Diagnosis and treatment of cardiac echinococcosis

Abstract

Cardiac echinococcosis is a rare manifestation of cystic echinococcosis (CE) caused by the tapeworm Echinococcus granulosus Among all patients suffering from CE, only 0.5%-2% exhibit a cardiac involvement. In addition, during the past years the number of CE cases reported in Western Europe remained roughly unchanged. However, we postulate that cases of CE in Western Europe will increase due to a growing number of refugees coming from endemic areas such as Southern Europe, Eastern Europe and the Middle East. Importantly, although cardiac echinococcosis is rare the disease can lead to many clinical complications, for instance acute heart failure and life-threatening arrhythmias. With respect to the increasing relevance of cardiac echinococcosis in Western Europe and the danger of fulminant disease courses, here we review diagnosis strategies and treatment options of the disease. Diagnosis of cardiac echinococcosis requires a detailed evaluation of the patients' case history, specific laboratory analyses and radiological imaging methods. Ultrasound, MRI and CT are key imaging tools for diagnosis, therapy control, prognosis estimation and disease course control. For the therapy of cardiac echinococcosis, a combination of surgical removal and drug treatment should be applied to symptomatic as well as asymptomatic patients. The complete surgical removal of the cyst(s) is the major prognosis factor of the cardiac manifestation of CE.

An intra‐cardiac mass in a patient with Behçet’s disease: Cardiac hydatid cyst

“…Table 1 demonstrates the differential diagnosis for intracardiac cysts. Among all cystic echinococcosis, 0.5% to 2% shows a cardiac involvement . Cardiac hydatid cysts should always be surgically removed, but there is also risk of death due to massive antigenic stimuli and pulmonary embolism after resection of the cyst, as Díaz‐Menéndez et al reported .…”

Intracardiac mass in a 66-year-old woman

“…Complications are related to their size and location, mainly including haemodynamic obstruction, valve dysfunction, embolism and infective endocarditis. The cyst may rupture as it grows, especially the hydatid cyst, resulting in allergy and embolism 1. Cystic tumour of the atrioventricular node may cause heart block and sudden death 2.…”

Quiste hidatídico intracardíaco en una niña: reporte de caso

“…Echinococcus de la familia Taeniidae que infecta el intestino del perro (tenia adulta), su huésped definitivo asintomático. En el hombre, su huésped intermediario incidental, un 10 % de sus huevos alcanzan la circulación, llegando a órganos específicos como los pulmones y otras ubicaciones sistémicas como el corazón, páncreas, bazo y cerebro (2,3,14,10) .…”

“…Una vez que el parásito alcanza al miocardio el quiste se forma entre uno a cinco años (2,5) . El ventrículo izquierdo, al recibir más flujo sanguíneo, se compromete con más frecuencia (55 % a 60 %), seguido del ventrículo derecho (15 % a 25 %), la aurícula izquierda (8 %), el pericardio (8 % a 11 %), el septum interventricular (5 % a 9 %) y arterias pulmonares (7 %) por su mayor vascularización (2)(3)(4)(5)10) . Los quistes hidatídicos del ventrículo izquierdo son usualmente localizados en el subepicardio, mientras que los del septum interventricular son intramiocárdicos (3,5,14) .…”