Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece

Ten cases of hydatid heart disease were treated over a 15-yearperiod (1980–1995). Cysts were located in the left ventricularwall (four patients), right ventricular wall (one patient),interventricular septum (one patient), interatnal septum (onepatient), right atrium (one patient), pericardial cavity (onepatient) and in multiple loci (one patient). Apart from twoasymptomatic cases, clinical manifestations included chest pain(four patients), anaphylactic shock (one patient), constrictivepericarditis (one patient), congestive heart failure (one patient)and arterial embolism (one patient). Computed tomography wasfound useful in the detection of hydatid cysts and also in thedetermination of their morphology. Magnetic resonance was performedin three patients, with satisfactory imaging. Three out of the10 patients died: rupture of pulmonary echinococcal cyst (onepatient), massive pulmonary hydatid embolism (one patient) andrupture of an undiagnosed hydatid cyst of the right atrium duringcannulation for cardiopulmonary bypass (one patient). One otherpatient experienced recurrent systemic embolism and became hemiplegic.Six patients were successfully treated. In five patients, thecysts were excised by open heart surgery, while in one by pericardiectomy.In addition, antiparasitic drugs were successfully used in twopatients with long-term satisfactory results. In conclusion, cardiac echinococcosis is associated with anincreased risk of potentially lethal complications. Newer techniquesof cardiac imaging have helped locate the cysts while surgicalremoval may offer cure. Some patients responded to specificlong-term drug treatment.