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(Circulation. 1997;95:2325-2326.)
© 1997 American Heart Association, Inc.

Articles

Hydatid Cyst of the Interventricular Septum

Jean F. Aupetit, MD; Bernard Ritz, MD; Marc Ferrini, MD; Michel Coppin, MD; Gérard Champsaur, MD

the Department of Cardiology, Centre Hospitalier St Joseph–St Luc (J.F.A., B.R., M.F., M.C.) and the Department of Cardiovascular Surgery, Hôpital Cardiologique (G.C.), Lyon, France.

Correspondence to Jean F. Aupetit, Department of Cardiology, Centre Hospitalier St Joseph–St Luc, 9 rue du Professeur Grignard, 69365 Lyon Cedex 07, France.

	Introduction

Top Introduction References

 
A 22-year-old woman without medical history presented with a grade 3/6 ejectional systolic murmur. She was asymptomatic. An ECG revealed sinus rhythm and nonspecific repolarization changes in the right precordial leads. The chest radiograph was normal. A transthoracic Doppler two-dimensional echocardiogram showed a spheroidal, 3-cm-diameter cystic mass in the upper interventricular septum protruding mainly into the left ventricular chamber without creating any significant intraventricular gradient (Figs 1 and 2). Transesophageal echocardiography demonstrated a liquid mass with a rounded and well-constrated capsule containing an inner sleigh bell (Fig 3). A CT scan and NMR confirmed a round, cystlike structure in the interventricular septum but finally failed to provide much information on the structure and anatomic relationship of the cyst. A blood test showed an erythrocyte sedimentation rate of 60 mm/h and absence of eosinophilia. Serological tests for Echinococcus granulosus were positive. Right and left cardiac catheterization showed normal pressures without intraventricular obstruction. Right and left ventricular angiography revealed an intraventricular mass defect in the interventricular septum. Coronary arteriography was normal except for a slightly curved and elongated diagonal branch of the left anterior descending coronary artery but without compression. Abdominal ultrasonographic examination, cranial and abdominal CT scans, and radionuclide bone scan imaging were normal. Surgical ablation was performed through the right ventricle; after the cyst was punctured and its contents were drained, hypertonic glucose solution was instilled, and the cyst capsule was entirely removed. Histopathological analysis of the surgical specimen confirmed a hydatid cyst. Postoperative evolution was uneventful, and the patient remains free of symptoms with normal echocardiography after 4 years of follow-up.

View larger version (47K): [in this window] [in a new window]   Figure 1. Top left, Transthoracic two-dimensional echocardiogram of parasternal long-axis view showing a 3-cm-diameter hydatid cyst (hc) in the upper ventricular septum. la indicates left atrium; lv, left ventricle; rv, right ventricle; and ao, aorta.

View larger version (44K): [in this window] [in a new window]   Figure 2. Top right, Same as Fig 1 in another view.

View larger version (47K): [in this window] [in a new window]   Figure 3. Bottom, Transesophageal echocardiography showing a hydatid cyst (hc) having a rounded and well-constrated capsule containing an inner sleigh bell (arrow) probably produced by the scolex. lv indicates left ventricle.

Cardiac hydatid disease is very uncommon. When the cysts are intramyocardial, the most common location is the interventricular septum¹ ; the diagnostic value of two-dimensional transthoracic and especially transesophageal echocardiography is better than that of CT and NMR imaging. Therefore, these methods should be reserved only for the study of extracardiac involvement of echinococcosis.^{2 3 4}

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC 4-265, Houston, TX 77030.

	References

Top Introduction References

 
1. Oliver JM, Sotillo JF, Dominguez FJ, Lopez de Sa E, Calvo L, Salvador A, Paniagua JM. Two dimensional echocardiographic features of echinococcosis of the heart and great blood vessels. Circulation. 1988;78:327-337.[Abstract/Free Full Text]

2. Ottino G, Villani M, De Paulis R, Trucco G, Viara J. Restoration of atrioventricular conduction after the surgical removal of a hydatid cyst of the intraventricular septum. J Thorac Cardiovasc Surg. 1987;93:144-147.[Medline] [Order article via Infotrieve]

3. Desnos M, Brochet E, Cristofini P, Cosmard G, Keddari M, Mostefai M, Gay J. Polyvisceral echinococcosis with cardiac involvement imaged by two dimensional echocardiography, computed tomography and nuclear magnetic resonance imaging. Am J Cardiol. 1987;59:383-384.[Medline] [Order article via Infotrieve]

4. Lanzoni AM, Barrios V, Moya JL, Epeldegui A, Lelemin D, Lafuente C, Asin-Cardiel E. Dynamic left ventricular outflow obstruction caused by cardiac echinococcosis. Am Heart J. 1992;124:1083-1085.[Medline] [Order article via Infotrieve]

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