Hydatid cyst in the right ventricle leading to tricuspid stenosis and heart failure: a case report.

backgroundCystic 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 emergency department with exertional dyspnea, hemoptysis, chest pain, syncope, peripheral edema, and signs of right-sided heart failure. The patient had a prior history of mechanical mitral valve replacement and was on chronic anticoagulation therapy. On physical examination, blood pressure 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 and radiopaque caged-ball mechanical mitral valve prosthesis. Transthoracic echocardiography and cardiac MRI revealed a large, multilocular cystic mass occupying the right ventricle, causing functional tricuspid stenosis with normal function of caged-ball mechanical mitral valve prosthesis. Serology for Echinococcus 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, thiopental and vecuronium for intubation. Anesthesia was maintained with fentanyl and isoflurane. Histopathology confirmed hydatid disease. The postoperative course was uneventful, and the patient was discharged on continued albendazole therapy.

conclusionThis case describes a right ventricular hydatid cyst causing functional tricuspid stenosis and acute right-sided heart failure. Diagnosis was established using multimodal imaging with transthoracic echocardiography, cardiac MRI, and confirmatory serology for Echinococcus granulosus. The patient underwent successful surgical excision under cardiopulmonary bypass with adjunctive albendazole therapy, resulting in complete symptomatic recovery. Cardiac hydatid disease should be considered in patients with intracardiac masses and right heart failure in endemic regions, as early recognition and timely surgical management are lifesaving.