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Ann Thorac Surg 2002;73:700
© 2002 The Society of Thoracic Surgeons

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Correspondence

Cardiac hydatid cysts: Reply

^a Departments of Cardiovascular and Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, 81010 Istanbul, Turkey

e-mail: mehmetkaplan{at}superonline.com

To the Editor

We thank Dr Losanoff and colleagues for their comments on our article [1]. Cardiac hydatid cysts are quite rare. Eight cases that we mentioned in our study were cardiac intracavitary hydatid cysts. Myocardial cysts without intracavitary extension or pericardial hydatid cysts were excluded.

As Losanoff and colleagues mentioned, presence of a pericardial cyst alone is rare. However, the idea that 98% of them are of cardiac origin is not consistent with our experience. Articles that the authors quoted supporting this figure were published in 1915 and 1966 and were case reports. A review of the current literature shows that this rate is not that high in most series [2] and our clinical experience parallels these findings. According to their second reference, 50% of pericardial hydatid cysts are associated with myocardial involvement [3]. Furthermore, pericardial hydatid cysts may rupture into the heart chambers.

Since we excluded pericardial hydatid cysts in our study, we did not provide detailed information about them. In 3 of 12 cases with pericardial hydatid cysts (25%), myocardial involvement was also present. The rate of pericardial hydatid cysts was 1.18% in 338 cases of pulmonary hydatid cysts that were operated in the thoracic surgery unit of our institution during the same period. According to our clinical experience, the frequency of hydatid cysts by organs in order of decreasing frequency is as follows: pulmonary, pericardial, and cardiac. No recurrence was observed in patients with operated pericardial hydatid cysts.

We agree with the suggestions of Losanoff and colleagues on diagnosis and treatment. All intracardiac hydatid cyst cases that we operated were symptomatic. We believe that asymptomatic patients with incidentally diagnosed cysts should be operated on if the cyst is intracardiac. If there is pericardial involvement, even though the patient is asymptomatic and serology is negative, we believe that operation is necessary, because of the risk of rupture and dissemination to the pericardial sac and myocardium, and development of allergic reactions.

References

1. 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]
2. Onursal E., Elmaci T.T., Tireli E., Dindar A., Atilgan D., Ozcan M. Surgical treatment of cardiac echinococcosis: report of eight cases. Surg Today 2001;31:325-330.[Medline]
3. Birinciolu 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]

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ilgaz Dogusoy Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kaplan, M. Articles by Dogusoy, I. Search for Related Content PubMed Articles by Kaplan, M. Articles by Dogusoy, I. Related Collections Cardiac - other Related Article