Bahjat Alaa S, Sharif Tahir Ahamd Mohammad, Mohammed Ayad Ahmad
Department of Surgery, College of Medicine University of Duhok, Duhok, Kurdistan Region, Iraq.
Duhok Directorate General of Health, Azadi Heart Center, Duhok City, Kurdistan Region, Iraq.
Ann Med Surg (Lond). 2019 Dec 6;49:49-52. doi: 10.1016/j.amsu.2019.11.018. eCollection 2020 Jan.
Hydatid cyst of the heart is very rare, the left ventricle is the commonest site of myocardial involvement due to dominant left coronary vessels and thicker wall. Isolated cardiac involvement is extremely rare. Patients may be quite asymptomatic but the cyst may cause palpitation, dyspnea, chest pain, or when ruptured in to the cardiac or pericardial cavities may cause emergency presentations like anaphylactic reactions, sudden collapse due to pericardial tamponade or even sudden death. A middle age female presented with exertional shortness of breath for 2 years. Echocardiography showed mitral valve stenosis. Computerized tomography scan of the chest showed a big complicated hydatid cyst arising from the wall of the right ventricle. Median sternotomy was done with excision of the hydatid cyst, and repair of mitral stenosis by commissurotomy. The patient received three cycles of albendazole for three months. Surgery is the best options of treatment of cardiac hydatid disease, when the disease is affecting the pericardium complete excision may be possible, but when the myocardium is involved it may be difficult or even impossible to do complete excision, in this situation the cyst contents should be evacuated completely, preventing spillage is very mandatary to prevent recurrence. Care must be taken to avoid damage to the conductive system, the papillary muscles, the aortic and the mitral valves. Medical treatment with anthelminthic medications is used after surgery to reduce the recurrence rate.
心脏包虫囊肿非常罕见，由于左冠状动脉占优势且心室壁较厚，左心室是心肌受累最常见的部位。孤立的心脏受累极为罕见。患者可能完全没有症状，但囊肿可能导致心悸、呼吸困难、胸痛，或者当囊肿破裂进入心脏或心包腔时，可能引发过敏反应、心包填塞导致的突然虚脱甚至猝死等紧急情况。一名中年女性因劳力性气短2年就诊。超声心动图显示二尖瓣狭窄。胸部计算机断层扫描显示右心室壁有一个巨大的复杂性包虫囊肿。行正中胸骨切开术切除包虫囊肿，并通过二尖瓣交界切开术修复二尖瓣狭窄。患者接受了三个周期、为期三个月的阿苯达唑治疗。手术是治疗心脏包虫病的最佳选择，当疾病累及心包时，可能可以完全切除，但当心肌受累时，可能难以甚至无法完全切除，在这种情况下，应将囊肿内容物完全排空，防止溢出对于预防复发非常关键。必须小心避免损伤传导系统、乳头肌、主动脉瓣和二尖瓣。术后使用抗蠕虫药物进行药物治疗以降低复发率。
