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).