In this study we reported one case of combined procedure for coronary artery bypass grafting and excision of right pulmonary hydatid cyst. Concerns of possible hydatid systemic dissemination as a result of direct vascular breaches are raised. We suggest that avoidance of cardiopulmonary bypass (CPB) if that possible is beneficial for the treatment. If not possible then the excision and clearance of the hydatid cyst should be done in the first place before going on bypass.
Hydatid disease caused by echinococcosis is an endemic parasitic disease in Mediterranean Countries [
In this study we reported one case of combined procedure for coronary artery bypass grafting and excision of right pulmonary hydatid cyst.
Fifty-six-year-old female referred for consideration of coronary artery bypass grafting. She was complaining of increasing angina and breathlessness. She was in class three CCS (Canadian Cardiovascular Society classification) and Class three NYHA (New York heart association Classification). Her coronary risk factors include: smoking for the last thirty years and uncontrolled DM (diabetes mellitus) type II.
Her chest X ray revealed smooth rounded lesion in the right lung (
Thoracic and abdomen CT scan (
Her coronary angiography revealed two vessel disease: 99% stenosis in the left anterior Descending artery (LAD) and 80% in the obtuse marginal artery with moderate left ventricular function with Ejection fraction EF 45%. Patient was consented for the combined procedure. She was quoted a 5% risk of Mortality and 3% risk of Stroke.
She underwent combined procedure coronary artery bypass grafting (CABG x2) and pulmonary hydatid cyst excision (
stered and cardiopulmonary bypass instituted using a right atrial single-stage cannula for venous drainage and ascending aortic cannulation for arterial return. Conduits were of satisfactory quality. The patient was cooled to 33 degrees centigrade, aortic cross-clamp applied and antegrade cold blood cardioplegia infused to achieve prompt cardiac arrest. The following grafts were then constructed:
1) SV to OM1
2) LIMA to LAD
The cross-clamp was then released and the heart resumed in sinus rhythm. The Proximal anastomoses were now constructed to the aorta using the side clamp.
Cardiopulmonary bypass was discontinued without complications. Two chest drains were inserted, haemostasis secured and the chest closed using 7 single sternal wires. The soft tissues were approximated in two layers.
The skin was closed using monocryl (absorbable) suture. No systemic immunoreaction had been observed.
The patient was extubated six hours postoperatively. Patient had minimal pleural and mediastinal drainage postoperatively 350 mls/24h. Patient received one unit of red cell straight away postoperatively. Patient was transferred from the intensive care unite to the ward on the second postoperative day. She was discharged home on the fifth postoperative day without any complication. Her X ray on discharge was clear (
The Clinical presentation of the hydatid disease depends upon the site of the cysts and their size [
Coronary artery bypass grafting (CABG) is still the type of surgery that improves blood flow to the heart. And
it is one of the treatments for coronary heart disease. The grafted artery or vein bypasses the blocked portion of the coronary artery. This creates a new path for oxygen rich blood to flow to the heart muscle.
Patients who require coronary artery bypass grafting and who also have concomitant surgical pathology like pulmonary hydatid disease constitute a high risk group. There are always concerns of possible hydatid systemic dissemination as a result of direct vascular breach [
Surgical strategy for these patients remains controversial.
There is always a risk of cyst rupture with any positive ventilation also it is high risk to perform any procedure under general anaesthesia with a sick heart therefore we have chosen to perform a combined procedure starting with the excision of the pulmonary hydatid cyst then performing the grafting, although with this approach there is small Risk of bleeding in the lung after administering the heparin therefore we obliged to check the pulmonary surgical site by the end of the procedure.
The avoidance of cardiopulmonary bypass CPB is beneficial for the treatment if that possible [
There was no problem with our access with median sternotomy to reach the pulmonary cyst, Although it is feasible to do lateral extension (half clamshell) of the midline incision if we need to.
Combined procedure of Coronary artery bypass grafting and excision of pulmonary hydatid disease is feasible starting with the excision of the hydatid cyst. It is advisable to avoid the cardiopulmonary bypass if that possible to prevent the passage of hydatid particle to the pump [
This study was approved by our ethical committee and it was presented at our hospital weekly scientific meeting.
A. AlKhaddour,S. AlHashimi,N.Abbas, (2016) Combined Procedure for Coronary Artery Bypass Grafting and Pulmonary Hydatid Disease. World Journal of Cardiovascular Surgery,06,14-18. doi: 10.4236/wjcs.2016.61003