiac echinococcosis. Ann Thorac Surg 1999;68:1290-1294.[Abstract/Free Full Text]
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Thameur H., Abdelmoula S., Chenik S., et al. Cardiopericardial hydatid cysts. World J Surg 2001;25:58-67.[Medline]
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Kardaras F., Kardara D., Tselikos D., et al. Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece. Eur Heart J 1996;17:1265-1270.[Abstract/Free Full Text]
