Chest pain due to compression effect of hydatid cyst on LAD: rare presentation of hydatid cyst in heart

ABSTRACT

Cardiac hydatid cysts usually involve other organs and in different sites of the heart. Treatment of heart hydatid cysts is usually surgical, followed by continuous medical therapy. We present a male patient with a hydatid cyst in the interventricular septum with compression effect on the left anterior descending artery [LAD]; the cyst was diagnosed with echocardiography, CT imaging, and angiography. The patient was treated via surgical excision of the cyst under cardiopulmonary bypass, and the treatment was continued with medical therapy. A follow-up, the patient was in good physical condition. Cardiac echinococcosis is uncommon, accounting for 0.5% to 3% of all hydatid infestations in human beings[1]. All the heart walls and cavities can be the site of hydatid development but hydatid cysts of the heart are located most often in the left ventricle. Involvement of the interventricular septum is rare and can cause symptoms arising from the compression of the atrioventricular conduction pathway and obstruction of the right or left ventricular outflow tract[1,5]. Diagnosis is with echocardiography, CT imaging, and occasionally angiography[1,2,4] There is always the lethal hazard of cyst perforation. Early diagnosis and an integrated treatment strategy are crucial. The results of the surgical treatment of heart echinococcosis are better than those of the conservative strategy only. Extraction of the cyst combined with chemotherapy perioperatively or postoperatively is aimed at decreasing recurrence[2]