Multiple hydatid cystectomy of the heart necessitating LIMA to LAD anastomosis in a young patient.

Cardiac hydatid disease is very rare, even in endemic regions. Clinical manifestations included chest pain, anaphylactic shock, constrictive pericarditis, congestive heart failure, and arterial embolism. Surgery is the exclusive therapy, where the cysts are excised during open-heart surgery. The surgical approach therefore must be performed carefully, given the potential complications that surgery may bring. Because of the risk of potentially lethal complications, early diagnosis and definitive treatment are important. A 32-year-old male patient was admitted with chest pain, weight loss, lethargy, and dizziness. On the transesophageal echocardiography study, a cystic mass (2.5 x 3 x 4.5 cm in dimension adjacent to the left ventricular posterior wall) that was divided into two by a septum was noted. Diagnosis of hydatidosis was confirmed with serologic tests (ELISA and indirect immunofluorescence). Echinococcosis, also known as hydatid disease, is common in several regions of the world, for example, the Mediterranean countries, the Middle East, South America, and East Africa. While performing pericystectomy in the anterior left ventricular wall, we noticed that there were three cysts, contrary to the preoperative diagnosis pointing a single one, and it was impossible to effectively complete the procedure without compromising anterosuperiorly displaced left anterior descending artery (LAD). We decided to go on bypass, arrest the heart, and complete the pericystectomy at the cost of injuring LAD and grafting the left internal mammary artery to LAD. Microscopic examination of the cyst showed a germinal layer and an avascular, eosinophilic, chitinous layer that confirmed the diagnosis of hydatid cyst. The patient was discharged on the fifth postoperative day on albendazole medication.