A 52-year-old female presented with features suggestive of acute coronary syndrome. A transthoracic echocardiogram done to assess the cardiac function and regional wall motion abnormality revealed a large cardiac cystic lesion instead, in the apical part of the interventricular septum, suggestive of a hydatid cyst. Cystic hydatid disease results from infection with the larval or adult form of the Echinococcus granulosus tapeworm. Cardiac hydatid cyst is a rare condition seen in 0.5%–2% of patients with hydatid disease, and the location of a hydatid cyst in the interventricular septum is exceptional. Cardiac hydatid cysts can rupture and cause cardiac tamponade, fatal arrhythmias, or systemic infection. The atypical location of a large hydatid cyst in the apical interventricular septum encroaching into the right ventricular cavity filling almost half of it, was an interesting finding, found worth reporting. Also, further investigations that unraveled two more hydatid cysts in the liver, made the case more interesting to report.
A 10-year-old boy presented with complaints of poor weight gain, progressively increasing dyspnea since early childhood, and orthopnea. Echocardiogram was suggestive of cor triatriatum. Cor triatriatum is a rare congenital cardiac anomaly in which the left atrium (cor triatriatum sinister) or the right atrium (cor triatriatum dextrum) is divided into two compartments by an abnormal fibromuscular septum usually with an opening between the two chambers associated with varying degrees of obstruction of the pulmonary veins. The pulmonary venous return is followed by pulmonary arterial hypertension. Cor triatriatum literally means a heart with three atria (triatrial heart), namely, the superior chamber, the inferior chamber or the true atrium, and the atrial appendage. This anomaly occurs in 0.4% of patients with congenital heart defects, with a slight male predominance. The present case of cor triatriatum sinister is being reported in view of the fact that the child remained undiagnosed till the age of 10 years, despite being “sick since a little boy” requiring multiple hospital admissions for chest infections. He had been receiving treatment for “chest problem” and had been on bronchodilators. The classical echocardiographic findings would be of academic interest as well.
Hypoplastic left heart syndrome (HLHS) includes a group of closely related anomalies characterized by severe hypoplasia of the left-sided structures of the heart including rudimentary left ventricle, combinations of mitral and aortic valve stenosis, or atresia with diminutive ascending aorta and aortic arch. Here, the case of a 10-day-old male baby with a variant of HLHS is being reported.
The clinical and echocardiographic findings in a 3-month-old cyanotic infant with congestive cardiac failure are described with stress on segmental approach to diagnosis. Echocardiography reveals dextrocardia, situs inversus, d-loop ventricle, tricuspid atresia, transposition of great vessels, subpulmonic ventricular septal defect (VSD), d-malposed aorta, restrictive atrial septal defect (ASD), and large mass in high-pressure left atrium (LA). Systemic veins drain to left-sided morphological right atrium (RA) and pulmonary veins returned to the right-sided morphological LA. In the presence of tricuspid atresia, blood from the morphological LA has only one outlet into the morphological RA through a restrictive ASD resulting in a high-pressure left atrial chamber. Blood from the morphological RA drains into the left-sided morphological left ventricle. From the left ventricle through the subpulmonic VSD, a portion of blood is directed into the pulmonary artery (PA) by passing the hypoplastic morphological right ventricle (RV) as the PA overrides the VSD. Blood flows from the hypoplastic RV into the aorta. Besides, LA mass seen in this 3 month-old-baby in the given setting is an extremely rare finding and to my knowledge has not been reported in literature before.
