A clinical dilemma: Cardiac and pericardiac echinococcosis

Background. Cardiac and pericardial echinococcosis as a life-threatening di sease may present with a clear picture most of the time, however it may als o become a clinical puzzle. Methods. In the period between 1977 and 1998, 14 patients were operated on with the diagnosis of cardiac and pericardial echinococcosis. Nine patients were operated on with standard cardiopulmonary bypass (CPB) techniques, an d the remaining 5 patients were operated on without CPB. Transesophageal ec hocardiography (TEE) or intraoperative surface echocardiography were used t o plan and perform the operation for the late cases. Results. One patient died during the postoperative period due to the ruptur e of interventricular septum. All other patients survived the perioperative period, received mebendazole treatment, and exhibited no recurrence during the follow-up. Conclusions. The definitive treatment is the surgical extraction of the cys t. Because the clinical picture may vary according to the number, size, and location of cysts, as well as complications, cardiac echinococcosis should be remembered and included in the differential diagnosis to achieve the tr eatment. Intraoperative surface echocardiography is of paramount value for diagnosis and planning the management of a successful surgery. (C) 1999 by The Society of Thoracic Surgeons.