title: Management and outcome of cardiac and endovascular cystic echinococcosis.
abstract: BACKGROUND
  Cystic echinococcosis (CE) can affect the heart and the vena cava but few cases are reported.
  
  
  METHODS
  A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995-2009) is reported.
  
  
  RESULTS
  Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4-93 months). One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE) and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications.
  
  
  CONCLUSIONS
  Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.
authors.affiliation: Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Díaz-Menéndez
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pérez-Molina
authors.forename: Francesca Florence
authors.initials: FF
authors.lastname: Norman
authors.forename: Ana
authors.initials: A
authors.lastname: Pérez-Ayala
authors.forename: Begoña
authors.initials: B
authors.lastname: Monge-Maillo
authors.forename: Pilar Zamarrón
authors.initials: PZ
authors.lastname: Fuertes
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000871:Anthelmintics / Q000008:administration & dosage; D002648:Child; D004443:Echinococcosis / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000469:parasitology / Q000473:pathology; D006331:Heart Diseases / Q000175:diagnosis / Q000469:parasitology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013903:Thoracic Surgery; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000469:parasitology* / Q000473:pathology / Q000628:therapy; D014682:Vena Cava, Inferior / Q000469:parasitology / Q000473:pathology; D055815:Young Adult
chemical_list: D000871:Anthelmintics