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Banisefid E, Baghernezhad K, Beheshti R, Hamzehzadeh S, Nemati S, Samadifar Z, Owaysee Osquee H, Javanshir E, Naseri A. Cardiac hydatid disease; a systematic review. BMC Infect Dis 2023; 23:600. [PMID: 37705012 PMCID: PMC10500901 DOI: 10.1186/s12879-023-08576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Human cystic echinococcosis (CE), is a common health problem in low- and middle-income countries. Cardiac involvement is a relatively rare manifestation of Echinococcus infection. This study aims to summarize the evidence regarding the features of cardiac CE. METHODS Case series of the patients with cardiac CE, were included in this study. Non-English papers, case reports, reviews, letters, , commentaries, and conference abstracts were not included. A systematic search was conducted in PubMed and EMBASE databases and the risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS Out of 3985 results of the searches, finally 37 studies were included in this systematic review. Based on available evidence, cardiac involvement is an uncommon but serious presentation of CE which presents with some non-specific signs and symptoms. Dyspnea, chest pain, and palpitation are the most common symptoms of the disease and normal sinus rhythm is the most common Electrocardiogram (ECG) feature. The disease is not associated with high mortality in case of timely diagnosis and appropriate management. DISCUSSION Consecutive and complete inclusion of participants, statistical analysis, and appropriate reporting of the demographics were the sources of bias in the included studies. The exclusion of non-English papers was a limitation during the review process. FUNDING The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380). REGISTRATION This study was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42022381204).
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Affiliation(s)
- Erfan Banisefid
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kosar Baghernezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rasa Beheshti
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hamzehzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheil Nemati
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azerbaijan, 5166/15731, Iran
| | - Zahra Samadifar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azerbaijan, 5166/15731, Iran
| | - Hamid Owaysee Osquee
- Department of Infectious Disease, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azerbaijan, 5166/15731, Iran.
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
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Abstract
INTRODUCTION Echinococcosis, also called hydatid disease, is a common parasitic infection of the liver. However, echinococcus lesions rarely involve the heart, especially in children. PATIENT CONCERNS An 8-year-old child from grazing areas of northwest China was referred to our hospital for the complaint of inpersistent precordial chest pain and left upper quadrant pain for 3 years. Palpation showed hepatomegaly, abdominal palpable mass while inspection abdominal distension. Routine blood tests were within the normal ranges. DIAGNOSIS Combining the life history in pasture area, imaging features and serology results, it was consistent with the diagnosis of cardiac echinococcosis. INTERVENTIONS Surgery was performed to evacuate cyst liquid and remove the internal capsule of the cyst. OUTCOMES There was no cystic lesion in heart on ultrasound and her physical condition improved significantly after the surgery. The patient died of hepatic hydatid cyst rupture due to refusing high-risk surgical treatment and other treatment. LESSONS We presented a rare case of cystic echinococcosis involving left ventricle in a child, and surgery is an alternative and effective therapy for this lesion due to the cyst rupture or leakage that can result in anaphylaxis. The typical imaging features of the cardiac echinococcosis on cardiac magnetic resonance are presented. Patient prognosis relies on proper treatment of all lesions.
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Yasim A, Ustunsoy H, Gokaslan G, Hafız E, Arslanoglu Y. Cardiac Echinococcosis: A Single-Centre Study with 25 Patients. Heart Lung Circ 2017; 26:157-163. [DOI: 10.1016/j.hlc.2016.05.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/29/2015] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
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Yan F, Huo Q, Abudureheman M, Qiao J, Ma S, Wen H. Surgical treatment and outcome of cardiac cystic echinococcosis. Eur J Cardiothorac Surg 2014; 47:1053-8. [PMID: 25193952 DOI: 10.1093/ejcts/ezu323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/21/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Cardiac cystic echinococcosis (CE), or hydatid cyst is exceptionally uncommon. We review the experience of surgical treatment of cardiac CE. METHODS Twenty-six patients (11 females; mean age, 28.9 ± 7.6 years) with cardiac CE undergoing surgical treatment from February 1978 to April 2013 were reviewed. The operative methods mainly included puncture-aspiration cystectomy, intact endocyst enucleation and total cyst resection. RESULTS Cardiac CE was located in the myocardium in 16 cases, pericardium in 8 and both myocardium and pericardium in 2. There were 21 cases with solitary hydatid cyst including at the left ventricle in 7, right ventricle in 5, right atrium in 2, interventricular septum in 1 and at the pericardium in 6; 5 cases were with multiple cysts. There was no operative mortality. All patients received albendazole postoperatively. The mean follow-up time was 68 ± 21 months (range 7-195 months) except for 4 who were lost to follow-up. There were three recurrences and one late death. CONCLUSIONS Cardiac cystic echinococcosis (CE) remains a very infrequent zoonotic infection. Presenting symptoms of cardiac hydatid disease are variable depending on the size, number and location of the cyst. Echocardiography, corroborated with computed tomography or magnetic resonance imaging, affords the best diagnostic and follow-up confirmation. Surgical treatment is associated with a low morbidity and mortality, and the selection of proper technique is very important to completely remove the hydatid cyst and prevent recurrence. Postoperative oral antiparasitic therapy is necessary for a definitive cure.
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Affiliation(s)
- Fei Yan
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qiang Huo
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Murat Abudureheman
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jun Qiao
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - SongFeng Ma
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hao Wen
- Xinjiang Key Lab of Fundamental Medical Research and Xinjiang Hydatid Clinical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Parvizi R, Namdar H, Bilehjani E, Bayat A, Sheikhalizadeh MA. Simultaneous operation of hydatid cyst of the heart and liver: a case report. J Cardiovasc Thorac Res 2013; 5:127-8. [PMID: 24252990 DOI: 10.5681/jcvtr.2013.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/04/2013] [Indexed: 12/28/2022] Open
Abstract
Primary echinococcosis of the heart is exceptionally uncommon and is reported 0.5% to 2% of all hydatid cyst sites in comparison with liver (70%) or lung (20%) involvement. Hydatid disease of the heart is caused by the cestode tapeworm echinococcosis granulosis or alveolaris. We present a 29-year-old female with hydatid disease of the liver and heart. She only complained of abdominal pain and palpitation. Echocardiography and multi-slice computed tomography (MSCT) showed a 120×101 mm cyst in the liver and 64 mm in the right ventricular free wall. Both cysts were excised within one procedure successfully.
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Affiliation(s)
- Rezayat Parvizi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Díaz-Menéndez M, Pérez-Molina JA, Norman FF, Pérez-Ayala A, Monge-Maillo B, Fuertes PZ, López-Vélez R. Management and outcome of cardiac and endovascular cystic echinococcosis. PLoS Negl Trop Dis 2012; 6:e1437. [PMID: 22235354 PMCID: PMC3250507 DOI: 10.1371/journal.pntd.0001437] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 10/30/2011] [Indexed: 12/29/2022] Open
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. Cardiac and vascular involvement are infrequent in classical cystic echinococcosis (CE), but when they occur they tend to present earlier and are associated with complications that may be life threatening. Cardiovascular CE usually requires complex surgery, so in low-income countries the outcome is frequently fatal. This case series describes the characteristics of cardiovascular CE in patients diagnosed and treated at a Tropical Medicine & Clinical Parasitology Center in Spain. 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. The main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. The clinical picture 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. CE is a neglected disease and further studies are necessary in order to make more definite management recommendations for this rare and severe form of the disease. The authors propose a general approach based on cyst location: exclusively cardiac, endovascular or both.
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Affiliation(s)
- Marta Díaz-Menéndez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - José Antonio Pérez-Molina
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francesca Florence Norman
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ana Pérez-Ayala
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Begoña Monge-Maillo
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Pilar Zamarrón Fuertes
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Rogelio López-Vélez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- * E-mail:
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Multidetector CT and MR imaging cardiac hydatidosis: case report and review of the literature. Int J Cardiovasc Imaging 2011; 27 Suppl 1:97-102. [PMID: 22012491 DOI: 10.1007/s10554-011-9958-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/04/2011] [Indexed: 10/16/2022]
Abstract
Cardiac hydatid cysts are uncommon but potentially fatal. We present a case of isolated unilocular and multivesicular hydatid cysts in the heart, and provide a literature review of this rare condition. A 35-year-old man presented to our cardiology unit with acute chest pain. Computed tomography showed two cystic lesions in the heart. One unilocular cyst was located close to the left atrium and compressed the pulmonary artery. The other multivesicular cyst adhered to the left ventricle and displaced the left coronary arteries. T2-weighted magnetic resonance images revealed lesions in the pericardial cavity with bright signal intensity. Dot immunogold filtration assay was performed, and positive results for anti-EgCF antibody, anti-EgP antibody and anti-EgB antibody for cystic hydatidosis were found. Cardiac hydatidosis was diagnosed because of typical imaging findings and positive serology. The patient underwent surgical excision of the cysts. Postoperatively, symptoms of the patient resolved.
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Gruttadauria S, D'Ancona G, Pagano D, Panarello G, Follis F, Gridelli B. Complex Hydatid Cyst of the Liver with Intra-Cardiac Involvement. Am Surg 2010. [DOI: 10.1177/000313481007601210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Salvatore Gruttadauria
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy and Department of Surgery University of Pittsburgh Pittsburgh, Pennsylvania
| | - Giuseppe D'Ancona
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy
| | - Duilio Pagano
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy
| | - Giovanna Panarello
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy
| | | | - Bruno Gridelli
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy and Department of Surgery University of Pittsburgh Pittsburgh, Pennsylvania
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Abstract
Parasitic infections previously seen only in developing tropical settings can be currently diagnosed worldwide due to travel and population migration. Some parasites may directly or indirectly affect various anatomical structures of the heart, with infections manifested as myocarditis, pericarditis, pancarditis, or pulmonary hypertension. Thus, it has become quite relevant for clinicians in developed settings to consider parasitic infections in the differential diagnosis of myocardial and pericardial disease anywhere around the globe. Chagas' disease is by far the most important parasitic infection of the heart and one that it is currently considered a global parasitic infection due to the growing migration of populations from areas where these infections are highly endemic to settings where they are not endemic. Current advances in the treatment of African trypanosomiasis offer hope to prevent not only the neurological complications but also the frequently identified cardiac manifestations of this life-threatening parasitic infection. The lack of effective vaccines, optimal chemoprophylaxis, or evidence-based pharmacological therapies to control many of the parasitic diseases of the heart, in particular Chagas' disease, makes this disease one of the most important public health challenges of our time.
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Franco-Paredes C, Rouphael N, Méndez J, Folch E, Rodríguez-Morales AJ, Santos JI, Hurst JW. Cardiac manifestations of parasitic infections part 3: pericardial and miscellaneous cardiopulmonary manifestations. Clin Cardiol 2007; 30:277-80. [PMID: 17551959 PMCID: PMC6653132 DOI: 10.1002/clc.20092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This is part three of a three-part series discussing parasites of the heart. In this section, we present an overview on parasitic diseases involving predominantly the pericardium and other miscellaneous cardiopulmonary manifestations such as some pulmonary hypertension syndromes and endomyocardial fibrosis.
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Affiliation(s)
- Carlos Franco-Paredes
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30303, USA.
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Zobel C, Kuhn-Regnier F, Krüger K, Gerharz M, Schneider CA, Müller-Ehmsen J, Erdmann E. Echinococcus cyst located in the interventricular septum. Clin Res Cardiol 2006; 95:600-4. [PMID: 16897142 DOI: 10.1007/s00392-006-0428-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
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Biyik I, Acar S, Ergene O. Left atrial mobile hydatid cyst mimicking left atrial myxoma and mitral stenosis and causing heart failure and arrhythmia. Int J Cardiovasc Imaging 2006; 23:193-5. [PMID: 16868856 DOI: 10.1007/s10554-006-9132-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 06/30/2006] [Indexed: 10/24/2022]
Abstract
Cardiac hydatid cysts are very rare in hydatid cyst disease. We report herein a case of hydatid cyst mimicking left atrial myxoma. A 78-year-old woman was admitted to our hospital with complaint of dyspnea and signs pulmonary edema and mitral stenosis. Echocardiography showed left atrial mobile, mostly solid mass with wall calcifications moving towards the orifice of the mitral valve. We also found loculated giant hepatic and right pulmonary cysts. We aimed to report this case because of mimicking mitral stenosis and left atrial myxoma and causing heart failure.
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Affiliation(s)
- Ismail Biyik
- Department of Cardiology, Usak State Hospital, Ismetpasa Caddesi 75/1, 64100 Usak, Turkey.
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