Discussion:
CE is highly prevalent in southern and northern provinces of Syria; however, epidemiologic studies on human echinococcosis are still not available (11). Our patient was from northeastern province in Syria, which is notably endemic for CE. In rare cases, the larvae reach the heart mainly through the coronary arteries and develop into hydatid cysts. Young adults are the most frequently affected, but very rare cases of cardiac hydatid cysts in children have been reported. Since it receives the most blood supply, the left ventricular wall is most frequently involved (55-60%), whereas the right ventricle is less involved (10-15%). Our case is a rare presentation of cardiac hydatid cyst within the right ventricle in a child. It has been reported that in cases of right ventricle hydatid cysts, intracavitary rupture is more frequent, and may lead to pulmonary embolization, pulmonary hypertension, and death (2,3,9,10). To avoid these complications, it is crucial to make an urgent diagnosis and investigations. High index of suspicion was the key of diagnosis in our case (the geographic origin and surgical history). There are multiple laboratory tests, such as Casoni’s intradermal test, the Weinberg reaction, and peripheral blood eosinophil count; however, they are not reliable since they carry false negative results (7). Electrocardiogram and Chest radiograph are not specific (7). TTE is the preferred diagnostic modality in detecting the cysts and their location and size (3,7). Other highly useful modalities include CT and MRI, which can be informative for a better surgical approach (3,5,7). The surgical excision combined with Albendazole therapy is still the gold standard for treatment of cardiac hydatid cysts (1-10). It is possible to excise the superficially or epicardially located cysts without the use of CPB; however it is more recommended to use CPB as it shows higher safety and less risk of cyst contents leakage during surgery (7,8). In order to reduce the cyst tension and avoid an accidental rupture, the entire cyst contents must be aspirated. Moreover, the cyst must be injected with protoscolicidal agent to create an osmotic gradient that kills the protoscolices to avoid any possible recurrence in case of their spillage or locally invasion during the operation. For this purpose, packing the operative field with gauze and sponges soaked in a scolicidal agent is performed. we used hypertonic saline solution due to its effectiveness and relatively non-toxicity (8,13). Albendazole (400 mg twice daily) should be prescribed at least 4 days preoperatively, and continued for 12 weeks postoperatively (2,3,8,9). The effectiveness of other therapeutic techniques such as puncture, aspiration, injection of a scolicidal agent, reaspiration, and radiofrequency ablation in the treatment of cardiac hydatid cysts are still unclear (8).