Abstract 4367951: Hydatid Cyst in the Right Ventricle leading to Tricuspid stenosis and Heart Failure– A Case Report

Abstract

Background: Cystic hydatid infection is a parasitic disease caused by the larval stages of Echinococcus granulosus, most commonly involving the liver and lungs. Cardiac involvement is rare, accounting for less than 2% of cases, with the left ventricle being the most commonly affected site. Involvement of the right ventricle is extremely uncommon and may lead to life-threatening complications such as tricuspid valve obstruction and hemodynamic compromise. Case Presentation: We report a rare case of a 42-year-old patient who presented to the ED with dyspnea,hemoptysis,chest pain,syncope,peripheral edema,and signs of ight heart failure.On physical examination BP was 100/70 mmHg,heart rate 96 beats/min, and lung auscultation revealed crackling rales, especially on the left. ECG showed abnormal rate and rhythm,and chest X-ray revealed mild to moderate cardiomegaly.Transthoracic echocardiography and cardiac MRI revealed a large,multilocular cystic mass occupying the right ventricle, causing functional tricuspid stenosis. Serology for E.granulosus was positive (ELISA titer 1/1600). After 2 weeks of albendazole therapy (400 mg), emergency cardiac surgery was performed. Under cardiopulmonary bypass, the cysts were carefully excised to avoid rupture. Premedication with midazolam (0.05 mg/kg IV) was administered. General anesthesia was induced with fentanyl (50 µg/kg), thiopental (5 mg/kg), and vecuronium (0.1 mg/kg) for intubation. Anesthesia was maintained with fentanyl (5 µg/kg) and isoflurane. Histopathology confirmed hydatid disease. The postoperative course was uneventful, and the patient was discharged on continued albendazole therapy. Conclusion: Cardiac hydatid cysts in the right ventricle are exceptionally rare but can be life-threatening. Cardiac involvement is rare as larvae are usually filtered by the liver and lungs; however, some may bypass these organs. The left ventricle is most commonly involved (50%), followed by the right ventricle (20%), interventricular septum (13%), left atrium (9%), right atrium (6%), and interatrial septum (2%). Clinical manifestations vary from asymptomatic to severe heart failure. The number, size, location, and stage of the cyst influence symptoms. Early diagnosis via imaging and serology, followed by timely surgical and antiparasitic treatment, is essential. Hydatid cysts of the right cardiac chambers should be considered in the differential diagnosis of tricuspid stenosis and right heart failure, especially in endemic areas.