15-YEAR SURVEILLANCE OF ECHINOCOCCAL HEART-DISEASE FROM A REFERRAL HOSPITAL IN GREECE

Ten cases of hydatid heart disease were treated over a 15-year period (1980-1995). Cysts were located in the left ventricular wall (four pat ients), right ventricular wall (one patient), interventricular septum (one patient), interatrial septum (one patient), right atrium (one pat ient), pericardial cavity (one patient) and in multiple loci (one pati ent). Apart from two asymptomatic cases, clinical manifestations inclu ded chest pain (four patients), anaphylactic shock (one patient), cons trictive pericarditis (one patient), congestive heart failure (one pat ient) and arterial embolism (one patient). Computed tomography was fou nd useful in the detection of hydatid cysts and also in the determinat ion of their morphology. Magnetic resonance was performed in three pat ients, with satisfactory imaging. Three out of the 10 patients died: r upture of pulmonary echinococcal cyst (one patient), massive pulmonary hydatid embolism (one patient) and rupture of an undiagnosed hydatid cyst of the right atrium during cannulation for cardiopulmonary bypass (one patient). One other patient experienced recurrent systemic embol ism and became hemiplegic. Six patients were successfully treated. In five patients, the cysts were excised by open heart surgery, while in one by pericardiectomy. In addition, antiparasitic drugs were successf ully used in two patients with long-term satisfactory results. In conc lusion, cardiac echinococcosis is associated with an increased risk of potentially lethal complications. Newer techniques of cardiac imaging have helped locate the cysts while surgical removal may offer cure. S ome patients responded to specific long-term drug treatment.