Complicated Case of Left Ventricular Echinococcosis
A 30-year-old man, initially from Turkey, was admitted to hospital because of fever and syncope of unknown origin with suspicion of endocarditis. With transthoracic and transesophageal ultrasonography (Figure 1), a cystic tumor of the lateral wall of the left ventricular myocardium was discovered. R wave-triggered cardiac magnetic resonance (MR) imaging confirmed this finding and showed spoke-like septations within the cyst. In addition to this main finding, MR revealed other smaller cystic lesions in the left ventricular myocardium extending to the level of the atrioventricular sulcus, ie, to the anulus of the mitral valve (Figure 2).
Together with the progressive clinical status, the ultrasound examination, the typical MR imaging findings, and a echinococcus granulosus positive serology (1:50), the diagnosis of echinococcus granulosus was made. Other lesions in liver, lung, and brain were excluded by computed tomography and MR imaging, respectively.
After consulting recent literature and having discussions in a multidisciplinary team, operative treatment with resection of the echinococcal cysts, reconstruction of the left ventricle with a patch, and replacement of the mitral valve was performed. Intraoperatively, the findings of the MR examination could be confirmed (Figure 3 and Figure 4⇓).
The MR examination was more specific and gave better information about the extent of the echinococcal lesions to the mitral anulus, which was important for preoperative planning. The syncope could be explained purely mechanically, as the cysts occupied large part of the left ventricular myocardium.
Several postoperative complications, including a drop in blood pressure, lung edema, and heart arrhythmias, resulted in death.