Virtual Conference

Hamidullah A. Abdumadjidov

JSC Republican Specialized Surgery Center, Uzbekistan

Title: Modern views on the treatment of cardiac echinococcosis


Material and methods.   In our center 73 patients had an echinococcosis of the heart and underwent surgical treatment. Patients were divided into two groups depending on the nature 1st group - 49 (67.1%) patients with isolated heart echinococcosis; group 2 - 24 (32.8%) patients with combined echinococcosis of the heart/pericardium and target organs (liver, lungs, mediastinum).The age of patients varied from 7 to 59 years old, averaged 31.6 ± 1.55 years. Men were 36 (49.3%), women - 37 (50.6%). Diagnosis of parasitic damage to the heart was made by X-ray examination of the chest, transthoracic (TT) and transesophageal (TE) echocardiography (EchoCG), multislice spiral computed tomography (MSCT) and coronarography. Surgical intervention in 64.2% of cases was performed under cardiopulmonary bypass (75.0 ± 7.6 min) and cardioplegia (45.3 ± 4.9 min) from sternal access. In cases of parasitic pericardial or combined echinococcosis of the pericardium and lung, interventions were performed from the thoracotomic access. In 5 (8.9%) cases, combined heart and lung echinococcosis was observed. At the same time, at the beginning of activity, surgical correction was carried out in stages, in recent years, simultaneous treatment tactics have been successfully applied. In 9 cases, we observed a combined lesion of the pericardium and lungs. In all cases, patients were successfully operated from the thoracotomic access. Pericardial cysts in these observations were located extrapericardially. In one case, pneumonectomy was performed (due to multifocal recurrent lung lesions) with EE from the pericardium.
Results. Total postoperative mortality in groups was 6.8% (5 patients). In the 1st group, 2 patients died in the early postoperative period. One of these patients was diagnosed with coronary angiography with a critical stenosis of the LAD.  In the 2nd group, mortality was 5.3% (3 patients). When the echinococcal cyst of the interventricular septum was removed, damage to the anterior interventricular artery occurred, which led to the development of incurable cardiac weakness and was fatal.  In the postoperative period, anthelmintic therapy was carried out according to the recommendations.  Among non-fatal complications, ventricular arrhythmias most often occurred, which were noted in the 1st group in 7 patients (28%), and in the 2nd group - in 6 (19.3%). Heart failure in the 1st group was observed in 4 (16%), and in the 2nd group - in 5 (16.1%) patients. In 2 (8%) patients of the 1st group in the early postoperative period, a clinical picture of compressive exudative pericarditis was observed, which required drainage of the pericardial cavity. 2 patients (one in each group) had pneumopathy. Complications from the organs of the abdominal and pleural bands were not identified. 
Conclusion.  In 55.3% of cases, a combination of echinococcosis of the heart and target organs was observed. Echinococcectomy from the heart is advisable to perform in the conditions of cardiopulmonary bypass and cardioplegia. Topographic anatomy (size, location, and relationships with coronary vessels) of an echinococcal cyst are important in developing optimal surgical treatment tactics.