Management of Cardiac Hydatid Disease

Hydatid disease also known as echinococcosis is an endemic zoonotic infestation in cattle-raising regions of the world formed by the larval forms of cestodes belonging to the genus Echinococcus. This disease is mainly caused by the larval form of Echinococcus granulosus and Echinococcus alveolaris. Although hydatidosis is most often occurred in the liver [60%-70%] and lung [20%-30%], it can occur in any organ or tissue from head to toe, including heart. Cardiac involvement is rare and accounts for only 0.5%-2% of all hydatidosis cases. Initially there may be no remarkable symptom in patients with cardiac hydatidosis. When the cyst reaches a significant size, some symptoms and complications may be manifested. Chest pain, palpitation, and shortness of breath are the main symptoms associated with cardiac hydatidosis. Although serologic tests are a helpful supplement for diagnosis, false negative results are possible. Definitive diagnosis of cardiac hydatidosis is mainly based on echocardiography. Even, asymptomatic patients can be diagnosed incidentally on echocardiography. The differential diagnosis of cardiac hydatidosis includes ventricular aneurysm, pericardial and cardiac cysts, myocardial abscess, pericardial hematomas, and cystic degenerative tumors. The combination of both surgical and medical treatment should be done in all patients with cardiac hydatid disease. Surgical treatment can be performed with or without cardiopulmonary bypass [CPB] according to the localization of the cardiac cysts. Although median sternotomy is preferred incision for surgical intervention, a mini anterolateral left thoracotomy incision can also be used successfully in patients with apical and apical-lateral myocardial hydatid cysts. If the protoscolices in the cystic fluid are accidentally poured into the surgical field during operation, formation of secondary cysts is possible. Hence, the whole of the surgical field must be protected by washing with scolicidal agents to prevent secondary cystic development. Although patients with cardiac hydatidosis may be asymptomatic for many years or have non-specific complaints, they may have lethal complications, including tamponade, anaphylactic shock and sudden death. Therefore, all patients with cardiac hydatidosis should be operated on as soon as possible.