Three-Dimensional Imaging of a Comma-Shaped Right Ventricular Hydatid Cyst

We report herein a hydatid cyst of the right ventricle and its two- and three-dimensional echocardiographic appearance.     

Hydatid cyst of the right ventricle

A 35 years old women has had palpitations for the last six months on auscultation she has a mid systolic clic. The echocardiogram shows a typical aspect of right ventricular hydatid cyst. The right and left catheterization confirms the diagnosis. A thoracic scan is done to rule out other localisations. The patient is successfully operated. The authors emphasized the importance of an echocardiogram in a visceral or secondary localisation of echinococcosis.     

Hydatid cyst presenting as an eosinophilic pleural effusion

A 61-year-old woman presented with an eosinophilic pleural effusion, secondary to transdiaphragmatic intrapleural spread of an hepatic hydatid cyst. Right posterolateral thoracotomy and frenotomy revealed a loculated pleural effusion associated with a 10 x 8 cm hydatid cyst in the posterior segment of the liver. Hydatid disease should be included in the differential diagnosis of eosinophilic pleural effusions in endemic regions.     

Not all obstructive cardiac lesions are created equal: double-chamber right ventricle in pregnancy

Double-chambered right ventricle (DCRV) is a rare form of right ventricular outflow tract (RVOT) obstruction accounting for approximately 1% of patients with congenital heart disease. It consists of an anomalous muscle bundle that divides the right ventricle usually between the sinus (inlet) and the infundibulum (outlet). This division creates a proximal chamber with high pressure and a distal chamber with low pressure. The hemodynamic obstruction of the RVOT is usually an acquired phenomenon, however the substrate for the anomalous muscle bundle is likely congenital. The diagnosis of DCRV should be considered in the young patient with an elevated right ventricular systolic pressure and intracavitary gradient. Echocardiography and cardiac MRI are the principal diagnostic tools for the assessment of DCRV. This entity is often misdiagnosed as pulmonary hypertension in the young patient, and can often go overlooked and untreated for many years. Definitive therapy involves surgical resection of the muscle bundle. This can often be curative and if done in a timely fashion, may prevent right ventricular remodeling. We describe the unique diagnostic dilemma, the course and management of a young adult with DCRV during pregnancy.     

Double-chambered right ventricle

Between May 1974 and December 1993, 37 patients (0.75%) witha double-chambered right ventricle underwent surgical repair.The patients ranged in age from 11 months to 12 years (mean4 ± 1.1 years). Cardiac catheterization was performedin 36 patients. The proximal right chamber pressure was 118±10 mmHg and the mean ventricular gradient pressure was 75 ±10 mmHg. A ventricular septal defect was present in 36 casesand fixed subaortic stenosis in eight. Longitudinal right ventriculotomy, group I, was performed in19 patients (51.3%): 11 had a perimembranous ventricular septaldefect and eight an infundibular ventricular septal defect.Combined pulmonary arteriotomy and right atriotomy, group II,was performed in 18 patients (48.7%): 17 patients had a perimembranousventricular septal defect. The ventricular septal defect wasclosed using a double velour patch in 26 patients, continuoussuture in four and a Gore-Tex patch in six. In the ventriculotomygroup one patient died shortly after the operation (followingpulmonary complication), and ten patients required inotropicsupport. Two patients developed patch dehiscence and underwentreoperation. There were no complications in group II patientswho underwent right atriotomy. Associated cardiac anomalieswere corrected in all patients. Follow-up of 6.5 ±3.1years after operation showed that 36 patients were alive andasymptomatic. Conclusion: the transatrial approach with pulmonary arteriotomyis an appropriate and effective double-chambered right ventriclecorrection even if it is associated with a perimembranous ventricularseptal defect.     

右室双出口超声和右心室造影与手术结果对比分析

对15例经手术证实的右室双出口患者术前超声检查和右心室造影诊断与手术病理结果进行对比分析，超声诊断准确率86．7％（13／15），右心室造影诊断准确率91．7％（11／12）。经统计学分析，两者无显著性差异（P＞0．05）。认为：超声心动图检查与右心定造影结合可在术前诊断右室双出口及合并畸形。     

Infected cardiac hydatid cyst

A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass—an echinococcal cyst or tumour—in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp.


Keywords: cardiac hydatid cyst; infected cardiac hydatid cyst     

Electro-vectorcardiographic features of double-chambered right ventricle

Twelve patients with double-chambered right ventricles wereinvestigated to determine the significance of the electrocardiogramand vectorcardiogram in the evaluation of this condition. Twosubgroups of individuals having various forms of obstructionto right ventricular outflow with and without intracardiac shuntingwere utilized as controls. The electrocardiogram of patientswith double-chambered right ventricle had a characteristic appearanceidentifiable as a right ventricular hypertrophy pattern seenbest in the extreme right precordial leads V₄R–V₃R withtendency to normalization of pattern in V₁, which contrastedwith the pattern in both control subgroups. The vectorcardiogramin all 8 cases of double-chambered right ventricle in whichthis study was performed exhibited homogeneity of loop appearanceand direction best identifiable in the horizontal plane by aprominent terminal orientation of the loop rightward and posteriorly.Both control subgroups exhibited heterogeneity of loop conformation,significantly more initial right-anterior force and less rightposteriorforce than the double-chambered right ventricle group. The electro-vectorcardiographicfindings with double-chambered right ventricle were predictablefor this abnormality and appear to have significant diagnosticimportance.     

The murmur of double-chambered right ventricle: phonocardiographic evaluation

Thirteen patients undergoing complete evaluation for double-chambered right ventricle were subjected to phonocardiographic evaluation. Each of these individuals revealed a holosystolic ejection-type murmur which exhibited a similarity of appearance unaltered by the degree of physiologic derangement or associated cardiac abnormalities. This finding is considered to be caused by the obstructive elements in double-chambered right ventricle and appears to be a characteristic finding for this condition.     

Double-chambered right ventricle with pulmonary valve endocarditis

A rare case of isolated pulmonary valve endocarditis associated with a double-chambered right ventricle in a nonaddict, was diagnosed on two-dimensional echocardiography and cardiac catheterization and angiography. The patient was successfully operated and the above findings confirmed on the operation table.     

Usefulness of bubble study in echocardiographic diagnosis of contained rupture of hydatid cyst in the right ventricular outflow tract

We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac‐like structure in the right ventricular outflow tract (RVOT) containing a heterogenous echogenic mass. This sac‐like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst. Bubble echoes were noted within the sac‐like structure but did not penetrate the inner wall of the cyst which contained echogenic material, indicating that the rupture was confined only to the outer layers. At surgery, a 0.5 cm communication was noted between the cyst and the RVOT and pathology confirmed the diagnosis of hydatid cyst.     

儿童右心室双出口的外科治疗体会

【摘要】目的 探讨儿童右室双出口的外科治疗体会。方法 自2009年2月至2017年3月共手术治疗87例患儿,其中男性48例,女性39例,年龄10天～18岁,平均(30.0±44.4)月,体重3.17～47kg,平均(11.1±8.8)kg。根据STS-EACTS数据库分类：VSD型43例,TOF型7例,TGA型9例,VSD远离大动脉型28例。共经历手术100例次,非体外循环下手术30例次。体外循环下手术70例次,体外循环时间32～234分钟,平均(103.3±49.3)分钟,主动脉阻断时间12～180分钟,平均(59.6±37.2)分钟。VSD型手术方法包括心室内隧道补片修补33例;PA Banding术5例;B-T分流术1例;双向Glenn术7例;改良Fontan术1例;术后出现右心室流出道狭窄行右心室流出道重建术3例。TOF型手术方法为心室内隧道补片修补+右室流出道疏通术。TGA型手术方法均为大动脉调转术,同期行IAA（A）矫治术1例,术后出现右心室流出道狭窄行右心室流出道重建术4例。VSD远离大动脉型手术方法包括B-T分流术4例;PA Banding术5例;双向Glenn术17例;改良Fontan术4例。术后呼吸机时间4～360小时,平均(46.4±60.6)小时,监护室时间6小时～21天,平均(127.2±81.6）小时,住院时间11～39天,平均(23.3±12.1)天。结果 100例次手术术后呼吸机时间平均(46.4±60.6)小时,监护室时间平均(127.2±81.6）小时,住院时间平均(23.3±12.1)天。97例患儿顺利存活,住院死亡3例,手术死亡率3％,1例B-T分流术后低氧血症;1例术后低心排综合征;1例术后心功能不全、肾功能不全及肝功能不全,经腹透及血液滤过治疗后并发颅内出血伴昏迷,家长要求放弃治疗而死亡。其余患儿效果良好,随访12月～5年,无晚期死亡病例。结论 DORV疾病谱广,病种复杂,术前需充分评估病情,根据患儿的解剖特点和年龄,制订个体化的手术方案,可以获得比较满意的手术效果。 【关键词】右室双出口 外科治疗 儿童     

Hydatid cyst of the interventricular septum causing obstruction of the right ventricular outflow tract: cross-sectional echocardiographic, angiographic and pathological findings

Cardioc echinococcal cysts rarely involve the interventricularseptum; when they do, they cause symptoms mainly related tothe compression of the atrio-ventricular conduction pathways.Mild obstruction of the right ventricular outflow tract hasalso been described in some cases. In the case reported here,an unusual, large hydatid cyst located in the interventricularseptum produced a marked, symptomatic obstruction of the rightventricular outflow tract (more than 100 mmHg gradient). Surgicalresection of the cyst was complicated by a ‘stone heart’syndrome, probably because of a severely affected right ventricle.Cross-sectional echocardiography gave the exact site and aetiologyof the mass. On the basis of these non-invasive findings, earlysurgery should be performed on asymptomatic patients to thereduce the risk of life-threatening evolutions.     

Natural history of a systemic right ventricle

The natural history of a systemic right ventricle after an atrial switch procedure has yet to be fully characterised. We describe the case of the longest surviving patient at our institution who underwent a Mustard Baffle correction for dextro‐transposition of great arteries in childhood. Over following decades he was reviewed regularly with deteriorating systemic right ventricle function. At around 50 years of age he developed worsening heart failure on maximal medical therapy. He was subsequently assessed for cardiac transplantation which he underwent successfully at the age of 55 years.     

Double outlet right ventricle assessed with Magnetic Resonance Imaging

In this article the value of magnetic resonance (MR) imaging for the evaluation of double outlet right ventricle (DORV) is reviewed from the literature and illustrated with several cases. MR imaging can be used for the determination of cardiac anatomy at initial diagnosis and may provide functional information during the follow-up of patients after surgical correction.     

30例双腔右心室的外科治疗

目的 探讨过去10年我院双腔右心室的诊断及外科治疗经验。方法 回顾分析2006年1月至2016年7月我院接受外科治疗的30例双腔右心室的诊治情况。术前经超声心动图确诊27例,术中确诊3例。其中肌隔型18例,肌束型12例,单纯右室双腔心2例,合并室间隔缺损25例,房间隔缺损2例,动脉导管未闭2例,合并主动脉瓣下隔膜1例。手术予切除右心室异常肥厚肌束,修补室间隔缺损,未予补片加宽右室流出道8例,用自体心包加涤纶补片加宽右室流出道22例,同时矫治心内其他畸形。结果 手术早期死亡1例,为成人双腔右心室合并三尖瓣中－重度关闭不全,术前有右心功能不全,出现腹胀及双下肢浮肿等临床症状,术后出现低心排综合征,2天后死亡。其余患者手术效果满意,康复出院。死亡率为3.33%(1/30),生存29例,无近期或中期死亡及相关并发症。术后29例随访,随访率100%,主要以门诊及电话随访。随访3个月－10年,本组2例术前三尖瓣轻度关闭不全,术后早期心脏彩超提示三尖瓣轻-中度关闭不全,考虑术中损失乳头肌所致,通过门诊心脏彩超随访,目前三尖瓣仍为轻-中度关闭不全,无右心功能不全表现。右室流出道疏通满意,目前暂无患者因右室流出道狭窄而再次手术。全组患者术后心功能明显改善,活动量明显增大,生长发育改善。结论 严格把握手术指征,术前充分评估,熟悉掌握病理解剖,有效疏通右室流出道并充分矫治心内其他畸形,手术治疗近、中期效果满意,远期待进一步随访。