Surgical treatment of heart echinococcosis

Echinococcosis of the heart is a rare but dangerous for life disease, very difficult for diagnosis. 5 patients with echinococcosis of the heart were examined, 2 were operated. Introduction into clinical practice of complex echocardiography contributed to precise diagnosis. The viability of the parasite was determined after application of the latex-test. Defection of the living echinococcus parasites in the heart was indication for surgery. Removal of the echinococcus from the myocardium of the left ventricle in 1 patient was carried out without artificial circulation and was accompanied by a significant risk, the complete excision of fibrous capsula being impossible. Intraventricular location of the echinococcus cyst in the other patient has required artificial circulation and cardioplegia. Intraventricular cyst was successfully and radically removed after preliminary sterilization by glycerine solution.     

Surgical management of cardiac echinococcosis. Report of four cases.

Four patients with echinococcosis of the heart are presented. The diagnosis was suspected or established before operation by serology, echocardiography and cardiac catheterization. The sites affected were the right and left atria, left ventricular apex and interventricular septum. The right and left atrial cystic masses simulated atrial myxoma, with brain embolization from the latter. The cyst in the interventricular septum was discovered on routine echocardiography in a patient with disseminated hydatidosis. All patients successfully underwent excision of their cysts under temporary cardiopulmonary bypass, and are doing well up to 2 years and 8 months afterwards on medical therapy.     

Surgical management of multivalvular heart disease

Background This study of patients with multivalvular lesions was undertaken to assess optimal surgical management and identify risk factors for prognosis. Methods Five hundred and twenty one patients underwent valve repair or replacement surgery between January’90 and December’98. Mean age was 30.19±12.2 years and 342 were males. All patients had dyspnoea on exertion, 467 (89.6%) were in New York Heart Association (NYHA) Class III and 47 (9.0%) were in Class IV. Congestive Heart Failure in 67 (12.3%) and prior cardiac procedure in 66 (12.2%) were other risk factors. The valves affected were mitral and aortic in 483 (Group 1), mitral and tricuspid in 43 (Group II) and mitral, aortic and tricuspid in 40 (Group III) patients. Surgical procedures included, several different combinations using repair or replacement with prosthetic or biological substitutes. Results Operative mortality was 9.8% (51 patients). Follow up (1 to 108 months, mean 45 months) was 94% complete. Late mortality occurred in 48 patients (10.4%). Causes included, left ventricular dysfunction (n=21), valve thrombosis (n=10) and, endocarditis (n=8). Freedom from late events was 50.7±8.5% at 9 years. At their last visit 40 patients were in Class IV, 18 were in Class III, 59 in Class II and the remaining in Class I (NYHA). Conclusions Important predictors of early mortality were NYHA Class IV, congestive heart failure, tricuspid valve disease and prior cardiac surgery. Left ventricular dysfunction was an important determinant of late outcome.     

Surgical management of carcinoid heart disease

Metastatic carcinoid tumor is often seen with flushing, diarrhea, and cardiac symptoms--the carcinoid syndrome. Cardiac failure is often associated with major morbidity and mortality in carcinoid disease. In this report, a case of successful cardiac valvar surgical intervention has resulted in prolonged alleviation of cardiac symptoms and survival.     

Surgical management of stab injuries of the heart

ITRODUCTION: Cardiac injuries today are not rare and they present a significant group of pathological cardiac diseases, with a large number of the injured (60-90%) dying before being transported to the hospital. CASE REPORT: A patient with a stab wound of the right chamber, upper abdomen and pelvis, in a state of hemorrhagic shock, was successfully managed after being reanimated. CONCLUSION: Good health service organization in the field and urgent transport of the injured should be obligatory in the management of heart trauma.     

肝包虫病的外科治疗

目的　总结肝包虫病 1740例手术治疗的经验 ,特别是对肝包虫性急腹症及其并发症的治疗方法。方法　对 196 0～ 1997年 1740例肝包虫病例资料进行回顾分析。结果　本组主要并发症中 ,感染为 116 9例次 ,内瘘 388例次 ,破裂 2 15例次。术后并发症为胆汁瘘、囊内感染、外囊残腔闭合不全等。本组手术治愈率为 99 4% ,死亡 9例 (0 6 % )。结论　肝包虫对人体损害主要为肝包虫并发症。肝包虫及其并发症的治疗以外科手术为主 ,特别是对肝包虫破裂所致的急腹症应立即手术 ,清除包虫内容物 ,并即时抗休克、抗感染、抗过敏治疗。术后即时给予抗包虫药物治疗。     

Surgical treatment of pulmonary echinococcosis

Operation with the use of a laser for resection of the external fibrous capsule with re-expansion of the remaining cavity in patients with echinococcosis of the lungs is more effective than operation by capitonnage of the cavity. The main advantages of laser operations were the absence of closed cavities, deformities of bronchi, atelectasic areas of tissue around the fibrous cavity, and disorders of capillary blood flow and bronchial patency. All this allowed poor results of the operation and fatal outcomes in the main group of patients to be avoided.     

肝包虫病的外科治疗进展

肝包虫病是我国西部牧区发病率较高的人兽共患病之一,手术及药物治疗是常规治疗手段.随着医疗器械、理念的更新,手术方式更多样化,手术效果却差别较大.通过查阅该领域的中外文相关文献,本文综述了肝包虫外科治疗过程中常用术式及相应优缺点,概述各手术方式的适用范围,并提出自己的观点.     

Surgical treatment of human echinococcosis

Hydatid disease may affect several organs in the human body and thus represents a major challenge for the general surgeon. The aim of this study was to analyze the multiple clinical presentations of hydatid disease and the surgical options according to the involved organ. The medical records of 272 adult patients operated on for hydatid disease in our department during the period 1970-1996 were retrospectively reviewed. The most commonly involved organ was the liver (204 patients; 75%), followed by the lung (42 patients; 15.4%) and the spleen (14 patients; 5.1%). In 12 patients, the cysts were located in uncommon sites: in the pancreas (4 patients; 1.5%), the gallbladder (2 patients; 0.74%), the kidney, the thyroid gland, the breast, the pericardium, the supraclavicular region and the thigh (1 patient in each case; 0.37%). Clinical symptomatology varied according to anatomic location and pre-operative diagnosis was accomplished with plain abdominal films, ultrasound, computerized tomography and serological tests. The surgical procedures performed included simple closure with drainage, unroofing of the cyst with omentoplasty (for liver cysts), marsupialization, cyst excision, excision of the involved organ or combinations of procedures. Postoperative morbidity was mainly due to septic complications (n = 41), postoperative bleeding (n = 2), deep vein thrombosis (n = 2) and fistulae (n = 13). Four patients died in the early postoperative period (mortality rate, 1.5%) secondary to septic complications (n = 3) and pulmonary embolism (n = 1). During long-term follow-up, 14 patients developed recurrent disease. In conclusion, hydatid disease should be included in the differential diagnosis of cystic masses in solid organs or other anatomic sites, especially in endemic countries. Since there is not an effective medical treatment, surgery still remains the treatment of choice, offering a good clinical result and an acceptable recurrence rate.     

Surgical therapy of liver echinococcosis

There is still no other therapeutic management for echinococcosis of the liver than surgical treatment. Indeed, drug therapy with Mebendazol prevents parasitosis from spreading. However, a complete regression has not been observed hitherto. Surgical procedure is dependent on expansion, localisation and type of echinococcosis. Generally, cystectomy is possible and adequate in case of Echinococcus granulosus, in case of Echinococcus multilocularis with its infiltrating growth, a complete healing can only be attained by lobectomy. With the hilus being invaded and obstructive jaundice proceeding, an improvement can be reached by Mebendazol or a palliative endless drainage tube.