Asian Cardiovasc Thorac Ann 2006;14:153-154
© 2006 Asia Publishing EXchange Ltd
Hydatid Cyst in the Wall of the Ascending Aorta
Naz B Aydin, MD,
Seden Celik, MD1,
Asuman Suzer, MD2,
Turkan Coruh, MD2,
Tamer Okay, MD3,
Hakan Gercekoglu, MD
Department of Cardiovascular Surgery
1 Department of Cardiology
2 Department of Anesthesiology
3 Department of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul, Turkey
For reprint information contact: Naz B Aydin, MD Tel: 1 216 444-3305 Fax: 1 216 445 6930 Email: bigeaydin{at}yahoo.com, 12000 Edgewater Dr. Apartement:903 Lakewood, Ohio 44107, USA.
 |
ABSTRACT
|
|---|
Hydatid disease rarely involves the aortic wall. We report a case of hydatidosis involving the ascending aorta and the left atrium. The patient underwent replacement of the ascending aorta with a prosthetic Dacron graft and left atrial cystectomy. At the 6-month follow-up, she was leading a normal life.
|
INTRODUCTION
|
|---|
Cystic echinococcosis caused by the parasite Echinococcus granulosus has worldwide distribution and poses a health problem in endemic areas. The cysts are frequently located in the liver and lung, but they may be found in any organ, including the brain, heart, and bone. Developed hydatid cysts are rarely found in the aortic wall, with only slightly over 10 cases having been reported, all involving the thoracic or abdominal aorta.1–6 We report a case of hydatidosis involving the ascending aorta and the left atrium.
|
CASE REPORT
|
|---|
A 24-year-old woman was referred to our hospital for echocardiographic evaluation following an acute embolic stroke due to occlusion of the left middle cerebral artery. She had a history of cystic echinococcosis and had undergone 2 operations for left pulmonary and pericardial hydatid cysts 6 and 8 years earlier, respectively. She was discharged without complications and placed on 6-month albendazole therapy after each operation.
On admission, physical examination revealed motor aphasia and right hemiparesis. Her biochemical and hematological findings were within normal ranges. The chest radiograph showed no evident anomalies. The electrocardiogram was normal. Transthoracic echocardiography revealed a cystic lesion with irregular contours and showing intracavitary expansion in the free left atrial wall. On the same day, surgery was performed through a median sternotomy. An intramural cystic mass measuring approximately 3 x 3 cm in diameter resembling a hydatid cyst was observed in the anterior wall of the ascending aorta 2 to 3 cm proximal to the origin of the innominate artery (Figure 1
). Following femoral artery and right atrial cannulation, cardiopulmonary bypass (CPB) was initiated and the patient was cooled to 16°C to commence total circulatory arrest. A woven Dacron graft was sewn to the distal aorta by an open technique. Cardiopulmonary bypass was again established, and the other end of the graft was sutured to the proximal aorta just above the aortic commissures. The other cyst was resected through a left atriotomy. This left atrial cyst measured 3 x 4 cm in diameter and was perforated (Figure 2). Cardiopulmonary bypass was terminated without any complications. Pathological analysis confirmed the resected specimens to be hydatid cysts.
After 8 days without complications and on mebendazole at 50 mg·kg–1, the patient was discharged with the advice to continue taking mebendazole for 1 year. She entered an outpatient rehabilitation program for stroke and aphasia. At the 6-month follow-up, the patient had regained her motor and speech abilities, and control echocardiography was normal.
|
DISCUSSION
|
|---|
The arterial wall is an unusual site for hydatid cysts even in endemic countries. Aortic wall hydatidosis can be diagnosed by digital subtraction angiography, computed tomography, and especially magnetic resonance imaging, which can detect the exact relationship of the cyst with the aorta.3,4 The disease may be associated with life-threatening complications such as anaphylactic or hemorrhagic shock, systemic emboli, arterial insufficiency, and dissemination of the infection.4 Several hypotheses have been proposed to describe how the parasite reaches the arterial wall. Some authors point to the presence of pre-existing small intimal tears or aneurysms, while others consider a possible route via the vasa vasorum.5 The vasa vasorum comprises small vessels of 10 to 15 µm in diameter, while the tapeworm’s scolex is 30 to 40 µm in diameter; this size difference makes the parasite’s approach through the vasa vasorum very unlikely.6 Considering that our patient had a previous operation for a pericardial hydatid cyst, local dissemination and external invasion from the outer wall of the aorta might be a possible way by which the ascending aorta was reached. During surgery, great care should be taken to avoid rupture of the cyst and subsequent dissemination of the infection.
There is as yet no definitive surgical treatment for arterial hydatidosis due to the rarity of this disease. However, resection coupled with graft interposition has been successful in all reported cases.2 One report described successful treatment by excision and local repair with a Dacron patch.5 Our case shows that hydatidosis of the ascending aorta may be treated successfully by surgery. Close follow-up is recommended in order to detect any recurrence early.
|
REFERENCES
|
|---|
- Pulathan Z, Cay A, Guven Y, Sarihan H. Hydatid cyst of the abdominal aorta and common iliac arteries complicated by a false aneurysm: a case report. J Pediatr Surg 2004;39:637–9.[Medline]
- Harris DG, Van Vuuren WM, Augustyn J, Rossouw GJ. Hydatid cyst fistula into the aorta presenting with massive hemoptysis. Case report and literature review. J Cardiovasc Surg (Torino) 2001;42:565–7.[Medline]
- Hendaoui L, Siala M, Fourati A, Thameur MH, Hamza R. Case report: hydatid cyst of the aorta. Clin Radiol 1991;43:423–5.[Medline]
- Karapinar K, Ergul Z, Keskin A, Bugra O, Duzgun C, Zengin M. Hydatid cyst of the abdominal aorta and bilateral common iliac arteries. A case report. J Cardiovasc Surg (Torino) 1999;40:583–5.[Medline]
- Biglioli P, Spirito R, Roberto M, Parolari A, Agrifoglio M, Pompilio G, et al. False hydatid aneurysm of the thoracic aorta. Ann Thorac Surg 1995;59:524–5.[Abstract/Free Full Text]
- Samarrai AA, Al-Shukri S. Intramural hydatid cyst of the abdominal aorta. Int Angiol 1999;18:239–40.[Medline]
This article has been cited by other articles:
|
|
|
|
 
A. Z. Apaydin, E. Oguz, and M. Zoghi
Hydatid cyst involving the aortic arch
Eur. J. Cardiothorac. Surg.,
March 1, 2007;
31(3):
558 - 560.
[Abstract]
[Full Text]
[PDF]
|
|
|
TOP
ABSTRACT
INTRODUCTION
