Liver autotransplantation and atrial reconstruction on a patient with multiorgan alveolar echinococcosis: a case report.

BACKGROUND: Alveolar echinococcosis (AE) primarily affects the liver and potentially spreads to other organs. Managing recurrent AE poses significant challenges, especially when it involves critical structures and multiple major organs. CASE PRESENTATION: We present a case of a 59-year-old female with recurrent AE affecting the liver, heart, and lungs following two previous hepatectomies, the hepatic lesions persisted, adhering to major veins, and imaging revealed additional diaphragmatic, cardiac, and pulmonary involvement. The ex vivo liver resection and autotransplantation (ELRA), first in human combined with right atrium (RA) reconstruction were performed utilizing cardiopulmonary bypass, and repairs of the pericardium and diaphragm. This approach aimed to offer a potentially curative solution for lesions previously considered inoperable without requiring a donor organ or immunosuppressants. The patient encountered multiple serious complications, including atrial fibrillation, deteriorated liver function, severe pulmonary infection, respiratory failure, and acute kidney injury (AKI). These complications necessitated intensive intraoperative and postoperative care, emphasizing the need for a comprehensive management strategy in such complicated high-risk surgeries. CONCLUSIONS: The multidisciplinary collaboration in this case proved effective and yielded significant therapeutic outcomes for a rare case of advanced hepatic, cardiac, and pulmonary AE. The combined approach of ELRA and RA reconstruction under extracorporeal circulation demonstrated distinct advantages of ELRA in treating complex HAE. Meanwhile, assessing diaphragm function during the perioperative period, especially in patients at high risk of developing pulmonary complications and undergoing diaphragmectomy is vital to promote optimal postoperative recovery. For multi-resistant infection, it is imperative to take all possible measures to mitigate the risk of AKI if vancomycin administration is deemed necessary.

Native parasite affecting an introduced host in aquaculture: cardiac henneguyosis in the red seabream Pagrus major Temminck & Schlegel (Perciformes: Sparidae) caused by Henneguya aegea n. sp. (Myxosporea: Myxobolidae).

BACKGROUND: Henneguya Thélohan, 1892 (Myxobolidae) is one of the most species-rich genera of myxosporean parasites infecting fish. Although common in nature, there are few reports of these parasites causing important disease in aquaculture. In this paper, we describe a new species of Henneguya infecting Pagrus major (Temminck & Schlegel), a fish host introduced to the Mediterranean Sea from Japan in the late 1980s. RESULTS: Large plasmodia of the parasite were found in the bulbus arteriosus and in the ventricle of the infected fish. Spores were found mainly in the kidney and heart and were accompanied by melanized macrophages or vascular intimal proliferation mixed with a mild non-suppurative response, respectively. Comparisons of morphometric data for spore and polar capsule length and width, suggest a unique combination of features in the newly described species. Molecular analysis, based on 18S rDNA sequence of the parasite, followed by phylogenetic analysis, indicated that the parasite described here is a novel species of Henneguya, clustered with the marine congeneric species. CONCLUSIONS: Henneguya aegea n. sp. infects in aquaculture P. major, a host introduced as eggs to the Mediterranean from Japan. Despite the high host specificity of the myxobolid parasites, H. aegea n. sp. seems to be able to use P. major as a host and propagate successfully, causing morbidity and mortality. This could result in spillback of the new species from high density cultured non-native P. major to native fish hosts.

Cardiac echinococcosis with intra-atrial localization.

Echinococcosis is a frequently encountered parasitic disease in the Mediterranean region, including Turkey. Cardiac disease is seen in 0.5-2% of patients. Usually the cysts are located within the pericardium or intramyocardially; intracavitary localization of the cyst is rarely seen. We herein report a patient who initially presented with hemoptysis and was echocardiographically diagnosed to have an intra-atrial hydatid cyst. Although patients with cardiac hydatid cysts may present with cardiac symptoms, symptoms typically involve other organ systems, following dissemination of the organism. Therefore, echocardiographic screening of patients who are diagnosed with echinococcosis, even if they have no cardiac symptoms, may ensure early diagnosis and prevent development of lethal complications, such as cyst rupture or embolization.

[Hydatid cyst of the right atrium]. / Le cas clinique du mois. Kyste hydatique de l'oreillette droite.

Cardiac hydatid cysts are rare; the right atrial location is even rarer and carries serious complications. We report three cases of cardiac hydatid cyst of the right atrium. The first patient died in the postoperative period due to right heart failure and massive tracheal bleeding. The course of the disease of the two other patients was uneventful. Echocardiography is the most informative technique for identifying and localising the cyst before surgery. Right atrium hydatid cyst should be treated by early surgical excision with a view to prevent the risk of pulmonary embolism.

The first record of Dirofilaria immitis infection in a Humboldt penguin, Spheniscus humboldti.

Dirofilaria immitis infection is an important parastic disease in many mammals, especially canids, but has not been reported in bird hosts. Filarial worms were isolated from the lumen of the right atrium of the heart and the connective tissue of the lung of a captive female Humboldt penguin, Spheniscus humboldti, that died at a zoo in Japan. One of these worms was observed morphologically and identified as D. immitis by features such as 4 pairs of cephalic papillae, 1 pair of cervical papillae, esophagus divided into 2 regions, 4 pairs of pre-anal papillae, 5 pairs of post-anal papillae, and unequal spicules. In addition, the partial DNA sequence (234 bp) of mitochondrial CO / gene of the filarial worm was identical to that of D. immitis. This is the first report of D. immitis infection in a bird.

Depletion of radiosensitive leukocytes exacerbates the heart sympathetic denervation and parasitism in experimental Chagas' disease in rats.

The acute phase of the Trypanosoma cruzi infection induces damage of the heart sympathetic nerve terminals in rats. The participation of the radiosensitive leukocytes in this process was assessed in young rats submitted to gamma irradiation 1 day before infection with T. cruzi, Y strain. Gamma irradiation increased the heart noradrenergic denervation evaluated at day 12 of infection by histochemical and electron-microscopic methods. The presence of numerous macrophages with ultrastructural features of activation and a significant rise in the myocardial parasitism suggest the involvement of radioresistant macrophages or parasite factors, or both, on the damage of the nerve terminals.

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.

Synchronized coronary revascularization and multiple cardiac cysthydatid operation.

Cardiac cysthydatid is rare pathology and is seen in 0.5 to 2% of echinococcal infections. It is found in the left ventricle most frequently and then in the right ventricle. We present a case with a ruptured cysthydatid at the right atrium's interatrial septum and multiple cysthydatids localized at the outer surface of the left ventricle's apex, which necessitated a synchronized coronary revascularization with our diagnosis and surgical procedure modalities. Our patient was a 61-year-old man with complaints of fever, dyspnea, tachycardia and chest pain, which began 2 months before admittance. An echocardiography in our clinic revealed a 4.7 x 1.7 centimeter, pediculled, going in and out to tricuspidal inflow, cystic mass adherent to the interatiral septum in the right atrium, which prompted immediate hospitalization. He was in New York Heart Association Class II. His electrocardiography (EKG) showed ischemia at inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His EKG showed ischemia at the inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His preoperative biochemical parameters were normal, and cysthydatid serology tests were negative. With these results,l we planned a synchronized surgical procedure for coronary artery disease with multiple cardiac cysthydatids. During operation, after the right atriotomy, a fragile cystic mass with a ruptured image and dimensions of 5 x 2 x 2 centimeters, originating from the interatrial septum and in a conglomerate form, was resected and extirpated. The left atrium was not involved. Then, 3 masses with dimensions of 2 x 2 centimeters, which were not diagnosed with the echocardiogram, at the epicardial surface of the left ventricle apex were excised. The defected part of the left ventricle was repaired with teflon felt supports for rupture prophylaxis. Then, a left internal mammary artery graft, which was prepared at the beginning of the operation, was anastomosed to LAD. The patient didn't have any additional problem during the postoperative period, and he was discharged at 1 week after surgery. To avoid recurrence, the patient was prescribed albendazole as a prophylaxis for the duration of 2 months. Histopathology confirmed the diagnosis of cysthydatid. Patients with cardiac cysthydatid can be asymptomatic or can cause minimal nonspecific symptoms for years. The condition can be lethal if not diagnosed and treated. The primary treatment for cysthydatid is surgery. Echocardiography is an important diagnostic method for cysthydatid. Serological tests can produce negative results if the immune responses of the patient is not sufficient, so it must be remembered in the endemic places for echinococcus.

The atrium of the fish heart as a site for Contracaecum spp. larvae.

Ninety-five percent of the larvae of Contracaecum spp. were found in the atrium of the heart of fathead minnows (Pimephales promelas) and five- and nine-spined sticklebacks (Culaea inconstans and Pungitius pungitius). Atria containing nematodes were two to three times larger than an atria from uninfected fish, were thin walled and the muscular trabeculae were damaged. Atria with larvae were congested with blood that appeared to be organizing and extending as a thrombus into the ventricle, but there was no other evidence of a host response. Alternatively, there was an intense cellular response surrounding larvae in the body cavity of these and other host species. Apparently, this parasite which lacks host specificity has evolved an additional strategy to evade the host immune response in sticklebacks and fathead minnows.

Use of a modified surgical approach to the right atrium for retrieval of heartworms in a dog.

A 2-year-old 2-kg female Maltese dog was referred for treatment of dirofilariosis and mild caval syndrome characterized by hemolysis and lethargy. Ultrasonography revealed worms within the caudal vena cava, right auricle, right ventricle, and pulmonary artery. Because of the mild clinical signs and small size of the dog, jugular venotomy was not performed, and treatment with sodium caparsolate was instituted. A markedly adverse reaction was noticed on initial injection, characterized by cardiac and respiratory arrest. Further treatment with sodium caparsolate was discontinued. Because of progression of the dog's condition surgical removal of heartworms was elected. A modified surgical approach to the right atrium was performed, using a cannula introduced through a pursestring placed in the wall of the right auricle. This technique allowed almost complete removal of heartworms with minimal blood loss. Postoperative ultrasonography revealed a single heart-worm remaining in the distal portion of the left pulmonary artery, but it was subsequently absorbed.

Case Report of dirofilariasis in grey wolf in Serbia.

This paper describes a case of dirofilariasis in a two-year old, female grey wolf (Canis lupus lupus). The autopsy revealed the presence of 42 adult forms of Dirofilaria immitis in the pulmonary artery, right ventricle and right atrium, varying in length from 9.5 to 30 cm. This is, to the best of our knowledge, the second report of D. immitis in grey wolves in Serbia. Our finding confirms that the wolf, as a subspecies distinct from the dog, should also be considered as a very suitable definitive host for dirofilariasis.

Morphological and biometric characteristics of the pectinate muscles and the taenia sagittalis of the right atrium in the human heart

The crista terminalis (CT) is a well-defined fibromuscular crest formed by the union of the venous sinus and the primitive right auricle, which extends along the posterolateral face of the right atrial wall. The pectinate muscles (PM) are muscular crests which extend anterolaterally from the CT to the auricle and may present in a series of variable shapes and sizes. The biggest and most prominent PM is called the taenia sagittalis (TS). PM with highly trabeculated muscle fibres predispose patients to the occurrence of arrhythmias. The present article is a descriptive study of the anatomical and biometric characteristics of the right atrium. We studied 30 hearts of adult Chilean individuals, aged between 18 and 84 years, of both sexes, with no apparent cardiac pathology, belonging to the Normal Human Anatomy Unit of the Basic Sciences Department of Universidad de La Frontera. The samples were washed with distilled water and immediately placed in formalin at 10%. The atria were first separated from the ventricles, then opened perpendicularly through the intercaval zone to give access to the interior. The distribution of pectinate muscles found, according to the classification of Loukas et al. (2008) and Siddiqui et al. (2013), was as follows: Type I, 20%; Type II, 23.3%; Type III, 23.3%; Type IV, 6.7%; Type V, 6.7%; Type VI, 20%. TS was found to be present in 46.6% of the hearts examined, two or more TS in 29.8% and no TS in 23.6%. The length of the pectinate muscles is variable; the shortest are located on the medial wall. Six types of pectinate muscle patterns were observed

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Retrospective study of canine heartworm disease with caval syndrome in Grenada, West Indies.

Canine heartworm disease caused by Dirofilaria immitis is an important disease of dogs. The aim of this retrospective study was to estimate the prevalence of canine heartworm disease and evaluate cases of caval syndrome in dogs submitted for necropsy in Grenada. Out of 1617 dogs necropsied over a period of 13 years (2001-2013), 249 were found to be infected with D. immitis; giving an overall prevalence of 15.4% (95% confidence interval, 13.6% to 17.1%). There was no significant difference between male and female dogs with respect to canine heartworm infection (p = 0.3). During this period, the annual prevalence of canine heartworm disease was 22% in 2001 before slightly declining to an average of 18% in 2002-2003 and peaking at 26.8% in 2004-2005. From 2006 onwards, annual prevalence rates have steadily been decreasing; reaching the lowest (9%) in 2013. Among the 249 positive cases, 33 (13.2%) of the dogs had caval syndrome. Caval syndrome cases presented with concurrent clinical signs and were associated with cardio-pulmonary and hepatic gross lesions at necropsy. Aberrant migration of D. immitis was also noted in 2 dogs with caval syndrome. This is the first report which presents the findings of canine heartworm disease with caval syndrome in Grenada.

Management and outcome of cardiac and endovascular cystic echinococcosis.

BACKGROUND: Cystic echinococcosis (CE) can affect the heart and the vena cava but few cases are reported. METHODS: A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995-2009) is reported. RESULTS: Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4-93 months). One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE) and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications. CONCLUSIONS: Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.

Catheter-guided percutaneous heartworm removal using a nitinol basket in dogs with caval syndrome.

Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs. Several non-surgical and interventional methods are currently used for mechanical worm removal. However, the success rate and complications related to these methods are heavily dependent on methodology and retrieval devices used. In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure. With this technique, we successfully treated four dogs with caval syndrome.

[A case of secondary localized pericardial cyst hydatic disease and determination of cyst hydatic scoleces and hooks with various stains]. / Sekonder Yerlesimli Bir Perikardiyak Kist Hidatik Olgusu ve Kist Hidatik Skoleks ve Cengellerinin Bazi Boya Solüsyonlari ile Boyanmasi.

A sixty-six year-old male patient with the complaint of palpitation presented at the out-patient clinic of the thorax diseases department. The patient underwent open heart surgery (cystectomy and capitonage) for the cystic hydatidosis which was located on the front wall of the right atrium and extended to the atrioventricular cleavage. Albendazol treatment (2 x 400 mg/3 months) was given postoperatively. The complaints of the patient reoccurred 2 years later, and a cystic formation measuring 45 cm by 2.5 cm was observed by transoesaphageal echocardiography. During pathological examination, the specimen obtained from the patient during surgery was diagnosed as cystic hydatic disease, and a final diagnosis was made after the observation of scoleces and hooks in the microbiology and parasitology laboratory. Cyst ingredients were centrifuged, and then stained with carbol-fuchsin, methylene blue, Giemsa, and Ziehl Nielsen methods in order to see scoleces and hooks of the parasite. The authors presented this case both because of the rare location and staining characteristics of the parasite with different staining methods.