Large cardiac hydatid cyst in the interventricular septum

Cystic hydatid disease results from infection with the larval or adult form of the Echinococcus granulosus tapeworm. Cardiac involvement is seen in 0.5% to 2% of patients with hydatid disease, and involvement of the interventricular septum is even rarer. Herein, we report our surgical treatment of a large cardiac hydatid cyst in the interventricular septum. A 39-year-old woman presented with dyspnea. Transthoracic echocardiography revealed a large cyst in the apical part of the interventricular septum. Thoracic computed tomography showed a cystic lesion in that site, and magnetic resonance imaging confirmed the presence of a 50 × 55-mm mass. The patient was placed on cardiopulmonary bypass. Hypertonic saline solution-soaked sponges were distributed within the pericardial cavity to prevent local invasion of the parasite intraoperatively. Through an incision parallel to the left anterior descending coronary artery, and without opening adjacent cardiac chambers, we aspirated the entire contents of the cyst, removed its germinative membrane, and washed the cavity with 20% hypertonic saline solution. The patient recovered uneventfully. She had begun taking albendazole 5 days preoperatively, and this therapy was continued for 12 weeks postoperatively. In cases of an interventricular cardiac hydatid cyst, the combination of surgical resection, washout of the remaining cavity with hypertonic saline solution, and albendazole therapy typically yields excellent results.     

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.     

Giant cardiac hydatid cyst in the interventricular septum protruding to right ventricular epicardium

Cardiac hydatid cyst is a rare condition, and the location of a hydatid cyst in the interventricular septum is exceptional. A 54-year-old female was admitted to our hospital with complaints of chest pain, shortness of breath and malaise. Transthoracic echocardiography defined a cystic mass lesion of 50 × 59 mm originating from apex of the heart protruding into and compressing the interventricular septum. The cyst was excised surgically and the patient was discharged on the 8th postoperative day without symptoms. In our case, localization of the cystic mass was within interventricular septum which is an uncommon site. It limited both ventricular volumes significantly. In addition, this cyst was extensively protruding to the right ventricular epicardium.     

A hydatid cyst of the interventricular septum diagnosed incidentally by multislice computed tomography

Cardiac involvement of the hydatid disease is uncommon. In this report a case of 54-year-old patient with a hydatid cyst in the interventricular septum was presented. The cyst was detected incidentally by cardiac multislice computed tomography and transthoracic echocardiographic appearances of the cyst raised the suspicion of cardiac echinococcosis. The patient was referred to surgery immediately for the removal of the cyst in order to prevent the potentially life threatening complications. The postoperative period was uneventful and she was discharged on albendazole therapy.     

Giant hydatid cyst in the interventricular septum of a pregnant woman

A 25-year-old woman, pregnant for 38 weeks, was admitted to our clinic with dyspnea. Transthoracic echocardiography revealed a large cyst that originated from the left side of the interventricular septum, decreasing left ventricular volume and almost entirely obstructing the left ventricular outflow tract. Cardiac magnetic resonance imaging confirmed a grade 1 hydatid cyst, which measured 61 x 59 x 66 mm. The cyst was excised after cesarean section. Extirpation required the creation of a small septal defect, which we closed without a patch, by suturing the septum directly to the left ventricular wall. The patient was discharged without symptoms. The case reported here is of particular interest not only because a hydatid cyst is rarely seen in the interventricular septum, but because a giant hydatid cyst obstructing the left ventricular outflow tract is very rare in pregnancy.     

Isolated hypertrophy of the basal ventricular septum: Characteristics of patients with and without outflow tract obstruction

Background

Isolated basal septal hypertrophy (IBSH) of the left ventricle (LV) is not a well understood phenomenon, particularly in the presence of concomitant left ventricular outflow tract obstruction (LVOTO). We evaluated the prevalence of IBSH and compared those with and without LVOTO.

Methods

Retrospective observational study of 4104 consecutive patients undergoing echocardiography at a community cardiology practice and a hospital without specialized Hypertrophic Cardiomyopathy (HCM) service to determine prevalence of IBSH, defined as isolated hypertrophy (> 15 mm) of the basal LV septum (BS) without hypertrophy elsewhere. Clinical, ECG and echocardiographic characteristics were compared in IBSH with and without LVOTO.

Results

Prevalence of IBSH was 5.8% (240/4104): mean (SD) age was 76.0y (10.4) with equal gender distribution. Prevalence increased with age (p < 0.001 for trend), reaching 7.8% over 70y. None had a family history of HCM, and HCM-associated ECG changes were uncommon. Mean BS thickness (SD) was 17.8 mm (0.24) with a BS/posterior wall ratio (SD) of 1.76 (0.31). Resting peak LVOT gradient (> 20 mm Hg) was present in 8/240 (3.3%), mean (SD) 69.6mm Hg (59.3). Patients with LVOTO had hypercontractile LV function (fractional shortening [SD] 51.8% [9.5] vs. 40.5% [10.9], p = 0.012) compared to those without LVOTO, but had similar BS thickness [SD] (17.8 mm [3.0] vs. 17.8 mm [2.8], p = 0.996) and ECG characteristics. Greater apical and septal displacements of the mitral valve co-aptation point characterized those with IBSH and LVOTO.

Conclusions

IBSH is common in elderly patients referred for echocardiography. LVOTO occurs only when concomitant mitral valve co-aptation and LV hypercontractility facilitate development of a gradient, rather than through differences in the degree of BS myocardial hypertrophy.     

Malaligned bioprosthetic valve causing left ventricular outflow tract obstruction

Left ventricular outflow tract obstruction resulting from strut impingement upon the interventricular septum is a rare complication of bioprosthetic mitral valve insertion. Obstruction is more likely to develop when a small, high profile prosthetic valve is inserted into a patient with a small outflow tract. The likelihood of this complication may be reduced by appropriate modification of surgical technique.     

Left ventricular myxoma originating from the interventricular septum and obstructing the left ventricular outflow tract

In a 60-year-old woman with episodic exertional faintness, alarge left ventricular (LV) myxoma attached by a pedicle tothe apical interventricular septum and prolapsing through theLV outflow tract and the aortic valve causing a severe obstructionwas found by echocardiography. Early surgical excision was successfullyperformed using the transaortic approach.     

Accessory mitral valve tissue causing left ventricular outflow tract obstruction

Although left ventricular outflow tract obstruction is commonly associated with congenitally corrected transposition of the great vessels, this obstruction is seldom caused by accessory mitral valve tissue. Three cases in which accessory mitral valve tissue caused left ventricular outflow tract obstruction in children are described. Two had congenitally corrected transposition and one had normally connected great vessels. The accessory leaflet tissue, which was identified by echocardiography and angiography, was attached by chordae tendineae to normally sited papillary muscles and herniated into the left ventricular outflow tract during systole. Operation was successful in these patients. The accessory valve tissue was excised via an arteriotomy in the great vessel that arose from the left ventricle. The obstructive tissue was excised close to its peripheral attachments in the outflow tract and its chordae tendineae were divided. Resection was performed without injury to the abnormally placed conduction system or to the normal valve structures.     

Inferior cardiac aneurysm involving the interventricular septum. A complication of an acquired ventricular septal defect

An acquired ventricular septal defect led to the formation of an unusual aneurysm within and overlying the posteroinferior part of the interventricular septum. This is a rare complication of a myocardial infarction and may not have been reported before. The aneurysm probably developed because of a combination of the anatomical localisation of the small ventricular septal defect and the long survival of the patient after its formation.     

Primary cardiac rhabdomyosarcoma causing obstruction to the right ventricular outflow.

A 72-year-old man presented with worsening shortness of breath and a systolic murmur. Transthoracic and transoesophageal echocardiograms revealed a huge mass (70 x 30 mm) obliterating the right ventricular outflow tract, with a peak transpulmonary gradient of 128 mmHg. Pathological examination confirmed the mass to be a primary cardiac rhabdomyosarcoma originating from the pulmonary valve.     

Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension

We report a challenging case of a 81-year-old male with history of severe calcific aortic valve stenosis and aneurysmal membranous interventricular septum. The presence of anomalies in the sub-annular area can lead to valve malpositioning and its consequences. Transcatheter aortic valve implantation(TAVR) in patients with aneurysm of the perimembranous interventricular septum extending into the left ventricular outflow tract has not been previously reported. This case describes a successful transfemoral TAVR with an Edwards SAPIEN XT valve(Edwards Lifesciences, Irvine, CA, United States) with such anomaly.     

Inferior cardiac aneurysm involving the interventricular septum. A complication of an acquired ventricular septal defect.

An acquired ventricular septal defect led to the formation of an unusual aneurysm within and overlying the posteroinferior part of the interventricular septum. This is a rare complication of a myocardial infarction and may not have been reported before. The aneurysm probably developed because of a combination of the anatomical localisation of the small ventricular septal defect and the long survival of the patient after its formation.     

Hydatid disease of the interventricular septum causing pulmonary dissemination

Pulmonary dissemination of a cardiac cyst is a rare condition. In the present study, we report a case of a 20-year-old patient with cardiac hydatosis located in the interventricular septum, which was previously diagnosed and treated as pulmonary hydatid disease. Diagnosis was made by spiral computed tomography and treated surgically with median sternotomy and cardiopulmonary bypass. Diagnosis and proper surgical excision of the cardiac hydatid cyst prevented potentially lethal complications such as cyst rupture with recurrent pulmonary dissemination and anaphylaxis.     

Accessory mitral valve tissue causing left ventricular outflow tract obstruction.

Although left ventricular outflow tract obstruction is commonly associated with congenitally corrected transposition of the great vessels, this obstruction is seldom caused by accessory mitral valve tissue. Three cases in which accessory mitral valve tissue caused left ventricular outflow tract obstruction in children are described. Two had congenitally corrected transposition and one had normally connected great vessels. The accessory leaflet tissue, which was identified by echocardiography and angiography, was attached by chordae tendineae to normally sited papillary muscles and herniated into the left ventricular outflow tract during systole. Operation was successful in these patients. The accessory valve tissue was excised via an arteriotomy in the great vessel that arose from the left ventricle. The obstructive tissue was excised close to its peripheral attachments in the outflow tract and its chordae tendineae were divided. Resection was performed without injury to the abnormally placed conduction system or to the normal valve structures.