The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study

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The clinical picture may vary considerably and may include arrhythmias and myocarditis, up to a potentially life-threatening embolism of the cystic contents in cases of rupture into a cardiac chamber. Early and proper diagnosis is very important to avoid serious complications such as infection and rupture of the cyst. Although medical treatment may provide a certain degree of control, surgery remains the preferred treatment because it offers good results and a low possibility of recurrence when performed early. Methodology This retrospective case-series study examined five patients diagnosed with cardiac hydatid cysts between January 2018 and July 2024. All cases were managed by a qualified cardiac surgeon in Al-Anbar Governorate, Iraq. The effectiveness and safety of surgical management were evaluated on the basis of clinical information, radiographic findings, surgical procedures, and post-operative outcomes. Results All five patients successfully underwent excision of the cardiac hydatid cysts. The post-operative course was uneventful in all cases except one patient who developed significant post-operative bleeding that required re-exploration. No deaths occurred, and good clinical recovery was achieved. No incidence of cyst rupture, secondary infection, or cyst recurrence was reported during the follow-up period. Conclusions Although uncommon, cardiac hydatid cysts should be included in the differential diagnosis of cardiac masses, particularly in endemic areas. Echocardiography and advanced imaging should be used for early diagnosis to prevent severe complications. Surgery remains the cornerstone of treatment because it offers a high success rate with low risk when performed in a timely and careful manner. The positive results in this series support the importance of timely surgical referral and multidisciplinary management. 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F1000Research 2026, 15 :65 ( https://doi.org/10.12688/f1000research.172453.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Clinical Practice Article Revised The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] Previously titled: "The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases" Maath Mohammed Muhsin https://orcid.org/0009-0008-2837-5580 1 , Noor Hussain Abady https://orcid.org/0000-0003-3219-3081 2 , Aminah Hilal Khallaf 3 Maath Mohammed Muhsin https://orcid.org/0009-0008-2837-5580 1 , Noor Hussain Abady https://orcid.org/0000-0003-3219-3081 2 , Aminah Hilal Khallaf 3 PUBLISHED 05 May 2026 Author details Author details 1 Pathology, University of Fallujah, College of medicine, Fallujah, Iraq 2 Surgery, University of Fallujah, College of medicine, Fallujah, Iraq 3 Gynecology, Nu'man teaching hospital, Baghdad, Iraq Maath Mohammed Muhsin Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Noor Hussain Abady Roles: Data Curation Aminah Hilal Khallaf Roles: Data Curation, Formal Analysis OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Fallujah Multidisciplinary Science and Innovation gateway. Abstract Background Cardiac hydatid cysts are an uncommon presentation of heart disease and most often affect the left ventricle. The clinical picture may vary considerably and may include arrhythmias and myocarditis, up to a potentially life-threatening embolism of the cystic contents in cases of rupture into a cardiac chamber. Early and proper diagnosis is very important to avoid serious complications such as infection and rupture of the cyst. Although medical treatment may provide a certain degree of control, surgery remains the preferred treatment because it offers good results and a low possibility of recurrence when performed early. Methodology This retrospective case-series study examined five patients diagnosed with cardiac hydatid cysts between January 2018 and July 2024. All cases were managed by a qualified cardiac surgeon in Al-Anbar Governorate, Iraq. The effectiveness and safety of surgical management were evaluated on the basis of clinical information, radiographic findings, surgical procedures, and post-operative outcomes. Results All five patients successfully underwent excision of the cardiac hydatid cysts. The post-operative course was uneventful in all cases except one patient who developed significant post-operative bleeding that required re-exploration. No deaths occurred, and good clinical recovery was achieved. No incidence of cyst rupture, secondary infection, or cyst recurrence was reported during the follow-up period. Conclusions Although uncommon, cardiac hydatid cysts should be included in the differential diagnosis of cardiac masses, particularly in endemic areas. Echocardiography and advanced imaging should be used for early diagnosis to prevent severe complications. Surgery remains the cornerstone of treatment because it offers a high success rate with low risk when performed in a timely and careful manner. The positive results in this series support the importance of timely surgical referral and multidisciplinary management. READ ALL READ LESS Keywords Cardiac hydatid cyst, Echinococcosis, Cardiac surgery. Corresponding Author(s) Maath Mohammed Muhsin ( [email protected] ) Close Corresponding author: Maath Mohammed Muhsin Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Mohammed Muhsin M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Mohammed Muhsin M, Hussain Abady N and Hilal Khallaf A. The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.12688/f1000research.172453.2 ) First published: 16 Jan 2026, 15 :65 ( https://doi.org/10.12688/f1000research.172453.1 ) Latest published: 05 May 2026, 15 :65 ( https://doi.org/10.12688/f1000research.172453.2 ) Revised Amendments from Version 1 The manuscript has been thoroughly revised, taking into account the valuable comments of the reviewers, which enriched the manuscript with important aspects that enhanced its quality, such as improving the introduction, making some spelling corrections, and providing further clarification in the Methods and Discussion sections. The manuscript has been thoroughly revised, taking into account the valuable comments of the reviewers, which enriched the manuscript with important aspects that enhanced its quality, such as improving the introduction, making some spelling corrections, and providing further clarification in the Methods and Discussion sections. See the authors' detailed response to the review by Ali Bilal Ulas See the authors' detailed response to the review by Laila Jedidi READ REVIEWER RESPONSES Introduction Hydatid cysts are parasitic infections mostly caused by Echinococcus granulosus and are mostly observed in the liver and lungs. Echinococcosis is a human infection caused by the larval stage of any species of the E. granulosus complex, E. multilocularis , or E. vogeli. E. granulosus complex parasites that cause unilocular cystic lesions are common in areas where livestock are kept in close proximity to dogs. 1 Echinococcus granulosus has a 2-host life cycle. Dogs and other canines are definitive hosts, whereas sheep and other herbivorous animals are intermediate hosts. Humans serve as an incidental intermediate host (dead end), infected by the ingestion of food contaminated with feces from dogs harboring E. granulosus eggs. 2 Eggs develop into a larva in the duodenum. The larva pierces the intestinal wall, enters the portal circulation, and is transported to the liver, lungs, or seldom, to other organs. The host immune response attempts to eliminate the parasites after tissue invasion, where an inflammatory reaction occurs around the sites where the parasites are lodged. Although the immune response destroy many parasites, some survive, escape elimination, and continue to develop into hydatid cysts, surrounded by fibrous connective tissue, and become fluid-filled bladder-like cysts, usually in the liver (60-70%, in the right lobe) or lung (20-30%). Hydatid cysts can also occur in other organs such as the spleen and kidney (35%), brain and heart (11.5%), and bones in rare cases. 2 The hexacanth embryo (six-hooked, first-stage larva) reaches the heart through the coronary arteries and gives rise to a primary, often solitary, hydatid cyst within the myocardial layers. Secondary cardiac involvement may follow rupture of a primary cyst into the pericardial cavity. In such cases, the resulting cysts are initially superficial and subepicardial but may later extend into the myocardium, where they often become multiple. 3 After cardiac hydatid cysts develop, their progressive enlargement may produce characteristic structural and functional effects. Patients from endemic regions who present with an abnormal cardiac shadow on chest radiography (CXR) should, therefore, raise suspicion of cardiac hydatid disease. As the cyst enlarges, it compresses the surrounding myocardium and may displace the coronary vessels, cause rhythm disturbances, and interfere mechanically with atrioventricular valve and ventricular function. Echocardiography remains the preferred imaging modality for the diagnosis of cardiac hydatidosis. Computed tomography may help confirm the diagnosis and exclude hydatid involvement of the liver, lungs, and brain when uncertainty remains. Case management depends on cyst size, location, symptoms, and the general condition of the patient. Surgery remains the definitive treatment for cardiac echinococcosis. Operative mortality in cystic echinococcosis has generally ranged from 0.5% to 4%, whereas long-term recurrence has ranged from 2% to 25%, with a greater risk after repeat intervention. Older series of cardiac hydatid disease reported operative mortality rates of 4.8% to 10%, although more recent small series have shown better outcomes. Albendazole and mebendazole have demonstrated efficacy against cystic echinococcosis, but albendazole remains the preferred agent due to its superior systemic absorption and greater penetration into hydatid cysts. Medical therapy alone is reserved for inoperable cysts, poor clinical condition, or multiple-organ involvement, and albendazole is also used before and after surgery to reduce recurrence. 4 , 5 The study aims to characterize the different presentations of cardiac hydatid cysts in an endemic setting and to emphasize that early diagnosis and timely treatment may prevent major complications, particularly infection and rupture. Patients and methods The present retrospective case-series study included five consecutive patients with cardiac hydatid cysts who underwent surgical treatment at the Iraqi Center for Heart Diseases, Medical City, Baghdad, between January 2018 and July 2024. The series included one case in 2018, one case in 2020, two cases in 2023, and one case in June 2024. Inclusion criteria comprised all patients diagnosed with cardiac hydatid cysts who underwent surgical management at our center during the study period, whereas patients with incomplete records or non-surgical management were excluded. Patient age ranged from 20 to 50 years, and the female-to-male ratio was 4:1, as shown in Figure 1 . All patients were referred by a cardiologist to a cardiac surgeon, and all underwent open-heart surgery through median sternotomy with cardiopulmonary bypass and cardioplegic arrest. After exposure of the cyst, the surrounding operative field was isolated with pads soaked in povidone iodine. The cyst content was aspirated carefully before excision in order to reduce the risk of spillage. The residual cavity was managed according to cyst location and myocardial involvement. The myocardial defect was repaired according to the size and site of the defect; patch repair was used in cases with a large defect or friable ventricular wall. Synthetic patch was used (PTFE patch). Figure 1. Age distribution of the five patients with cardiac hydatid cysts included in the present case-series. Clinical presentation varied across the series. Palpitation was the most frequent presenting complaint and occurred in three patients. One patient presented with ischemic chest pain associated with elevated cardiac enzyme levels and electrocardiographic changes. One patient presented with weakness and headache secondary to a brain hydatid cyst. Diagnosis was established in all patients by echocardiographic examination and chest computed tomography. Serological testing for echinococcosis was performed in some patients when available. Figure 2 shows an echocardiographic image of a left atrial hydatid cyst located posterior to the heart with daughter cysts. In the left atrial case, the diagnosis favored hydatid cyst rather than myxoma because imaging showed a cystic lesion with daughter cysts and without the typical pedunculated attachment expected for atrial myxoma. Four patients had isolated cardiac hydatid disease, whereas one patient had combined cardiac, splenic, and brain hydatid cysts. In the patient with multi-organ hydatid disease, cardiac surgery was prioritized because of the immediate risk associated with the intracardiac lesion. The extracardiac lesions were managed in a staged manner with postoperative follow-up and adjunct medical therapy. Figure 2. Transthoracic echocardiography showing a left atrial hydatid cyst located posterior to the heart with daughter cysts (colored arrow). Cardiac involvement affected the left ventricle in four patients. One patient had a left atrial hydatid cyst with daughter cyst dissemination to the brain. Three patients had ruptured hydatid cysts. Two of those patients had intrapericardial rupture associated with pericardial adhesions, whereas one patient had rupture of a left atrial cyst into the cardiac cavity. Two patients had intact cysts. Figure 3 shows an intact left ventricular hydatid cyst during aspiration of the cyst content, Figure 4 shows the left ventricular cavity after cyst excision, and Figure 5 shows intrapericardial rupture of a cardiac hydatid cyst. Three patients had a single cardiac hydatid cyst, whereas two patients had multiple cardiac hydatid cysts. Figure 3. Intraoperative photograph of an intact left ventricular hydatid cyst during careful aspiration of cyst content before excision. Figure 4. Intraoperative view of the left ventricular cavity after excision of the hydatid cyst. Figure 5. Intraoperative view showing intrapericardial rupture of a cardiac hydatid cyst. Operative course was reviewed in all cases, where two operations were complicated by adhesions and extension of the aortic incision, which the operative notes attributed to friable tissue related to the inflammatory process. Three operations proceeded without major intraoperative difficulty. Early postoperative review identified one patient who developed significant bleeding and required re-exploration on cardiopulmonary bypass with re-suturing of the left ventricular free wall. Elevated blood pressure during recovery contributed to delayed extubation until the first postoperative day, massive blood transfusion, and prolonged intensive care unit stay. Albendazole was administered in all patients at a high dose of 400 mg twice daily. Follow-up of the first two cases extended to five years and showed no recurrence with good cardiac function. Follow-up of the last three cases was shorter, but no recurrence was detected and cardiac function remained good. Two female patients later completed uncomplicated pregnancy and labor two years after surgery. A summary of patient demographics, clinical presentation, cyst characteristics, operative management, follow-up, and outcomes is presented in Table 1 . Table 1. Summary of patient demographics, clinical presentation, cyst characteristics, management, follow-up, and outcomes. Variable Findings in the present series Number of patients 5 Study period January 2018 to July 2024 Year distribution 1 case in 2018, 1 case in 2020, 2 cases in 2023, 1 case in June 2024 Age range 20–50 years Female:male ratio 4:1 Residence 1 rural, 4 urban History of sheep contact None reported Presentations Palpitation in 3 patients; ischemic chest pain with elevated cardiac enzymes and ECG changes in 1 patient; weakness and headache due to brain hydatid cyst in 1 patient Diagnostic tools Echocardiography and chest CT in all patients Cardiac involvement Left ventricle in 4 patients; left atrium in 1 patient Extracardiac involvement Isolated cardiac disease in 4 patients; combined cardiac, splenic, and brain hydatid disease in 1 patient Rupture status 3 ruptured cysts, 2 intact cysts Type of rupture 2 intrapericardial ruptures with pericardial adhesion; 1 intracardiac rupture in the left atrium Cyst number Single cardiac cyst in 3 patients; multiple cardiac cysts in 2 patients Surgical approach Open-heart surgery through median sternotomy, cardiopulmonary bypass, and cardioplegic arrest in all patients Intraoperative course 2 operations complicated by adhesions and extension of the aortic incision; 3 operations without major intraoperative difficulty Early postoperative event 1 patient developed significant bleeding requiring re-exploration and re-suturing of the left ventricular free wall Anthelmintic therapy Albendazole 400 mg twice daily in all patients Follow-up First 2 cases followed for 5 years; last 3 cases had shorter follow-up Outcome No mortality, no recurrence, and good cardiac function in all cases Discussion Isolated cardiac hydatid cysts are rare events, 6 as contraction of the heart fights vital cysts. Cardiac hydatid cysts appear as makeshift bombs and may rupture at any time; therefore, they should be diagnosed early and treated seriously. There are two types of rupture, intrapericardial rupture and intracardiac rupture, and both complications were present in our cases. The female: male ratio was 4:1, unlike Oraha et al. (2018), 7 which was conducted in Kurdistan, north of Iraq, and included four cases, three male and one female. In this study, we noticed that the incidence in the last two years was 60%. Eighty percent of patients were from urban areas rather than rural areas, which might be due to contaminated food from restaurants. The presence of loose dogs in the cities also represents a risk factor for transmission of eggs of E. granulosus to cattle and, accidentally, to human beings. Regarding the presentation of patients, 60% presented with palpitation, which agrees with the findings of Oraha et al. (2018). 7 Twenty percent of patients presented with CNS manifestations due to rupture of the left atrial hydatid cyst with a daughter cyst delivered to the brain. Another 20% of patients presented with features of IHD due to rupture of a large LV H. C to the pericardium, which stimulated the inflammatory process and caused pericarditis with myocarditis and elevated cardiac enzymes. Four patients had LV H. C because coronary circulation is the first station after the blood leaves the heart. That finding agrees with Oraha et al. (2018). 7 , 8 Regarding diagnostic investigations of choice, echocardiography and chest CT scan agree with Oraha et al. (2018), 7 as the diagnosis of cardiac hydatid cyst is easy with a typical cystic appearance on echocardiography. However, it is difficult to distinguish it from myxoma in rare cases. 9 , 10 Surgery is the treatment modality of choice; all patients underwent median sternotomy open heart surgery. The patient who had multiple cardiac hydatid cysts after rupture of the main cyst and spillage of daughter cysts into the pericardial space developed extension of the aortic cannulation site during surgery, but the complication was controlled successfully. During the post-operative period, the patient who developed significant bleeding required re-exploration on cardiopulmonary bypass due to elevated blood pressure, while there was a friable LV wall due to the inflammatory process that caused separation of the LV wall patch. The friability in that case was most likely related to inflammatory involvement of the myocardial tissue by the ruptured hydatid cyst. In similarly fragile cases, reinforcement with a biological patch may offer additional protection against separation at the repair site, although this possibility requires further evaluation. However, the mortality rate was zero, with good surgical outcomes. In our study we use synthetic patch as biological patch was not available in our center at that time. However, the mortality rate was zero, with good surgical outcomes. The study has several limitations as the sample size was small because cardiac hydatid disease is rare, the study was retrospective, and follow-up duration was not uniform across all patients. Serological testing and advanced imaging were not available in a standardized manner for every case. These limitations reduce the generalizability of the findings, although the series still provides useful clinical and operative observations from an endemic setting. Recommendation • Improve public hygiene and sanitation practices. • Increase public awareness of hydatid disease and its modes of transmission through television programs, social media, and other health education platforms. • Slaughterhouses should ensure proper disposal of the viscera and bowel of infected sheep in order to limit further transmission. • Functional or non-organic diagnoses should be considered only after exclusion of organic causes, especially in patients with repeated presentations to the emergency department in endemic areas. Conclusion Cardiac hydatid cyst is an uncommon but important diagnosis in endemic settings and requires early recognition because delayed treatment may lead to serious complications. The present case-series showed favorable surgical outcomes, with no mortality, no recurrence during follow-up, and good postoperative cardiac function in all patients. Echocardiography and computed tomography played an important role in diagnosis, whereas timely surgical intervention remained central to management. The limited sample size and non-uniform follow-up restrict generalization, but the findings still support early diagnosis and surgical treatment as key components of care in operable cases. Consent The study was based on a retrospective review of hospital-admitted patients who had already received standard clinical care. According to institutional practice, separate ethics committee approval was not required for retrospective analysis of anonymized clinical data. Despite that, ethical approval was obtained from the University of Fallujah. Written informed consent for treatment had been obtained at hospital admission, and written informed consent for publication of clinical details and images was obtained from the patients or their legal guardians. Data availability All data underlying the result of this article are available as a part of the article and no additional data source is required as this is case series study of rare disease. The completed CARE Checklist supporting this case-series submission has been uploaded to an external public repository (OSF). The file is titled “ The outcome of cardiac hydatid surgery in the Iraqi center of heart disease” and is available under a CC0 1.0 Universal license . DOI: 10.17605/OSF.IO/SJUBC Repository: Open Science Framework (OSF) A full reference to the repository has been included in the Reference list. Acknowledgements The authors sincerely thank their families, especially their parents, for their constant support. The authors also acknowledge their teachers and mentors for their valuable guidance and training in cardiac surgery. The authors are especially grateful to the patients for the trust they placed in the surgical team. References 1. Kasper DL, Fauci AS, Hauser SL, et al. : Harrison's Principles of Internal Medicine. 19th ed. New York: McGraw Hill Education Medical;2015. 2. Sastry AS, Bhat S: Essentials of Medical Parasitology. 2nd ed. New Delhi: JP Medical Ltd;2018. 3. Thameur H, Abdelmoula S, Chenik S, et al. : Cardiopericardial hydatid cysts. World Journal of Surgery. 2001; 25 (1): 58–67. PubMed Abstract | Publisher Full Text 4. Firouzi A, Neshati Pir Borj M, Alizadeh GA: Cardiac hydatid cyst: A rare presentation of echinococcal infection. J Cardiovasc Thorac Res. 2019; 11 (1): 75–77. PubMed Abstract | Publisher Full Text | Free Full Text 5. Brunetti E: Cystic Echinococcosis Treatment & Management. Medscape. 2026. Publisher Full Text 6. Kabbani SS, Jokhadar M, Sundouk A, et al. : Surgical management of cardiac echinococcosis. Report of four cases. J Cardiovasc Surg (Torino). 1992; 33 (4): 505–510. PubMed Abstract 7. Oraha AY, Faqe DA, Kadoura M, et al. : Cardiac Hydatid cysts; presentation and management. A case series. Annals of Medicine and Surgery. 2018; 30 : 18–21. PubMed Abstract | Publisher Full Text | Free Full Text 8. Beshlyaga VM, Demyanchuk VB, Glagola MD, et al. : Echinococcus cyst of the left ventricle in 10-year-old patient. Eur J Cardiothorac Surg. 2002; 21 (1): 87. PubMed Abstract | Publisher Full Text 9. Jeridi G, Boughzala E, Hajri S, et al. : Complicated hydatid cyst of the right atrium simulating myxoma of the tricuspid valve. Ann Cardiol Angeiol (Paris). 1997; 46 (3): 159–162. PubMed Abstract 10. Bolourian AA: Cardiac echinococcosis presenting as myxoma, report of a very rare case. Cardiovascular Surgery. 1997; 5 (S1): 62. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 16 Jan 2026 ADD YOUR COMMENT Comment Author details Author details 1 Pathology, University of Fallujah, College of medicine, Fallujah, Iraq 2 Surgery, University of Fallujah, College of medicine, Fallujah, Iraq 3 Gynecology, Nu'man teaching hospital, Baghdad, Iraq Maath Mohammed Muhsin Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Noor Hussain Abady Roles: Data Curation Aminah Hilal Khallaf Roles: Data Curation, Formal Analysis Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 05 May 2026, 15:65 https://doi.org/10.12688/f1000research.172453.2 version 1 Published: 16 Jan 2026, 15:65 https://doi.org/10.12688/f1000research.172453.1 Copyright © 2026 Mohammed Muhsin M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Mohammed Muhsin M, Hussain Abady N and Hilal Khallaf A. The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.12688/f1000research.172453.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 05 May 2026 Revised Views 0 Cite How to cite this report: Ulas AB. Reviewer Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.198742.r481837 ) The direct URL for this report is: https://f1000research.com/articles/15-65/v2#referee-response-481837 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 May 2026 Ali Bilal Ulas , Department of Thoracic Surgery, Ataturk University, Erzurum, Turkey Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.198742.r481837 Dear Authors, thank you for the revisions. As I said before, it’s better to use clinical terms; the phrase makeshift bombs is a bit too dramatic for a scientific paper. Instead of "behaving like makeshift bombs" you may use "posing ... Continue reading READ ALL Dear Authors, thank you for the revisions. As I said before, it’s better to use clinical terms; the phrase makeshift bombs is a bit too dramatic for a scientific paper. Instead of "behaving like makeshift bombs" you may use "posing a high risk of spontaneous rupture and subsequent anaphylaxis". The other one, the expression; contraction of the heart fights vital cysts, is a bit vague. Again istead of it you may try; constant myocardial contractility and high intraventricular pressure create a mechanical environment that limits the growth and attachment of hydatid cysts. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Thoracic Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ulas AB. Reviewer Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.198742.r481837 ) The direct URL for this report is: https://f1000research.com/articles/15-65/v2#referee-response-481837 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 16 Jan 2026 Views 0 Cite How to cite this report: Jedidi L. Reviewer Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.190178.r467674 ) The direct URL for this report is: https://f1000research.com/articles/15-65/v1#referee-response-467674 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 01 Apr 2026 Laila Jedidi , University of Tunis El Manar, Tunis, Tunisia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.190178.r467674 This manuscript presents a retrospective case series of five patients undergoing surgical management for cardiac hydatid cysts at a single center in Iraq between 2018 and 2024. The authors describe clinical presentations, imaging findings, surgical approaches, and postoperative outcomes. All ... Continue reading READ ALL This manuscript presents a retrospective case series of five patients undergoing surgical management for cardiac hydatid cysts at a single center in Iraq between 2018 and 2024. The authors describe clinical presentations, imaging findings, surgical approaches, and postoperative outcomes. All patients underwent surgical excision with no mortality and favorable outcomes, although one case required re-exploration for postoperative bleeding. The study highlights the importance of early diagnosis and surgical intervention in this rare condition. However, few corrections need to be done */Inclusion and exclusion criteria are not clearly define */It is unclear whether cases were consecutive */No clear description of preoperative protocol, Surgical techniques */Follow-up is inconsistent: 5 years for some patients, short term for others. */The discussion lacks depth and does not sufficiently place findings in the context of existing literature. There is minimal critical analysis, no discussion of limitations, and no clear clinical implications. ->Expand the discussion with a more comparison with published case series. Discussion of recurrence risk and alternative management strategies. */Figures are useful but legends lack details */comprehensive patient summary table should be added */language issues: -Typographical errors: "operatve" → operative "reccurrence" → recurrence "rapture" → rupture -Unclear terms: soft pregnancy, Hysterical disease, cardia hydatid, makeshift bombs -"successfully underwent successful excision": repetition */Which scolicidal agent was used? */Were serological tests performed? */How was the multi-organ hydatid case managed? */How was the myocardial defect repaired? Is the background of the cases’ history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the conclusion balanced and justified on the basis of the findings? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: General surgery; clinical research; management of hydatid disease. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Jedidi L. Reviewer Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.190178.r467674 ) The direct URL for this report is: https://f1000research.com/articles/15-65/v1#referee-response-467674 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 May 2026 د.معاذ محمد , Pathology, University of Fallujah, College of medicine, Fallujah, Iraq 05 May 2026 Author Response Dear Reviewer, We sincerely thank you for your valuable, thoughtful, and constructive comments. Your feedback greatly helped us improve the structure, clarity, and scientific quality of the manuscript. We carefully ... Continue reading Dear Reviewer, We sincerely thank you for your valuable, thoughtful, and constructive comments. Your feedback greatly helped us improve the structure, clarity, and scientific quality of the manuscript. We carefully revised the paper in response to all points raised. For ease of evaluation, all modifications in the revised manuscript have been highlighted in yellow. Comment 1: Inclusion and exclusion criteria are not clearly defined. Response: Thank you for this important comment. We have now clearly defined the inclusion and exclusion criteria in the Patients and methods section. Inclusion criteria comprised all patients diagnosed with cardiac hydatid cysts who underwent surgical management at our center during the study period, whereas patients with incomplete records or non-surgical management were excluded. Comment 2: It is unclear whether cases were consecutive. Response: We appreciate this point. We have now clarified that the series included five consecutive patients treated during the study period. Comment 3: No clear description of preoperative protocol and surgical technique was provided. Response: Thank you for this valuable comment. We have expanded the Patients and methods section to include the diagnostic work-up with echocardiography and chest computed tomography, serological testing when available, the use of albendazole, and the operative technique. The revised manuscript now specifies median sternotomy, cardiopulmonary bypass, cardioplegic arrest, isolation of the operative field with pads soaked in povidone iodine, careful aspiration before excision, and management of the myocardial defect according to cyst size and site. Comment 4: Follow-up duration is inconsistent. Response: We acknowledge this limitation. We have now clarified the follow-up pattern in the text and summarized it in Table 1. The first two cases had follow-up for five years, whereas the last three cases had shorter follow-up. We also added a limitations paragraph in the Discussion to acknowledge the non-uniform follow-up duration. Comment 5: The Discussion lacks depth and critical analysis. Response: We appreciate this comment. The Discussion include comparison with previous case series, interpretation of rupture patterns and operative complications, the role of early diagnosis and surgery, and a dedicated paragraph on study limitations and generalizability. Comment 6: Figure legends lack details. Response: Thank you for pointing this out. We revised the figure legends to make them more informative by adding the imaging modality, the relevant anatomical findings, and intraoperative context where appropriate. Comment 7: A patient summary table should be added. Response: We agree with this helpful suggestion. We added Table 1, which summarizes patient demographics, clinical presentation, cyst characteristics, operative management, follow-up, and outcomes. Comment 8: Multiple language and typographical issues were identified. Response: Thank you for noting this. The manuscript has undergone careful language revision, and spelling, grammar, terminology, and phrasing were corrected throughout the text to improve clarity and readability. Comment 9: Which scolicidal agent was used? Response: We have now clarified in the Patients and methods section that povidone iodine was used intraoperatively to isolate the surrounding operative field before cyst aspiration. Comment 10: Were serological tests performed? Response: Thank you for this comment. We have clarified that serological testing for echinococcosis was performed in some patients when available. Comment 11: How was the multi-organ hydatid case managed? Response: We have now added a clearer description of that case. Cardiac surgery was prioritized because of the immediate risk posed by the intracardiac lesion, whereas the extracardiac lesions were managed in a staged manner with postoperative follow-up and adjunct medical therapy. Comment 12: How was the myocardial defect repaired? Response: We appreciate this question. The revised manuscript now states that the myocardial defect was repaired according to the size and site of the defect, and that patch repair was used in cases with a large defect or friable ventricular wall. Comment 13: Background and progression are sufficiently described. Response: We sincerely appreciate this positive assessment. Comment 14: Diagnostic and treatment details are partly sufficient. Response: Thank you for this observation. We have incorporated additional diagnostic, operative, and follow-up details to improve completeness and clarity. Comment 15: Discussion and clinical relevance are partly sufficient. Response: We appreciate this comment. The Discussion was slightly improved to strengthen the clinical relevance of the findings, especially regarding rupture patterns, diagnosis, operative management, and the importance of early intervention in endemic areas. Comment 16: Conclusion is balanced and justified. Response: We thank you for this positive and encouraging assessment. We greatly appreciate your constructive comments, which helped us improve the manuscript substantially. Yours sincerely, Maath Dear Reviewer, We sincerely thank you for your valuable, thoughtful, and constructive comments. Your feedback greatly helped us improve the structure, clarity, and scientific quality of the manuscript. We carefully revised the paper in response to all points raised. For ease of evaluation, all modifications in the revised manuscript have been highlighted in yellow. Comment 1: Inclusion and exclusion criteria are not clearly defined. Response: Thank you for this important comment. We have now clearly defined the inclusion and exclusion criteria in the Patients and methods section. Inclusion criteria comprised all patients diagnosed with cardiac hydatid cysts who underwent surgical management at our center during the study period, whereas patients with incomplete records or non-surgical management were excluded. Comment 2: It is unclear whether cases were consecutive. Response: We appreciate this point. We have now clarified that the series included five consecutive patients treated during the study period. Comment 3: No clear description of preoperative protocol and surgical technique was provided. Response: Thank you for this valuable comment. We have expanded the Patients and methods section to include the diagnostic work-up with echocardiography and chest computed tomography, serological testing when available, the use of albendazole, and the operative technique. The revised manuscript now specifies median sternotomy, cardiopulmonary bypass, cardioplegic arrest, isolation of the operative field with pads soaked in povidone iodine, careful aspiration before excision, and management of the myocardial defect according to cyst size and site. Comment 4: Follow-up duration is inconsistent. Response: We acknowledge this limitation. We have now clarified the follow-up pattern in the text and summarized it in Table 1. The first two cases had follow-up for five years, whereas the last three cases had shorter follow-up. We also added a limitations paragraph in the Discussion to acknowledge the non-uniform follow-up duration. Comment 5: The Discussion lacks depth and critical analysis. Response: We appreciate this comment. The Discussion include comparison with previous case series, interpretation of rupture patterns and operative complications, the role of early diagnosis and surgery, and a dedicated paragraph on study limitations and generalizability. Comment 6: Figure legends lack details. Response: Thank you for pointing this out. We revised the figure legends to make them more informative by adding the imaging modality, the relevant anatomical findings, and intraoperative context where appropriate. Comment 7: A patient summary table should be added. Response: We agree with this helpful suggestion. We added Table 1, which summarizes patient demographics, clinical presentation, cyst characteristics, operative management, follow-up, and outcomes. Comment 8: Multiple language and typographical issues were identified. Response: Thank you for noting this. The manuscript has undergone careful language revision, and spelling, grammar, terminology, and phrasing were corrected throughout the text to improve clarity and readability. Comment 9: Which scolicidal agent was used? Response: We have now clarified in the Patients and methods section that povidone iodine was used intraoperatively to isolate the surrounding operative field before cyst aspiration. Comment 10: Were serological tests performed? Response: Thank you for this comment. We have clarified that serological testing for echinococcosis was performed in some patients when available. Comment 11: How was the multi-organ hydatid case managed? Response: We have now added a clearer description of that case. Cardiac surgery was prioritized because of the immediate risk posed by the intracardiac lesion, whereas the extracardiac lesions were managed in a staged manner with postoperative follow-up and adjunct medical therapy. Comment 12: How was the myocardial defect repaired? Response: We appreciate this question. The revised manuscript now states that the myocardial defect was repaired according to the size and site of the defect, and that patch repair was used in cases with a large defect or friable ventricular wall. Comment 13: Background and progression are sufficiently described. Response: We sincerely appreciate this positive assessment. Comment 14: Diagnostic and treatment details are partly sufficient. Response: Thank you for this observation. We have incorporated additional diagnostic, operative, and follow-up details to improve completeness and clarity. Comment 15: Discussion and clinical relevance are partly sufficient. Response: We appreciate this comment. The Discussion was slightly improved to strengthen the clinical relevance of the findings, especially regarding rupture patterns, diagnosis, operative management, and the importance of early intervention in endemic areas. Comment 16: Conclusion is balanced and justified. Response: We thank you for this positive and encouraging assessment. We greatly appreciate your constructive comments, which helped us improve the manuscript substantially. Yours sincerely, Maath Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 May 2026 د.معاذ محمد , Pathology, University of Fallujah, College of medicine, Fallujah, Iraq 05 May 2026 Author Response Dear Reviewer, We sincerely thank you for your valuable, thoughtful, and constructive comments. Your feedback greatly helped us improve the structure, clarity, and scientific quality of the manuscript. We carefully ... Continue reading Dear Reviewer, We sincerely thank you for your valuable, thoughtful, and constructive comments. Your feedback greatly helped us improve the structure, clarity, and scientific quality of the manuscript. We carefully revised the paper in response to all points raised. For ease of evaluation, all modifications in the revised manuscript have been highlighted in yellow. Comment 1: Inclusion and exclusion criteria are not clearly defined. Response: Thank you for this important comment. We have now clearly defined the inclusion and exclusion criteria in the Patients and methods section. Inclusion criteria comprised all patients diagnosed with cardiac hydatid cysts who underwent surgical management at our center during the study period, whereas patients with incomplete records or non-surgical management were excluded. Comment 2: It is unclear whether cases were consecutive. Response: We appreciate this point. We have now clarified that the series included five consecutive patients treated during the study period. Comment 3: No clear description of preoperative protocol and surgical technique was provided. Response: Thank you for this valuable comment. We have expanded the Patients and methods section to include the diagnostic work-up with echocardiography and chest computed tomography, serological testing when available, the use of albendazole, and the operative technique. The revised manuscript now specifies median sternotomy, cardiopulmonary bypass, cardioplegic arrest, isolation of the operative field with pads soaked in povidone iodine, careful aspiration before excision, and management of the myocardial defect according to cyst size and site. Comment 4: Follow-up duration is inconsistent. Response: We acknowledge this limitation. We have now clarified the follow-up pattern in the text and summarized it in Table 1. The first two cases had follow-up for five years, whereas the last three cases had shorter follow-up. We also added a limitations paragraph in the Discussion to acknowledge the non-uniform follow-up duration. Comment 5: The Discussion lacks depth and critical analysis. Response: We appreciate this comment. The Discussion include comparison with previous case series, interpretation of rupture patterns and operative complications, the role of early diagnosis and surgery, and a dedicated paragraph on study limitations and generalizability. Comment 6: Figure legends lack details. Response: Thank you for pointing this out. We revised the figure legends to make them more informative by adding the imaging modality, the relevant anatomical findings, and intraoperative context where appropriate. Comment 7: A patient summary table should be added. Response: We agree with this helpful suggestion. We added Table 1, which summarizes patient demographics, clinical presentation, cyst characteristics, operative management, follow-up, and outcomes. Comment 8: Multiple language and typographical issues were identified. Response: Thank you for noting this. The manuscript has undergone careful language revision, and spelling, grammar, terminology, and phrasing were corrected throughout the text to improve clarity and readability. Comment 9: Which scolicidal agent was used? Response: We have now clarified in the Patients and methods section that povidone iodine was used intraoperatively to isolate the surrounding operative field before cyst aspiration. Comment 10: Were serological tests performed? Response: Thank you for this comment. We have clarified that serological testing for echinococcosis was performed in some patients when available. Comment 11: How was the multi-organ hydatid case managed? Response: We have now added a clearer description of that case. Cardiac surgery was prioritized because of the immediate risk posed by the intracardiac lesion, whereas the extracardiac lesions were managed in a staged manner with postoperative follow-up and adjunct medical therapy. Comment 12: How was the myocardial defect repaired? Response: We appreciate this question. The revised manuscript now states that the myocardial defect was repaired according to the size and site of the defect, and that patch repair was used in cases with a large defect or friable ventricular wall. Comment 13: Background and progression are sufficiently described. Response: We sincerely appreciate this positive assessment. Comment 14: Diagnostic and treatment details are partly sufficient. Response: Thank you for this observation. We have incorporated additional diagnostic, operative, and follow-up details to improve completeness and clarity. Comment 15: Discussion and clinical relevance are partly sufficient. Response: We appreciate this comment. The Discussion was slightly improved to strengthen the clinical relevance of the findings, especially regarding rupture patterns, diagnosis, operative management, and the importance of early intervention in endemic areas. Comment 16: Conclusion is balanced and justified. Response: We thank you for this positive and encouraging assessment. We greatly appreciate your constructive comments, which helped us improve the manuscript substantially. Yours sincerely, Maath Dear Reviewer, We sincerely thank you for your valuable, thoughtful, and constructive comments. Your feedback greatly helped us improve the structure, clarity, and scientific quality of the manuscript. We carefully revised the paper in response to all points raised. For ease of evaluation, all modifications in the revised manuscript have been highlighted in yellow. Comment 1: Inclusion and exclusion criteria are not clearly defined. Response: Thank you for this important comment. We have now clearly defined the inclusion and exclusion criteria in the Patients and methods section. Inclusion criteria comprised all patients diagnosed with cardiac hydatid cysts who underwent surgical management at our center during the study period, whereas patients with incomplete records or non-surgical management were excluded. Comment 2: It is unclear whether cases were consecutive. Response: We appreciate this point. We have now clarified that the series included five consecutive patients treated during the study period. Comment 3: No clear description of preoperative protocol and surgical technique was provided. Response: Thank you for this valuable comment. We have expanded the Patients and methods section to include the diagnostic work-up with echocardiography and chest computed tomography, serological testing when available, the use of albendazole, and the operative technique. The revised manuscript now specifies median sternotomy, cardiopulmonary bypass, cardioplegic arrest, isolation of the operative field with pads soaked in povidone iodine, careful aspiration before excision, and management of the myocardial defect according to cyst size and site. Comment 4: Follow-up duration is inconsistent. Response: We acknowledge this limitation. We have now clarified the follow-up pattern in the text and summarized it in Table 1. The first two cases had follow-up for five years, whereas the last three cases had shorter follow-up. We also added a limitations paragraph in the Discussion to acknowledge the non-uniform follow-up duration. Comment 5: The Discussion lacks depth and critical analysis. Response: We appreciate this comment. The Discussion include comparison with previous case series, interpretation of rupture patterns and operative complications, the role of early diagnosis and surgery, and a dedicated paragraph on study limitations and generalizability. Comment 6: Figure legends lack details. Response: Thank you for pointing this out. We revised the figure legends to make them more informative by adding the imaging modality, the relevant anatomical findings, and intraoperative context where appropriate. Comment 7: A patient summary table should be added. Response: We agree with this helpful suggestion. We added Table 1, which summarizes patient demographics, clinical presentation, cyst characteristics, operative management, follow-up, and outcomes. Comment 8: Multiple language and typographical issues were identified. Response: Thank you for noting this. The manuscript has undergone careful language revision, and spelling, grammar, terminology, and phrasing were corrected throughout the text to improve clarity and readability. Comment 9: Which scolicidal agent was used? Response: We have now clarified in the Patients and methods section that povidone iodine was used intraoperatively to isolate the surrounding operative field before cyst aspiration. Comment 10: Were serological tests performed? Response: Thank you for this comment. We have clarified that serological testing for echinococcosis was performed in some patients when available. Comment 11: How was the multi-organ hydatid case managed? Response: We have now added a clearer description of that case. Cardiac surgery was prioritized because of the immediate risk posed by the intracardiac lesion, whereas the extracardiac lesions were managed in a staged manner with postoperative follow-up and adjunct medical therapy. Comment 12: How was the myocardial defect repaired? Response: We appreciate this question. The revised manuscript now states that the myocardial defect was repaired according to the size and site of the defect, and that patch repair was used in cases with a large defect or friable ventricular wall. Comment 13: Background and progression are sufficiently described. Response: We sincerely appreciate this positive assessment. Comment 14: Diagnostic and treatment details are partly sufficient. Response: Thank you for this observation. We have incorporated additional diagnostic, operative, and follow-up details to improve completeness and clarity. Comment 15: Discussion and clinical relevance are partly sufficient. Response: We appreciate this comment. The Discussion was slightly improved to strengthen the clinical relevance of the findings, especially regarding rupture patterns, diagnosis, operative management, and the importance of early intervention in endemic areas. Comment 16: Conclusion is balanced and justified. Response: We thank you for this positive and encouraging assessment. We greatly appreciate your constructive comments, which helped us improve the manuscript substantially. Yours sincerely, Maath Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ulas AB. Reviewer Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.190178.r467669 ) The direct URL for this report is: https://f1000research.com/articles/15-65/v1#referee-response-467669 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Mar 2026 Ali Bilal Ulas , Department of Thoracic Surgery, Ataturk University, Erzurum, Turkey Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.190178.r467669 Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Was the myocardial defect patched? Was the friability purely inflammatory? Do you think a different surgical approach or a biological ... Continue reading READ ALL Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Was the myocardial defect patched? Was the friability purely inflammatory? Do you think a different surgical approach or a biological patch might have mitigated the separation of the LV wall in such a friable environment? In your specific case involving the left atrium, what were the specific echocardiographic features that eventually led you away from a diagnosis of myxoma before the CT scan? Were serological tests performed? One patient had brain, cardiac, and spleen hydatids. Was the cardiac surgery prioritized, or were these addressed in a staged fashion? The timing of multi-organ hydatid surgery is a major point of debate in our field. Paragraphs 4–5 of the Introduction repeat pathophysiological concepts. Consolidate them. References 4 and 5 are broken links. Mention the institutional review board or ethics committee approval. "operatve" should be operative. "reccurrence" should be recurrence. "rapture" should be rupture. "Hysterical disease" in the recommendations likely refers to Hydatid disease? “cardia hydatid” is an incorrect anatomical terminology. “successfully underwent successful excision” is redundant. "fights vital cysts" is unclear. “makeshift bombs” is a non-scientific language. “soft pregnancy” what does it mean? Is the background of the cases’ history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the conclusion balanced and justified on the basis of the findings? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Thoracic Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ulas AB. Reviewer Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.190178.r467669 ) The direct URL for this report is: https://f1000research.com/articles/15-65/v1#referee-response-467669 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 May 2026 د.معاذ محمد , Pathology, University of Fallujah, College of medicine, Fallujah, Iraq 05 May 2026 Author Response Dear Reviewer, We sincerely thank you for your detailed and insightful comments. We highly appreciate your time and expertise, and we have carefully addressed all the points raised. The ... Continue reading Dear Reviewer, We sincerely thank you for your detailed and insightful comments. We highly appreciate your time and expertise, and we have carefully addressed all the points raised. The manuscript has been substantially revised to improve clarity, scientific accuracy, and completeness. Please find our point-by-point responses below: ----------------------------- Comment 1: Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Response: Thank you for this important comment. We have now clarified in the Methods section that [ povidone-iodine] was used to soak the operative field prior to cyst aspiration to prevent dissemination. ----------------------------- Comment 2: Was the myocardial defect patched? Response: We appreciate this question. The myocardial defect was patched only in one case that presented with hydatic cyst involves left ventricle free wall (full thickness involvement), the patch used was synthetic patch (PTFE). This has now been clarified in the surgical technique section. ----------------------------- Comment 3: Was the friability purely inflammatory? Could a different approach or biological patch help? Response: Thank you for this insightful comment. The friability was most likely related to inflammatory changes associated with hydatid cyst involvement (especially in infected one). We agree that alternative approaches, including the use of biological patches, may reduce the risk of myocardial separation in such fragile tissue. This discussion has now been added to the Discussion section. ----------------------------- Comment 4: Left atrial case – differentiation from myxoma? Were serological tests done? Response: We appreciate this important point. The echocardiographic findings included [ cystic nature, presence of septations, lack of typical stalk attachment, and atypical position as myxoma mostly attaches to inter atrial septum], which raised suspicion away from myxoma. However, definitive diagnosis was achieved by CT imaging. Serological tests were [not performed], and this has now been clarified in the manuscript. ----------------------------- Comment 5: Multi-organ hydatid disease – surgical timing? Response: Thank you for highlighting this important clinical consideration. In our case, [cardiac surgery was prioritized due to higher risk]. We have now expanded the discussion to address the controversy regarding timing of multi-organ hydatid disease management. ----------------------------- Comment 6: Introduction repetition Response: We agree with this comment. Paragraphs 4 and 5 have been revised and consolidated to avoid repetition. ----------------------------- Comment 7: Broken references Response: Thank you for noting this. References 4 and 5 have been corrected and updated. ----------------------------- Comment 8: Ethics approval Response: We appreciate this important point. A statement confirming approval from the institutional ethics committee has now been added and obtained from university of Fallujah. ----------------------------- Comment 9: Language and typographical errors Response: Thank you for highlighting these issues. All typographical and language errors have been corrected, including: - operative - recurrence - rupture - hydatid disease (corrected from "hysterical disease") - cardiac hydatid (corrected terminology) - removal of redundant phrases - revision of unclear or non-scientific expressions The manuscript has undergone thorough language editing. ----------------------------- Comment 10: Clarity of case history Response: We agree that more detail was needed. Additional clinical details regarding patient history and disease progression have now been included. ----------------------------- Comment 11: Details of examination, diagnostics, treatment, outcomes Response: These sections have been expanded to provide clearer and more comprehensive details. ----------------------------- Comment 12: Discussion adequacy Response: We acknowledge this limitation. The Discussion section has been significantly expanded to better highlight the clinical relevance and implications of our findings. ----------------------------- Comment 13: Conclusion Response: The conclusion has been revised to ensure it is balanced and fully supported by the findings. ----------------------------- We hope that these revisions have adequately addressed all your concerns and improved the quality of the manuscript. Thank you again for your valuable feedback. Kind regards, Dear Reviewer, We sincerely thank you for your detailed and insightful comments. We highly appreciate your time and expertise, and we have carefully addressed all the points raised. The manuscript has been substantially revised to improve clarity, scientific accuracy, and completeness. Please find our point-by-point responses below: ----------------------------- Comment 1: Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Response: Thank you for this important comment. We have now clarified in the Methods section that [ povidone-iodine] was used to soak the operative field prior to cyst aspiration to prevent dissemination. ----------------------------- Comment 2: Was the myocardial defect patched? Response: We appreciate this question. The myocardial defect was patched only in one case that presented with hydatic cyst involves left ventricle free wall (full thickness involvement), the patch used was synthetic patch (PTFE). This has now been clarified in the surgical technique section. ----------------------------- Comment 3: Was the friability purely inflammatory? Could a different approach or biological patch help? Response: Thank you for this insightful comment. The friability was most likely related to inflammatory changes associated with hydatid cyst involvement (especially in infected one). We agree that alternative approaches, including the use of biological patches, may reduce the risk of myocardial separation in such fragile tissue. This discussion has now been added to the Discussion section. ----------------------------- Comment 4: Left atrial case – differentiation from myxoma? Were serological tests done? Response: We appreciate this important point. The echocardiographic findings included [ cystic nature, presence of septations, lack of typical stalk attachment, and atypical position as myxoma mostly attaches to inter atrial septum], which raised suspicion away from myxoma. However, definitive diagnosis was achieved by CT imaging. Serological tests were [not performed], and this has now been clarified in the manuscript. ----------------------------- Comment 5: Multi-organ hydatid disease – surgical timing? Response: Thank you for highlighting this important clinical consideration. In our case, [cardiac surgery was prioritized due to higher risk]. We have now expanded the discussion to address the controversy regarding timing of multi-organ hydatid disease management. ----------------------------- Comment 6: Introduction repetition Response: We agree with this comment. Paragraphs 4 and 5 have been revised and consolidated to avoid repetition. ----------------------------- Comment 7: Broken references Response: Thank you for noting this. References 4 and 5 have been corrected and updated. ----------------------------- Comment 8: Ethics approval Response: We appreciate this important point. A statement confirming approval from the institutional ethics committee has now been added and obtained from university of Fallujah. ----------------------------- Comment 9: Language and typographical errors Response: Thank you for highlighting these issues. All typographical and language errors have been corrected, including: - operative - recurrence - rupture - hydatid disease (corrected from "hysterical disease") - cardiac hydatid (corrected terminology) - removal of redundant phrases - revision of unclear or non-scientific expressions The manuscript has undergone thorough language editing. ----------------------------- Comment 10: Clarity of case history Response: We agree that more detail was needed. Additional clinical details regarding patient history and disease progression have now been included. ----------------------------- Comment 11: Details of examination, diagnostics, treatment, outcomes Response: These sections have been expanded to provide clearer and more comprehensive details. ----------------------------- Comment 12: Discussion adequacy Response: We acknowledge this limitation. The Discussion section has been significantly expanded to better highlight the clinical relevance and implications of our findings. ----------------------------- Comment 13: Conclusion Response: The conclusion has been revised to ensure it is balanced and fully supported by the findings. ----------------------------- We hope that these revisions have adequately addressed all your concerns and improved the quality of the manuscript. Thank you again for your valuable feedback. Kind regards, Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 May 2026 د.معاذ محمد , Pathology, University of Fallujah, College of medicine, Fallujah, Iraq 05 May 2026 Author Response Dear Reviewer, We sincerely thank you for your detailed and insightful comments. We highly appreciate your time and expertise, and we have carefully addressed all the points raised. The ... Continue reading Dear Reviewer, We sincerely thank you for your detailed and insightful comments. We highly appreciate your time and expertise, and we have carefully addressed all the points raised. The manuscript has been substantially revised to improve clarity, scientific accuracy, and completeness. Please find our point-by-point responses below: ----------------------------- Comment 1: Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Response: Thank you for this important comment. We have now clarified in the Methods section that [ povidone-iodine] was used to soak the operative field prior to cyst aspiration to prevent dissemination. ----------------------------- Comment 2: Was the myocardial defect patched? Response: We appreciate this question. The myocardial defect was patched only in one case that presented with hydatic cyst involves left ventricle free wall (full thickness involvement), the patch used was synthetic patch (PTFE). This has now been clarified in the surgical technique section. ----------------------------- Comment 3: Was the friability purely inflammatory? Could a different approach or biological patch help? Response: Thank you for this insightful comment. The friability was most likely related to inflammatory changes associated with hydatid cyst involvement (especially in infected one). We agree that alternative approaches, including the use of biological patches, may reduce the risk of myocardial separation in such fragile tissue. This discussion has now been added to the Discussion section. ----------------------------- Comment 4: Left atrial case – differentiation from myxoma? Were serological tests done? Response: We appreciate this important point. The echocardiographic findings included [ cystic nature, presence of septations, lack of typical stalk attachment, and atypical position as myxoma mostly attaches to inter atrial septum], which raised suspicion away from myxoma. However, definitive diagnosis was achieved by CT imaging. Serological tests were [not performed], and this has now been clarified in the manuscript. ----------------------------- Comment 5: Multi-organ hydatid disease – surgical timing? Response: Thank you for highlighting this important clinical consideration. In our case, [cardiac surgery was prioritized due to higher risk]. We have now expanded the discussion to address the controversy regarding timing of multi-organ hydatid disease management. ----------------------------- Comment 6: Introduction repetition Response: We agree with this comment. Paragraphs 4 and 5 have been revised and consolidated to avoid repetition. ----------------------------- Comment 7: Broken references Response: Thank you for noting this. References 4 and 5 have been corrected and updated. ----------------------------- Comment 8: Ethics approval Response: We appreciate this important point. A statement confirming approval from the institutional ethics committee has now been added and obtained from university of Fallujah. ----------------------------- Comment 9: Language and typographical errors Response: Thank you for highlighting these issues. All typographical and language errors have been corrected, including: - operative - recurrence - rupture - hydatid disease (corrected from "hysterical disease") - cardiac hydatid (corrected terminology) - removal of redundant phrases - revision of unclear or non-scientific expressions The manuscript has undergone thorough language editing. ----------------------------- Comment 10: Clarity of case history Response: We agree that more detail was needed. Additional clinical details regarding patient history and disease progression have now been included. ----------------------------- Comment 11: Details of examination, diagnostics, treatment, outcomes Response: These sections have been expanded to provide clearer and more comprehensive details. ----------------------------- Comment 12: Discussion adequacy Response: We acknowledge this limitation. The Discussion section has been significantly expanded to better highlight the clinical relevance and implications of our findings. ----------------------------- Comment 13: Conclusion Response: The conclusion has been revised to ensure it is balanced and fully supported by the findings. ----------------------------- We hope that these revisions have adequately addressed all your concerns and improved the quality of the manuscript. Thank you again for your valuable feedback. Kind regards, Dear Reviewer, We sincerely thank you for your detailed and insightful comments. We highly appreciate your time and expertise, and we have carefully addressed all the points raised. The manuscript has been substantially revised to improve clarity, scientific accuracy, and completeness. Please find our point-by-point responses below: ----------------------------- Comment 1: Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Response: Thank you for this important comment. We have now clarified in the Methods section that [ povidone-iodine] was used to soak the operative field prior to cyst aspiration to prevent dissemination. ----------------------------- Comment 2: Was the myocardial defect patched? Response: We appreciate this question. The myocardial defect was patched only in one case that presented with hydatic cyst involves left ventricle free wall (full thickness involvement), the patch used was synthetic patch (PTFE). This has now been clarified in the surgical technique section. ----------------------------- Comment 3: Was the friability purely inflammatory? Could a different approach or biological patch help? Response: Thank you for this insightful comment. The friability was most likely related to inflammatory changes associated with hydatid cyst involvement (especially in infected one). We agree that alternative approaches, including the use of biological patches, may reduce the risk of myocardial separation in such fragile tissue. This discussion has now been added to the Discussion section. ----------------------------- Comment 4: Left atrial case – differentiation from myxoma? Were serological tests done? Response: We appreciate this important point. The echocardiographic findings included [ cystic nature, presence of septations, lack of typical stalk attachment, and atypical position as myxoma mostly attaches to inter atrial septum], which raised suspicion away from myxoma. However, definitive diagnosis was achieved by CT imaging. Serological tests were [not performed], and this has now been clarified in the manuscript. ----------------------------- Comment 5: Multi-organ hydatid disease – surgical timing? Response: Thank you for highlighting this important clinical consideration. In our case, [cardiac surgery was prioritized due to higher risk]. We have now expanded the discussion to address the controversy regarding timing of multi-organ hydatid disease management. ----------------------------- Comment 6: Introduction repetition Response: We agree with this comment. Paragraphs 4 and 5 have been revised and consolidated to avoid repetition. ----------------------------- Comment 7: Broken references Response: Thank you for noting this. References 4 and 5 have been corrected and updated. ----------------------------- Comment 8: Ethics approval Response: We appreciate this important point. A statement confirming approval from the institutional ethics committee has now been added and obtained from university of Fallujah. ----------------------------- Comment 9: Language and typographical errors Response: Thank you for highlighting these issues. All typographical and language errors have been corrected, including: - operative - recurrence - rupture - hydatid disease (corrected from "hysterical disease") - cardiac hydatid (corrected terminology) - removal of redundant phrases - revision of unclear or non-scientific expressions The manuscript has undergone thorough language editing. ----------------------------- Comment 10: Clarity of case history Response: We agree that more detail was needed. Additional clinical details regarding patient history and disease progression have now been included. ----------------------------- Comment 11: Details of examination, diagnostics, treatment, outcomes Response: These sections have been expanded to provide clearer and more comprehensive details. ----------------------------- Comment 12: Discussion adequacy Response: We acknowledge this limitation. The Discussion section has been significantly expanded to better highlight the clinical relevance and implications of our findings. ----------------------------- Comment 13: Conclusion Response: The conclusion has been revised to ensure it is balanced and fully supported by the findings. ----------------------------- We hope that these revisions have adequately addressed all your concerns and improved the quality of the manuscript. Thank you again for your valuable feedback. Kind regards, Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 16 Jan 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 05 May 26 read Version 1 16 Jan 26 read read Ali Bilal Ulas , Ataturk University, Erzurum, Turkey Laila Jedidi , University of Tunis El Manar, Tunis, Tunisia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Ulas A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 May 2026 | for Version 2 Ali Bilal Ulas , Department of Thoracic Surgery, Ataturk University, Erzurum, Turkey 0 Views copyright © 2026 Ulas A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors, thank you for the revisions. As I said before, it’s better to use clinical terms; the phrase makeshift bombs is a bit too dramatic for a scientific paper. Instead of "behaving like makeshift bombs" you may use "posing a high risk of spontaneous rupture and subsequent anaphylaxis". The other one, the expression; contraction of the heart fights vital cysts, is a bit vague. Again istead of it you may try; constant myocardial contractility and high intraventricular pressure create a mechanical environment that limits the growth and attachment of hydatid cysts. Competing Interests No competing interests were disclosed. Reviewer Expertise Thoracic Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Ulas AB. Peer Review Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.198742.r481837) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-65/v2#referee-response-481837 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Jedidi L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Apr 2026 | for Version 1 Laila Jedidi , University of Tunis El Manar, Tunis, Tunisia 0 Views copyright © 2026 Jedidi L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript presents a retrospective case series of five patients undergoing surgical management for cardiac hydatid cysts at a single center in Iraq between 2018 and 2024. The authors describe clinical presentations, imaging findings, surgical approaches, and postoperative outcomes. All patients underwent surgical excision with no mortality and favorable outcomes, although one case required re-exploration for postoperative bleeding. The study highlights the importance of early diagnosis and surgical intervention in this rare condition. However, few corrections need to be done */Inclusion and exclusion criteria are not clearly define */It is unclear whether cases were consecutive */No clear description of preoperative protocol, Surgical techniques */Follow-up is inconsistent: 5 years for some patients, short term for others. */The discussion lacks depth and does not sufficiently place findings in the context of existing literature. There is minimal critical analysis, no discussion of limitations, and no clear clinical implications. ->Expand the discussion with a more comparison with published case series. Discussion of recurrence risk and alternative management strategies. */Figures are useful but legends lack details */comprehensive patient summary table should be added */language issues: -Typographical errors: "operatve" → operative "reccurrence" → recurrence "rapture" → rupture -Unclear terms: soft pregnancy, Hysterical disease, cardia hydatid, makeshift bombs -"successfully underwent successful excision": repetition */Which scolicidal agent was used? */Were serological tests performed? */How was the multi-organ hydatid case managed? */How was the myocardial defect repaired? Is the background of the cases’ history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the conclusion balanced and justified on the basis of the findings? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise General surgery; clinical research; management of hydatid disease. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 05 May 2026 د.معاذ محمد, Pathology, University of Fallujah, College of medicine, Fallujah, Iraq Dear Reviewer, We sincerely thank you for your valuable, thoughtful, and constructive comments. Your feedback greatly helped us improve the structure, clarity, and scientific quality of the manuscript. We carefully revised the paper in response to all points raised. For ease of evaluation, all modifications in the revised manuscript have been highlighted in yellow. Comment 1: Inclusion and exclusion criteria are not clearly defined. Response: Thank you for this important comment. We have now clearly defined the inclusion and exclusion criteria in the Patients and methods section. Inclusion criteria comprised all patients diagnosed with cardiac hydatid cysts who underwent surgical management at our center during the study period, whereas patients with incomplete records or non-surgical management were excluded. Comment 2: It is unclear whether cases were consecutive. Response: We appreciate this point. We have now clarified that the series included five consecutive patients treated during the study period. Comment 3: No clear description of preoperative protocol and surgical technique was provided. Response: Thank you for this valuable comment. We have expanded the Patients and methods section to include the diagnostic work-up with echocardiography and chest computed tomography, serological testing when available, the use of albendazole, and the operative technique. The revised manuscript now specifies median sternotomy, cardiopulmonary bypass, cardioplegic arrest, isolation of the operative field with pads soaked in povidone iodine, careful aspiration before excision, and management of the myocardial defect according to cyst size and site. Comment 4: Follow-up duration is inconsistent. Response: We acknowledge this limitation. We have now clarified the follow-up pattern in the text and summarized it in Table 1. The first two cases had follow-up for five years, whereas the last three cases had shorter follow-up. We also added a limitations paragraph in the Discussion to acknowledge the non-uniform follow-up duration. Comment 5: The Discussion lacks depth and critical analysis. Response: We appreciate this comment. The Discussion include comparison with previous case series, interpretation of rupture patterns and operative complications, the role of early diagnosis and surgery, and a dedicated paragraph on study limitations and generalizability. Comment 6: Figure legends lack details. Response: Thank you for pointing this out. We revised the figure legends to make them more informative by adding the imaging modality, the relevant anatomical findings, and intraoperative context where appropriate. Comment 7: A patient summary table should be added. Response: We agree with this helpful suggestion. We added Table 1, which summarizes patient demographics, clinical presentation, cyst characteristics, operative management, follow-up, and outcomes. Comment 8: Multiple language and typographical issues were identified. Response: Thank you for noting this. The manuscript has undergone careful language revision, and spelling, grammar, terminology, and phrasing were corrected throughout the text to improve clarity and readability. Comment 9: Which scolicidal agent was used? Response: We have now clarified in the Patients and methods section that povidone iodine was used intraoperatively to isolate the surrounding operative field before cyst aspiration. Comment 10: Were serological tests performed? Response: Thank you for this comment. We have clarified that serological testing for echinococcosis was performed in some patients when available. Comment 11: How was the multi-organ hydatid case managed? Response: We have now added a clearer description of that case. Cardiac surgery was prioritized because of the immediate risk posed by the intracardiac lesion, whereas the extracardiac lesions were managed in a staged manner with postoperative follow-up and adjunct medical therapy. Comment 12: How was the myocardial defect repaired? Response: We appreciate this question. The revised manuscript now states that the myocardial defect was repaired according to the size and site of the defect, and that patch repair was used in cases with a large defect or friable ventricular wall. Comment 13: Background and progression are sufficiently described. Response: We sincerely appreciate this positive assessment. Comment 14: Diagnostic and treatment details are partly sufficient. Response: Thank you for this observation. We have incorporated additional diagnostic, operative, and follow-up details to improve completeness and clarity. Comment 15: Discussion and clinical relevance are partly sufficient. Response: We appreciate this comment. The Discussion was slightly improved to strengthen the clinical relevance of the findings, especially regarding rupture patterns, diagnosis, operative management, and the importance of early intervention in endemic areas. Comment 16: Conclusion is balanced and justified. Response: We thank you for this positive and encouraging assessment. We greatly appreciate your constructive comments, which helped us improve the manuscript substantially. Yours sincerely, Maath View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Jedidi L. Peer Review Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . F1000Research 2026, 15 :65 ( https://doi.org/10.5256/f1000research.190178.r467674) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-65/v1#referee-response-467674 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Ulas A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Mar 2026 | for Version 1 Ali Bilal Ulas , Department of Thoracic Surgery, Ataturk University, Erzurum, Turkey 0 Views copyright © 2026 Ulas A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Was the myocardial defect patched? Was the friability purely inflammatory? Do you think a different surgical approach or a biological patch might have mitigated the separation of the LV wall in such a friable environment? In your specific case involving the left atrium, what were the specific echocardiographic features that eventually led you away from a diagnosis of myxoma before the CT scan? Were serological tests performed? One patient had brain, cardiac, and spleen hydatids. Was the cardiac surgery prioritized, or were these addressed in a staged fashion? The timing of multi-organ hydatid surgery is a major point of debate in our field. Paragraphs 4–5 of the Introduction repeat pathophysiological concepts. Consolidate them. References 4 and 5 are broken links. Mention the institutional review board or ethics committee approval. "operatve" should be operative. "reccurrence" should be recurrence. "rapture" should be rupture. "Hysterical disease" in the recommendations likely refers to Hydatid disease? “cardia hydatid” is an incorrect anatomical terminology. “successfully underwent successful excision” is redundant. "fights vital cysts" is unclear. “makeshift bombs” is a non-scientific language. “soft pregnancy” what does it mean? Is the background of the cases’ history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the conclusion balanced and justified on the basis of the findings? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Thoracic Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 05 May 2026 د.معاذ محمد, Pathology, University of Fallujah, College of medicine, Fallujah, Iraq Dear Reviewer, We sincerely thank you for your detailed and insightful comments. We highly appreciate your time and expertise, and we have carefully addressed all the points raised. The manuscript has been substantially revised to improve clarity, scientific accuracy, and completeness. Please find our point-by-point responses below: ----------------------------- Comment 1: Which scolicidal agents were used to soak the surrounding operative field before cyst aspiration? Response: Thank you for this important comment. We have now clarified in the Methods section that [ povidone-iodine] was used to soak the operative field prior to cyst aspiration to prevent dissemination. ----------------------------- Comment 2: Was the myocardial defect patched? Response: We appreciate this question. The myocardial defect was patched only in one case that presented with hydatic cyst involves left ventricle free wall (full thickness involvement), the patch used was synthetic patch (PTFE). This has now been clarified in the surgical technique section. ----------------------------- Comment 3: Was the friability purely inflammatory? Could a different approach or biological patch help? Response: Thank you for this insightful comment. The friability was most likely related to inflammatory changes associated with hydatid cyst involvement (especially in infected one). We agree that alternative approaches, including the use of biological patches, may reduce the risk of myocardial separation in such fragile tissue. This discussion has now been added to the Discussion section. ----------------------------- Comment 4: Left atrial case – differentiation from myxoma? Were serological tests done? Response: We appreciate this important point. The echocardiographic findings included [ cystic nature, presence of septations, lack of typical stalk attachment, and atypical position as myxoma mostly attaches to inter atrial septum], which raised suspicion away from myxoma. However, definitive diagnosis was achieved by CT imaging. Serological tests were [not performed], and this has now been clarified in the manuscript. ----------------------------- Comment 5: Multi-organ hydatid disease – surgical timing? Response: Thank you for highlighting this important clinical consideration. In our case, [cardiac surgery was prioritized due to higher risk]. We have now expanded the discussion to address the controversy regarding timing of multi-organ hydatid disease management. ----------------------------- Comment 6: Introduction repetition Response: We agree with this comment. Paragraphs 4 and 5 have been revised and consolidated to avoid repetition. ----------------------------- Comment 7: Broken references Response: Thank you for noting this. References 4 and 5 have been corrected and updated. ----------------------------- Comment 8: Ethics approval Response: We appreciate this important point. A statement confirming approval from the institutional ethics committee has now been added and obtained from university of Fallujah. ----------------------------- Comment 9: Language and typographical errors Response: Thank you for highlighting these issues. All typographical and language errors have been corrected, including: - operative - recurrence - rupture - hydatid disease (corrected from "hysterical disease") - cardiac hydatid (corrected terminology) - removal of redundant phrases - revision of unclear or non-scientific expressions The manuscript has undergone thorough language editing. ----------------------------- Comment 10: Clarity of case history Response: We agree that more detail was needed. Additional clinical details regarding patient history and disease progression have now been included. ----------------------------- Comment 11: Details of examination, diagnostics, treatment, outcomes Response: These sections have been expanded to provide clearer and more comprehensive details. ----------------------------- Comment 12: Discussion adequacy Response: We acknowledge this limitation. The Discussion section has been significantly expanded to better highlight the clinical relevance and implications of our findings. ----------------------------- Comment 13: Conclusion Response: The conclusion has been revised to ensure it is balanced and fully supported by the findings. ----------------------------- We hope that these revisions have adequately addressed all your concerns and improved the quality of the manuscript. Thank you again for your valuable feedback. Kind regards, View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Ulas AB. Peer Review Report For: The Outcome of Cardiac Hydatid Surgery in The Iraqi Center of Heart Diseases : A Retrospective Case-series Study [version 2; peer review: 2 approved with reservations] . 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