Cardiac hydatid cysts with intracavitary expansion

Background. Hydatid cyst disease is a significant health problem for undeve loped and developing countries. Although cardiac involvement is rare, early diagnosis and treatment of this situation is important. Methods. To investigate the long-term outcome of patients who underwent ope ration for cardiac hydatid cysts with intracavitary expansion, we reviewed 8 patients who had cardiac hydatidosis and who underwent operation in our i nstitution between January 1988 and November 1999. All patients presented w ith intracavitary protrusion of the cysts. Seven patients were women. The m ean age was 33 +/- 14.3 years with a range of 17 to 55 years. The cysts wer e located on the right ventricular outflow tract (2 patients), right midven tricular part of the muscular septum, left atrial free wall and apical port ions of the right (2), or left (2 patients) ventricle. Standard cardiopulmo nary bypass and crystalloid antegrade cardioplegia with aortic cross-clampi ng were used in all patients. In one, with right ventricular hydatid cyst, we used cardiopulmonary bypass with femoral cannulation and total circulato ry arrest at less than 18 degreesC systemic hypothermia. This patient, who was arrested because of pulmonary emboli could not be weaned from cardiopul monary bypass and died. Results. The cystic cavity was cleaned and closed with multiple pursestring sutures in 4 patients. In 2, cardiac and cystic cavities were united by pa rtially resecting part of the cyst facing the cavity. In another patient, a left ventricular patch plasty was performed after removal of the cystic ma terial in the left ventricle. Mebendazole was used postoperatively in all p atients. Except for 1 patient who died, all were discharged without postope rative complications. The mean follow-up was 7.5 +/- 5 years. There was no late cardiac mortality or recurrence. Conclusions. Cardiac hydatid cysts with intracavitary expansion should be t reated surgically without delay. Gentle handling of the heart during cardio pulmonary bypass minimizes operative risk. All patients should be investiga ted for systemic cysts. (Ann Thorac Surg 2001;71:1587-90) (C) 2001 by The S ociety of Thoracic Surgeons.