1. 11th International Pulmonary Hypertension Forum, Dublin, Ireland, 11-13 may 2012
Pulmonary Hypertension and Right Cardiac Hydatidosis : Review of 2 Cases
D Hakem*(1); R Yahyiaoui*(2); Z Benoui (3), S Ayat(4); R Boughrarou(4), B Mansouri (4); R Bourezag (5);
R Amrane*(2), A Berrah *(1);
(1) Internal Medicine ; (2) Pneumology ; (3) Cardiology, Beni-Messous Universitary Hospital Center, (4) Radiology :
Dr Mohammad-Lamine Debaghine’s Hospital; Bab-El-Oued Universitary Hospital Centre, Algiers;
(5) Cardiac Surgery, Mohammad Abderrahmani’s Hospital, Bir-Mourad Rais, Algiers.
Pulmonary Hypertension Committee Of Bab-El-Oued Universitary Hospital Center*

2. Introduction
The cardiac hydatidosis is a rare and serious localization which can complicate of an arterial hypertension pulmonary (PH) consequence of a secondary pulmonary embolism in the rupture of the hydatid cysts (HC) in the right cardiac cavities or a fistulization of a hepatic HC in the inferior vena cava (IVC).

3. Aims
To report 2 cases reports to illustrates an unusual etiology of PH observed respectively in Internal Medicine and in Pneumology department.

4. Case report 1
37 years old woman is explored in internal medicine for a lung and renal syndrome making evoke micro-polyangeitis (ANCA vasculitis).
Medical history begins a few weeks rather with an acute dyspnoea mimicking embolism disease and leading to the diagnosis of a release of pulmonary ball.
Consequences are labeled by a degradation of the renal function requiring 9 sessions of hemodialysis which allows the restitution of the renal function in a complete way.
The investigations exclude a vasculitis and a metastatic cause of these bilateral and multiple lung opacities.
The symptomatology complicates by the appearance of a bilateral pulmonary embolism ‘PE’ at the origin of a pulmonary hypertension (PH).
The cardiac echo-Doppler ultrasound method objectifies 55 mm Hg of pulmonary arterial systolic pressure
The transeasophageal ultrasound echocardiography allows identifying a mass of the compatible right ventricle with a cardiac thrombus or a tumor process.
The imaging by cardiac MRI allows making the diagnosis of HC localized in the right ventricle with invasion of the intraventricular septum complicated with a hydatic pulmonary embolism.
Liver scanner tomography imaging does not localize HC at the hepatic level nor at the level of the IVC.
The patient receives a symptomatic treatment and beneficiate of cardiac surgery.
The post surgery is marked by nosocomial endocarditis and favorable followed with moderate residual PH

5. Case report 2
27-year-old man in the history of bilateral lungwort hydatidosis witch was treated by thoracic surgery in 2003 presents it 2006 a PE revealed by an acute dyspnoea and a hemoptysis of small abundance.
The data of the thoracic angioscan confirms the diagnosis of PE and ends in a secondary bilateral massive pulmonary embolism in the rupture of a cardiac HC of the right ventricle.
So the patient benefits from an anticoagulant treatment then from a cardiac surgery (cystectomy) under extracorporeal circulation.
The immediate course is favorable.
However in 3 months of the intervention the patient is seen again for a dyspnoea stage III of NYHA with signs of right-sided heart failure.
The cardiac echo-Doppler ultrasound method objectifies then PA (80 mm Hg of pulmonary arterial systolic pressure) and note dilation of the right cavities.
The cardiac MRI does not objectives local recurrence.
The test of walking of 6mn is evaluated in 350m and the rate of pro-BNP estimated in 950pg / ml.
The patient is stabilized under a conventional treatment associated with an antagonist of the receptors of the endothelin.

6. Conclusion
Following the example of the portal high blood pressures complicating the compressive HC cysts of the hepatic dome, the PH complicates the rupture of the HC of the right ventricle
This clinical status aggravates the prognosis of this still endemic, multifocal disease proving a systematic cardiac exploration (ultrasonic echocardiography by transesophageal way and cardiac 'MRI' imaging...) besides the hepatic imaging and the abdominal vascular exploration (vacuity of the IVC) in front of any hydatidosis lungwort.

7. Iconography : patient 1
Cardiac MRI and chest angio-TDM showing a HC localized in the right ventricle with invasion of the intraventricular septum complicated with a hydatic pulmonary embolism.

8. Iconography : patient 2
Dilatation of right heart cavities and pulmonary artery in cardiac MRI, chest angiotomodensitometry and echocardiography

9. Bibliography
Kolsi M. ; Frikha I. ; Triki N ; Ayadi H ; Siala I ; Ayoub A; Sahnoun Y : Localisation cardiaque d'une hydaditose multifocale : À propos d'un cas. Cardiac multifocal hydatid cyst . Archives des maladies du cœur et des vaisseaux Y. 2005, vol. 98, No. 1, pages 75-77
El Hattaoui M, Charei N ; Bennis A ; Tahiri A ; Chraibi N, Haddani J ; Mehadji B.A : Cardiac hydatid cysts: report of 10 cases ; Archives des maladies du cœur et des vaisseaux Y. Cardiac hydatid cysts: 2006, vol. 99, no1, pp
X. Bréchignac, I. Durieu, M. Perinetti, L. Gérinière, C. Richalet, D. Vital Durand : Kyste hydatique du cœur ; Presse médicale, Vol 26 - N° 14 ; P avril 1997
S. Jerbi, N. Romdhani, A. Tarmiz, C. Kortas, S. Mlika, N. Khelil, M. Belghith, F. Limayem, K. Ennabli ; Kyste hydatique emboligène du cœur droit : Annales de Cardiologie et d'Angéiologie, Volume 57, Issue 1, Pages 62-65 
R. Abounadi , A. El Meziane , M. El Biaze, A. Bakhatar ,N. Yassine , A. Alaoui-Yazidi, A. Bahlaoui : Hydatidose cardiaque compliquée d'une dissémination parenchymateuse, pulmonaire et vasculaire artérielle pulmonaire : Revue de pneumologie, Vol 62 - N° 4 P septembre 2006.