Surgical Management of Cardiac Hydatid Cyst and the Residual Intramural Ectocyst.

The cardiac hydatid cyst (HC) is a rare pathology and mostly is endemic in livestock raising countries. Patients do not have a specific presentation so it is mainly a diagnosis based on imaging. Finding HC anywhere in the body warrants looking for another hydatid in other organs. This is a case report of a young male who presented with nonspecific symptoms and during diagnostic workup, it happened that he has combined hepatic and cardiac HCs. The cardiac cyst was located intramurally in the interventricular septum and expanding down mostly to the left side of the diaphragmatic surface of the heart and partly crossing intramurally to the diaphragmatic surface of the right ventricle. Emergency open-heart surgery was performed; the endocyst was removed while intramural ectocyst was drained to prevent potential future residual space.

Combined Coronary Artery Bypass Grafting and Extra-anatomic Ascending Aorta to Bifemoral Grafting Through Median Sternotomy.

A high proportion of patients with severe systemic atherosclerotic disease present with the involvement of both the coronary and aortoiliac arteries. For these patients with multiple comorbidities and high surgical risk, it is critical to minimize the overall physiologic burden of the operation when possible. Furthermore, with severe or complete occlusion of vascular supply to the lower extremities, it is beneficial to avoid two-stage surgeries because of the high risk of irreversible ischemia necessitating amputation. In select cases, a single combined operation without entering the abdominal cavity may be a reliable option. We present a case with excellent results using the technique of coronary artery bypass grafting (CABG) and extra-anatomic ascending aorta to bifemoral grafting through median sternotomy and subcutaneous tunneling. Furthermore, there is a wide variation in anticoagulation reversal practices among surgeons after performing these combined grafting operations. We administered only half of the ideal calculated protamine dose for reversal of heparinization, which achieved favorable results in our patient. Overall, with symptomatic occlusion of the coronary and aortoiliac arteries, combined CABG and extra-anatomic aortobifemoral grafting with subcutaneous tunneling is a reliable surgical option. The indication for this approach should be tailored to the anatomy of the lesion and the urgency of the clinical scenario.

Acute common iliac arterial occlusion caused by ruptured primary cardiac hydrated cyst -A case report.

INTRODUCTION: Hydatid cyst of the heart provides very rarely because of contractions of the heart natural resistance to the presence of viable cysts. Patients with cardiac hydatid cyst may remain asymptomatic for many years or have minor nonspecific complaints, but it is associated with an increased risk of lethal complications if left undiagnosed and untreated. Post rupture cardiac hydatid there is disseminated echinococcosis in the body. CASE PRESENTATION: We report a healthy 20-year old male, while he was working as a farmer who presented with sudden onset acute right lower limb ischemia caused by ruptured of primary hydatid cyst of the heart which managed as a surgical emergency. DISCUSSION: Patients with a cardiac hydatid cyst usually have symptoms after its rupture. Hydatid cyst rupture into left-sided chambers may cause systemic emboli, like in our case which presented with emboli of right common iliac artery and later on the patient had cerebral hydatid. Cardiac hydatid cyst can have two extremes, either remain asymptomatic over long periods or be discovered after serious and even fatal complications. CONCLUSION: Acute limb ischemia should be considered as an extremely a rare cause of rupture cardiac hydatid in an endemic area of echinococcosis also, this case confirms the need for the evaluation of the patient well after ruptured cardiac hydatid for other sites of emboli like brain hydrated as in our patient.

An Unusual Presentation of a Cardiac Foreign Body in a Pediatric Patient.

Cardiac foreign bodies (FBs) are rare. Their etiology can be attributed to penetrating injuries although they are also often found incidentally. The approach for removal of these FBs is variable and patient dependent. Although there is debate regarding indications for removal, there is a general consensus that symptomatic FBs presenting acutely, as well as asymptomatic FBs posing a greater risk of complication to the patient, should be removed. We present the case of a 14-year-old patient with a cardiac FB and a step-wise approach for removal.