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In cardiac echinococcosis, a hydatid cyst most frequently forms either solely in the heart or in the pericardium, but there are several reports of cysts forming in the liver or lung or in both. In two cases reported here, both patients developed cysts in new sites after one or more previous surgeries for hydatid cyst removal. In Case 1, the patient first underwent spleenectomy and resection of multiple cysts with no evidence of a cyst in the heart; 3 years later, there was no sign of Echinococcus in the liver, but a large inframyocardial cyst had damaged the left ventricle. In Case 2, the patient first underwent surgery to remove cysts from the pericardium, 2 years later from the anterior wall of the left ventricle, and, finally, 8 months after this second operation, from the left atrium also with no evidence of cyst formation anywhere else in the heart at the time of surgery. These cases emphasize the need for thorough and frequent reevaluation to detect new hydatid cyst formation in the heart and elsewhere caused by the Echinococcus organism.

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A 40-year-old man was emergently hospitalized because of high fever, a transient ischemic attack, and complete atrioventricular block. The diagnosis was endocarditis, cyst of the interventricular septum (IVS), and complete atrioventricular block. A temporary pacemaker was introduced, and the patient underwent surgery that included IVS cystectomy, ventricular septum plication, and aortic valve replacement. A permanent pacemaker was implanted during the early postoperative period. The patient was discharged from the medical center on day 9 after primary surgery. At the 4-month postoperative follow-up, the patient was found to be in normal condition. Patients with high temperature, heart rhythm and conduction disorders, and dyspnea of unknown etiology might be harboring Echinococcus despite the absence of primary liver or lung damage. Urgent surgical treatment is necessary even on suspicion of complicated hydatid damage to the heart.

The best surgical approach for the treatment of patients with severe cerebral artery disease and simultaneous serious coronary artery disease remains controversial. In this report, we present a case of a 65-year-old man admitted to the hospital with unstable angina. Triple coronary artery obstructive disease and severe right internal carotid artery stenosis in the retroparotid region were diagnosed. A combined, simultaneous surgical procedure was performed. A lesion located in the retroparotid space required an approach by a presternocleidomastoid cervicotomy extended distally. Venous grafting of the internal carotid artery was performed. After carotid reconstruction, the three coronary arteries were revascularized without extracorporeal circulation. The patient showed a satisfactory postoperative outcome.