SURGICAL-TREATMENT OF ACUTE PERICARDIAL T AMPONADE DUE TO HYDATID CYST OF THE HEART

History and clinical findings: A 56-year-old turkish patient, previous ly in good health, was admitted because of pain suggesting myocardial infarction. Physical examination of the heart, lungs and abdomen was u nremarkable. Investigations and diagnosis: The concentrations of myoca rdium-specific enzymes were not elevated and the ECG showed no signs o f ischaemia. Echocardiography and magnetic resonance imaging ruled out acute aortic dissection, but demonstrated a round cystic space-occupy ing mass over the anterior wall of the heart. Hydatid cyst was suspect ed from the imaging results and the patient's origin from area endemic for Echinococcus. The diagnosis was confirmed by a titre of 1 : 6,400 (normal: 1 : < 100) for Echinococcus antibodies. Treatment and course : Albendazole administration was initiated. Planned elective surgical removal of the hysatid cyst had to be performed urgently because of ac ute pericardial tamponade. Cyst rupture was suspected but an actually undamaged cyst was subtotally removed under cardiopulmonary bypass. Th e postoperative course was uneventful and albendazole treatment was co ntinued. Conclusion: Because of the high incidence of fatal complicati ons urgent surgical removal under cardiopulmonary bypass is the treatm ent of choice for hydatid cyst involving the heart. Perioperative albe ndazole administration is also essential.