Discussion:
HCD is an endemic parasitic infection that can develop in almost any body part, especially the liver (75%) and lungs (15%).[4] Echinococci reach the right heart cavities by the portal or lymphatic routes, reach the left heart through the pulmonary circulation, patent foramen ovale, or an intracardiac defect that causes a right-left shunt and settles into the myocardium via the coronary circulation.[5] LV, the part of the heart with the most abundant blood supply, is most frequently involved (60%), followed by the right ventricle (10%), pericardium (7%), pulmonary artery (6%), left atrial appendage (6%) the interventricular septum (4%) have been reported.[1] In this case, no focus of HC was detected, except for multiple organ involvement in the cranial and cardiac areas; accordingly, echinococci probably reached the left heart without attaching to the pulmonary capillaries.
HCD is generally asymptomatic, and signs and symptoms typically appear decades later because the cyst grows slowly.[6]The clinical presentation of CHC varies depending on the location, age, size, infection, number, and calcification.[5] Chest pain, palpitations, and dyspnea are the main symptoms of HCD. However, it can cause fatal complications such as sudden rupture, suppuration, anaphylactic shock, arrhythmia, and embolization.[5] HC in the LV are usually located subepicardially and rarely rupture into the pericardial cavity.[7] Intracavitary rupture in LV may cause systemic embolism, such as occlusion of the mesenteric or lower extremity arteries.[8] However, HC in the right ventricle is usually located subendocardially and causes pulmonary embolization, mainly due to intracavitary rupture.[9] Operative and surviving perforated CHCs have been rarely reported in the literature. In our case, there was occlusion in the distal abdominal aorta and bilateral iliac arteries due to the rupture of the cardiac cysts into the LV. The patient had no symptoms, both the CHC and its complications.
In addition, CHC can mimic left ventricular aneurysms (LVA) or cardiac malignancies. It can also be thought to cause cardiac aneurysms acquired in childhood since it is a progressive parasitic infection that forms cystic cavities. However, no information was found in the literature regarding this.[10] In our rare case, the evaluations show that the cyst was not mimicking an aneurysm but caused a true cardiac aneurysm by the destruction of the left ventricle apical wall that was noticed after it ruptured.
The diagnosis of cardiac HCD is mainly based on clinical suspicion, cardiac imaging, and serological tests. Antibody assays are helpful primarily to confirm the possible radiological diagnosis. However, negative serological test results do not exclude the diagnosis.[11]TTE is a very sensitive and specific diagnostic tool that shows the effect of the lesion on ventricular or valve functions. CT is necessary in the diagnosis, but it can be misleading, especially in the case of myocardial cyst rupture. Cardiac MRI can provide valuable information about the lesion and its relationship to other cardiac and extracardiac structures.[12] In our patient, the negative serological tests and the absence of pathological findings in the abdomen and lung imaging caused a shift away from the diagnosis of HC in the unit that first evaluated the patient. However, cardiac involvement was detected by TTE, and MRI revealed that it caused intracavitary rupture and aneurysm in the apex of the LV.
CHC should be surgically removed even in asymptomatic patients because of the high fatal risk of complications.[13] Ventricular aneurysms are also rare in children, and theories of etiology differ.[14] Approaches to surgical treatment also differ among surgeons.[15] Typically, aneurysmectomy or primary closure with plication of the aneurysm sac is preferred.[14]  Endoventricular circular patch plasty, also known as the Dor procedure, was described by Dor in adults to repair akinetic wall segments due to transmural ischemia. The procedure reshapes the left ventricle with a suture surrounding the transition zone between the contractile myocardium and aneurysmal tissue. It restores ventricular wall continuity with a patch, but the akinetic or dyskinetic portions of the anterior wall and septum are excluded from the procedure.[16-17] This surgical approach was rarely described in children, but it offers the same benefits as in adults, such as excision of noncontractile (fibrotic) ventricular wall to minimize akinetic or dyskinetic tissues and restore natural ventricular chamber geometry.[14-15] In this case, surgical treatment was deemed appropriate because of our patient’s complicated CHC, the unknown presence of an intracardiac cystic structure, and the risks of additional complications related to the apical LVA. 
Although some superficially located small cysts can be directly intervened, resection under cardiopulmonary bypass, since 1962, has been considered the safest method for its advantages, such as preventing systemic embolization by placing aortic cross-clamps and enabling the recognition of additional lesions missed before surgery.[18] Gentle and limited manipulation of the heart under cardiopulmonary bypass reduces the risk of operative complications.[19] The choice for surgical treatment is total excision of the cyst. However, if this is not possible, complete closure of the cyst by plication and obliteration of the cavity should be performed since complications are observed in cases of simple drainage or marsupialization of the cavity near the cardiac structures.[5] In our case, the LV was explored under cardiopulmonary bypass,and no pathological tissue sample of the HC was observed. Surgical repair was performed with aneurysmectomy and Dor procedure since complete excision would not be possible in the current state.
Serological and echocardiographic check-ups are recommended five years after surgical treatment to detect recurrences after manipulation or cysts not discovered during the operation.[20]No late cardiac problems or cyst recurrence was observed during the 5 years follow-up period.