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Swiss cheese heart

Year: 2017
Type: article
Study design: Case Report
Abstract: Prior to immigrating to the USA, a 49-year-old man lived in rudimentary conditions, taking care of sheep and goats, in the Democratic Republic of the Congo. A transthoracic echocardiogram (Panel A) demonstrated a complicated cystic structure in the anteroseptum with calcified regions noted within the lesion. This cystic region did fill with echocardiographic contrast, but a blood supply was not identified. On cardiac magnetic resonance (CMR) imaging (Panels B–G), the left ventricle was mildly dilated with moderately reduced systolic function (left ventricular ejection fraction 37%). There were three large cystic cavities in the basal-to-mid anteroseptum and anterior wall as seen on cine CMR (Panels B, C and E; see Supplementary material online, Video S1–S2). Velocity-encoded phase contrast imaging demonstrated that the most basal cyst filled directly from the aortic root during diastole (Panel F; see Supplementary material online, Video S3). Flow during systole may not be present due to high pressure within the cyst during myocardial contraction or the aortic valve leaflet may close the communication during opening. First-pass perfusion demonstrated the cysts enhanced 1–2 heartbeats after contrast arrival in the aortic root (see Supplementary material online, Video S4). The cystic capsules enhanced on late gadolinium enhancement imaging. A cardiac computed tomography (CT) (Panels H and I; see Supplementary material online, Video S5) demonstrated calcification of portions of the cystic capsule and a communication between the left sinus of Valsalva and the most basal cyst. Given the cystic appearance of the lesion, calcification of the capsule, and the significant exposure history, the patient was diagnosed with cardiac echinococcosis. Isolated cardiac echinococcosis is rare. Albendazole is the primary antihelminthic therapy for echinococcosis. However, albendazole was not initiated in this patient as the extensive calcifications of the cystic capsules suggested that the parasite was dead. Surgical resection has been reported in the literature, but surgery was not performed in this patient due to the extensive nature of the myocardial cysts. Transthoracic echocardiogram. (Panel A) A three-chamber view on transthoracic echocardiogram that shows a cystic structure within the anteroseptum. CMR. (Panel B) A three-chamber steady-state free precession (SSFP) cine image demonstrates the three cystic cavities within the anteroseptum. (Panel C) A short-axis SSFP cine image shows one of the cysts in the anteroseptum. (Panel D) A three-chamber T1 parametric map shows similar T1 time in the cysts as the blood pool. (Panels E and F) A coronal cine image and associated velocity-encoded phase contrast image demonstrates the blood flow (red arrow) from the aortic root into the basal cyst in the anteroseptum. (Panel G) A three-chamber late gadolinium enhancement image shows enhancement along the capsule of the cyst. Cardiac CT. (Panel H) A three-chamber non-contrast CT image shows calcifications along the capsules of the cysts. (Panel I) A coronal contrast-enhanced CT image shows that thrombus (yellow arrow) partially fills the cyst in the anteroseptum. This work was funded in part by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health and the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health. Supplementary material is available at European Heart Journal online.
DOI: 10.1093/eurheartj/ehx626
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W2774544211
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