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Canadian Journal of Cardiology

Swiss Cheese Heart: Cardiac Hydatid Cysts

Published:November 02, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.031
      A 22-year-old man was referred to our hospital with complaints of chest pain and fatigue. He breeds a variety of animals and reported no relevant past medical history. The patient’s New York Heart Association functional class was III, and he had a grade VI/VI mitral systolic murmur. Other physical examination results were unremarkable. Electrocardiography showed a left anterior divisional block and a right anterior fascicular block. Transthoracic echocardiography revealed multiple hydatid cyst lesions extending into the myocardium of the posterior and septal walls of the left ventricle suggestive of echinococcosis (Fig. 1, A and B). Echocardiography showed severe mitral valve regurgitation, with an ejection fraction of 35%. Chest computed tomography (CT) confirmed these echocardiographic findings (Fig. 1, C-E). The primary focus of the hydatid cyst was investigated using abdominal ultrasound, and no positive signs of a hydatid cyst were noted. Surgical resection was contraindicated because of the severe myocardial involvement. Thus, the patient was treated medically by the administration of albendazole 400 mg twice daily. The patient died of anaphylactic shock within 1 month of follow-up. An autopsy was performed, and macroscopy confirmed the echocardiography and CT findings (Fig. 2, A and B). A histologic examination confirmed the diagnosis of cardiac hydatid disease.
      Figure thumbnail gr1
      Figure 1Two-dimensional transthoracic echocardiogram. (A) Two-chamber view showing multiple hydatid cysts extending into the posterior and septal walls (asterisks). (B) Short-axis view showing a giant hydatid cyst (asterisk). (C-E) Chest angiotomograph of different views showing a giant multilobulated hydatid cyst occupying almost the entire interventricular septum and posterior wall (asterisks). The white arrow indicates the mitral valve, whereas the yellow arrow indicates the right coronary artery. Ao, aorta; LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; RA, right atrium; RV, right ventricle.
      Figure thumbnail gr2
      Figure 2Macroscopic specimen showing multiple cystic lesions throughout the myocardium of the left ventricle (white arrows). LV, left ventricle.
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