Cardiac hydatid disease; a systematic review
BMC Infectious Diseases volume 23, Article number: 600 (2023)
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.
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.
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.
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.
The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380).
This study was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42022381204).
Human cystic echinococcosis (CE), also known as hydatid disease, is a tissue infestation, which is endemic in many sheep-farming areas of the world, notably Mediterranean countries, the Middle East, South America, and Australia [1, 2]. Echinococcosis is a common health problem in low- and middle-income countries , and the European Registry of CE found it a neglected health problem in these countries . CE has a considerable economic impact, with the cost of the disease approximated at 0.03% of the country’s gross domestic product in Iran . CE occurs mainly as a result of infection with the larvae of Echinococcus granulosus. Most often, dogs and other carnivores are the primary hosts and sheep are intermediate hosts, whereas humans are accidental hosts of the parasite. Humans usually become infected by ingesting food, milk, or water contaminated by dog feces containing the ova of the parasite [6, 7]. The most common sites of CE involvement are the liver and lung ; however, it can affect other organs in the body such as the heart, too . Cardiac CE is a relatively rare manifestation of Echinococcus infection, which represents 0.5 to 2% of CE cases [10,11,12] Despite the multiple studies regarding the features of cardiac CE [13, 14], there was no systematic review of the literature on this topic, therefore this study aimed to determine the characteristics of cardiac CE disease based on available evidence.
This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement .
Case-series studies which presented the features of cardiac CE were considered for inclusion in this systematic review. Non-English studies, case reports, conference abstracts, review articles, letters, and commentaries were excluded.
Medline via PubMed and EMBASE databases were searched systematically from inception to March 2022 with the following keywords: ((Echinococc* OR Hydatid*) AND (Heart OR cardi*)) OR Cardiac Hydatid in title, abstract, and author keywords. During the search, no restrictions on language and type of study were applied. Also, forward and backward searches from references and cited studies of included studies were performed for a comprehensive coverage of the published studies.
Study selection and data collection
Two authors separately reviewed the full-texts of the studies after being primarily screened based on title/abstract. The data from the included studies were extracted into a Microsoft Excel table. Information from eligible studies, including the name of the first author, publication year, study setting, patients’ demographics, the site of the heart’s involvement, the involvement of other organs, clinical manifestations, Electrocardiogram (ECG) findings, echocardiography, Chest X-ray (CXR) or magnetic resonance imaging, laboratory findings, management, final outcome, and follow-up, is extracted by two authors and cross-checked. Disagreements between authors were solved by the third author.
Risk of bias assessment
The potential for risk of bias in the studies was assessed by The Joanna Briggs Institute (JBI) Critical Appraisal tool for Case Series. The validity and reliability of condition evaluation, the contiguous recruitment of participants, the reporting of patient demographic and clinical data, clinical management, and follow-up are the sources of bias that being evaluated by this checklist.
Search and selection process
Electronic searches in the databases results in 3985 records and finally, 37 studies met our criteria for inclusion in this systematic review. The details of the selection process are presented in Fig. 1.
Seventeen studies were conducted in Turkey and the setting in other studies were Tunisia (5 studies), Iraq (3 studies), Spain, Syria, China, Greece (2 studies for each), Saudi Arabia, Kyrgyzstan, India, and France (1 study for each). The sample of cardiac CE in the studies varies between 2 and 62.
Risk of bias in studies
Figure 2 is a summary of the risk of bias assessments based on The JBI Critical Appraisal tool for Case Series. The details are reported in supplementary material 1. Based on our assessments, the most common possible sources of bias in the included studies were regarding the consecutive and complete inclusion of participants and statistical analysis, which were not reported in a clear form for a conclusive judgment. Inappropriate reporting of the demographics was also another source of bias in the studies.
Results of individual studies
The evidence regarding the site of involvement, other organ involvement, signs and symptoms, ECG findings, echocardiography or CXR findings, laboratory findings, management, outcome, and follow-up are summarized and presented in Table 1. Cardiac CE can infect people of any age in both males and females. LV is reported as the most common site of infection. Studies suggested that cardiac CE can be secondary to other site infections, such as lung, liver, and spleen; however, cases of cardiac involvement without other organ involvement are also documented. The most commonly reported symptoms were chest pain, dyspnea, and palpitation and normal sinus rhythm (NSR) was the most common declared ECG feature. Regarding the laboratory findings, serological tests such as echinococcus indirect hemagglutination (EIHA) and enzyme-linked immunosorbent assay (ELISA), as well as eosinophilia, and positive casoni were the most commonly reported findings. A combination of surgical methods, such as cardiopulmonary bypass, and pharmacological management were reported in the studies; which were associated with appropriate outcomes, so the rate of mortality and recurrence were not considerable.
This study is the first systematic review to summarize the evidence regarding the features of cardiac CE. Cardiac involvement occurs mainly by invasion of myocardium from the coronary arteries or pulmonary veins as a result of rupture of pulmonary echinococcal cysts . Various locations of the heart can be infected with CE; however, LV is the most common site [17,18,19,20,21,22] and it can be presented in the pericardium as well as the myocardium layer, too [23, 24]. The main reason for higher rate of LV involvement can be the dominance of the left coronary artery [13, 25].
The clinical presentation of CE ranges from asymptomatic to life-threatening conditions and sudden death. Symptoms depend on location, size, compression, or involvement of abutting structures. The most frequent symptoms of CE are dyspnea, chest pain, and palpitation. The stretch of pericardium and/or compression of coronary vessels can be an explanation for this [11, 26, 27]. Also, the NSR is the most common ECG finding in CE patients, which suggested a crucial role of imaging and laboratory methods in the detection of cardiac CE.
Cardiac CE can affect almost everyone in each age group in the endemic areas; however, non-specific signs and ECG changes, make it a diagnostic challenge. Transthoracic echocardiogram (TTE) is suggested to be sensitive and specific in the diagnosis of cardiac CE [28, 29]. Classic cystic CE lesions appear as well-defined echo-lucent structures on echocardiographic images, whereas those that have become solidified, calcified, or degenerated can be hyper-echogenic and, thus, mimic semi-solid or solid mass lesions . In a case series 6/16 (37.5%) of increased cardiothoracic ratio was reported . Also, 5 cases of pericardial effusion were reported in the included studies [31,32,33]; which suggested that these features can be sign of cardiac CE, too. Cardiac CE infection is predominantly secondary to more commonly involved organs such as the liver and lung , therefore, in patients with CE in other organs, imaging and blood tests can help detect the cardiac form of the disease. Serological methods such as EIHA and ELISA are suggested as highly sensitive and specific tests for CE [14, 35]; however, the diagnostic accuracy of these blood tests, specifically in the cardiac form of the disease is not investigated. Most of the included studies reported a considerable rate of positive EIHA in patients with cardia CE; however, there is a need for future diagnostic accuracy studies of EIHA in cardiac CE, for clinical recommendation.
Cardiac CE is an uncommon but serious condition; however, it is not associated with a high rate of mortality in case of timely diagnosis and appropriate surgical and non-surgical management . Overall, there was no significant cardiac CE-related mortality in the included studies. Rupture of the cyst during surgery, pulmonary embolism, and multi-organ failure was the cause of mortality in cardiac CE patients [17, 37, 38]. Also, pharmacotherapy with mebendazole or albendazole for 6–24 months postoperatively, is recommended for prevention of the recurrence of the disease .
Systematic and predefined approach of the review and a comprehensive database search as well as hand searching for full coverage of the published evidence were the main strengths of this study. The exclusion of non-English papers was the main limitation of this study. Future multi-center studies with larger sample sizes and comprehensive reports of the characteristics of the disease can strengthen the evidence in this regard and help appropriate management in cardiac CE patients. Also, it is recommended to report more details of cardiac CE patients in future studies.
Cardiac involvement is an uncommon presentation of CE which is associated with some non-specific signs and symptoms such as dyspnea, chest pain, palpitation, and fatigue. In the case of diagnosed CE in other organs such as the lungs and liver, cardiac CE, should be considered by clinicians. Non-specific signs and symptoms make cardiac CE a diagnostic challenge; however, imaging methods such as TTE as well as serological tests, can help diagnosis of the disease. Cardiac CE is not associated with considerable mortality in the case of timely diagnosis and appropriate management.
All data generated during this study are included in this published article and its supplementary information file.
Grosso G, Gruttadauria S, Biondi A, Marventano S, Mistretta A. Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol. 2012;18(13):1425–37.
Moro P, Schantz PM. Echinococcosis: a review. Int J Infect Dis. 2009;13(2):125–33.
Gholami S, Tanzifi A, Sharif M, Daryani A, Rahimi MT, Mirshafiee S, Sarvi S. Demographic aspects of human hydatidosis in iranian general population based on serology: a systematic review and meta-analysis. Vet World. 2018;11(10):1385–96.
Rossi P, Tamarozzi F, Galati F, Akhan O, Cretu CM, Vutova K, Siles-Lucas M, Brunetti E, Casulli A, Angheben A, et al. The european Register of cystic echinococcosis, ERCE: state-of-the-art five years after its launch. Parasites & Vectors. 2020;13(1):236.
Fasihi Harandi M, Budke CM, Rostami S. The monetary burden of cystic echinococcosis in Iran. PLoS Negl Trop Dis. 2012;6(11):e1915.
Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev. 2004;17(1):107–35.
Beiromvand M, Rafiei A, Razmjou E, Maraghi S. Multiple zoonotic helminth infections in domestic dogs in a rural area of Khuzestan Province in Iran. BMC Vet Res. 2018;14(1):224.
McManus DP, Zhang W, Li J, Bartley PB. Echinococcosis. Lancet. 2003;362(9392):1295–304.
Sachar S, Goyal S, Goyal S, Sangwan S. Uncommon locations and presentations of hydatid cyst. Ann Med Health Sci Res. 2014;4(3):447–52.
Fennira S, Kamoun S, Besbes B, Ben Mrad I, Zairi I, Ben Moussa F, Mzoughi K, Kraiem S. Cardiac hydatid cyst in the interventricular septum: a literature review. Int J Infect Dis. 2019;88:120–6.
Kosecik M, Karaoglanoglu M, Yamak B. Pericardial hydatid cyst presenting with cardiac tamponade. Can J Cardiol. 2006;22(2):145–7.
El Boussaadani B, Regragui H, Bouhdadi H, Wazaren H, Ajhoun I, Laaroussi M, Cherti M. Primary cardiac hydatid cyst presenting with massive pericardial effusion: a case report. Egypt Heart J. 2020;72(1):51.
Firouzi A, Neshati Pir Borj M, Alizadeh Ghavidel A. Cardiac hydatid cyst: a rare presentation of echinococcal infection. J Cardiovasc Thorac Res. 2019;11(1):75–7.
Kahlfuß S, Flieger RR, Roepke TK, Yilmaz K. Diagnosis and treatment of cardiac echinococcosis. Heart. 2016;102(17):1348.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Cacoub P, Chapoutot L, Du-Boutin LT, Derbel A, Gandjbakhch I, Sal R, Godeau P. [Hydatid cyst of the interventricular septum. Contribution of magnetic resonance imaging]. Arch Mal Coeur Vaiss. 1991;84(12):1857–60.
Yasim A, Ustunsoy H, Gokaslan G, Hafız E, Arslanoglu Y. Cardiac echinococcosis: a single-centre study with 25 patients. Heart Lung and Circulation. 2017;26(2):157–63.
Barbetseas J, Lambrou S, Aggeli C, Vyssoulis G, Frogoudaki A, Tsiamis E, Stefanadis C. Cardiac hydatid cysts: echocardiographic findings. J Clin Ultrasound. 2005;33(4):201–5.
Kankilic N, Aydin MS, Günendi T, Göz M. Unusual hydatid cysts: Cardiac and pelvic-ilio femoral Hydatid Cyst Case Reports and Literature Review. Braz J Cardiovasc Surg. 2020;35(4):565–72.
Noaman H, Rawaf S, Majeed A, Salmasi AM. Hydatid Cyst of the heart. Angiology. 2017;68(9):765–8.
Akrim Y, Babokh F, El Hakkouni A. Cardiac echinococcosis with hepatic involvement in a child: a Case Report. Cureus. 2022;14(10):e30390.
Oraha AY, Faqe DA, Kadoura M, Kakamad FH, Yaldo FF, Aziz SQ. Cardiac Hydatid cysts; presentation and management. A case series. Annals of Medicine and Surgery. 2018;30:18–21.
Jusabani AM, Kalambo CF, Jusabani M, Surani S. Myocardial echinococcosis: rare manifestation of a common parasitic disease in Northern Tanzania. Cureus. 2020;12(6):e8681.
Tufekcioglu O, Birincioglu CL, Arda K, Fansa I, Saritas A, Karahan M. Echocardiography findings in 16 cases of cardiac echinococcosis: proposal for a new classification system. J Am Soc Echocardiogr. 2007;20(7):895–904.
Cantoni S, Frola C, Gatto R, Loria F, Terzi MI, Vallebona A. Hydatid cyst of the interventricular septum of the heart: MR findings. AJR Am J Roentgenol. 1993;161(4):753–4.
Kosar F, Aksoy Y, Sahin I, Erdil N. Pericardial hydatid cyst mimicking acute coronary syndrome. Tex Heart Inst Journal/from Tex Heart Inst St Luke’s Episcop Hosp Tex Children’s Hosp. 2005;32(4):570.
Gossios K, Passas G, Kontogiannis D, Kakadellis J. Mediastinal and pericardial hydatid cysts: an unusual cause of circulatory collapse. Am J Roentgenol. 2003;181(1):285–6.
Shojaei E, Yassin Z, Rezahosseini O. Cardiac Hydatid Cyst: a Case Report. Iran J Public Health. 2016;45(11):1507–10.
Canpolat U, Yorgun H, Sunman H, Aytemir K. Cardiac hydatid cyst mimicking left ventricular aneurysm and diagnosed by magnetic resonance imaging. Turk Kardiyoloji Dernegi Arsivi: Turk Kardiyoloji Derneginin Yayin Organidir. 2011;39(1):47–51.
Birincioglu CL, Tarcan O, Nisanoglu V, Bardakci H, Taşdemir O. Is it cardiac tumor or echinococcosis? Tex Heart Inst J. 2001;28(3):230–1.
Abid A, Khayati A, Zargouni N. Hydatid cyst of the heart and pericardium. Int J Cardiol. 1991;32(1):108–9.
Wadhawa V, Shah J, Doshi C, Ramani J, Lakhia K, Rathod D, Tavar R, Kothari J. Surgical overview of cardiac echinococcosis: a rare entity. Interact Cardiovasc Thorac Surg. 2018;27(2):191–7.
Djoshibaev S, Kudaiberdiev T, Maralov A, Shabraliev S, Djooshev K, Halikov UM, Yankovskaya L. Surgical treatment of isolated cardiac echinococciasis: report of five cases. Anadolu Kardiyol Derg. 2003;3(2):137–43.
Neysi H, Mohammadzadeh T, Sadjjadi SM, Akhavanmoghaddam J, Shamsaei A. Genetic diversity of Hepatic/Non-Hepatic cystic echinococcosis in Baqiyatallah Hospital, Tehran, Iran. Iran J Parasitol. 2020;15(1):130–7.
Yaliniz H, Tokcan A, Salih OK, Ulus T. Surgical treatment of cardiac hydatid disease: a report of 7 cases. Tex Heart Inst J. 2006;33(3):333–9.
Tsigkas G, Chouchoulis K, Apostolakis E, Kalogeropoulou C, Koutsogiannis N, Koumoundourou D, Alexopoulos D. Heart echinococcus cyst as an incidental finding: early detection might be life-saving. J Cardiothorac Surg. 2010;5(1):124.
Akar R, Eryilmaz S, Yazicioğlu L, Eren NT, Durdu S, Uysalel A, Uçanok K, Corapçioğlu T, Ozyurda U. Surgery for cardiac hydatid disease: an anatolian experience. Anadolu Kardiyol Derg. 2003;3(3):238–44.
Kardaras F, Kardara D, Tselikos D, Tsoukas A, Exadactylos N, Anagnostopoulou M, Lolas C, Anthopoulos L. Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece. Eur Heart J. 1996;17(8):1265–70.
Parvizi R, Joudati Ar, Hasanzadeh Salmasi S Montazeriv, Varshouchi M. Cardiac Echinococcosis: Surgical Treatment and Results in 10 Cases. Iran Heart J. 2006;7(4):67–71.
von Sinner WN. CT and MRI findings of cardiac echinococcosis. Eur Radiol. 1995;5(1):66–73.
Gürbüz A, Tetik O, Yilik L, Emrecan B, Ozsöyler I, Ozbek C. Cardiac involvement of hydatid disease. Jpn J Thorac Cardiovasc Surg. 2003;51(11):594–8.
Birincioğlu CL, Tarcan O, Bardakci H, Saritaş A, Taşdemir O. Off-pump technique for the treatment of ventricular myocardial echinococcosis. Ann Thorac Surg. 2003;75(4):1232–7.
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(1):e1437.
Shehatha J, Alward M, Saxena P, Konstantinov IE. Surgical management of cardiac hydatidosis. Tex Heart Inst J. 2009;36(1):72–3.
Tuncer E, Tas SG, Mataraci I, Tuncer A, Donmez AA, Aksut M, Yakut C. Surgical treatment of cardiac hydatid disease in 13 patients. Tex Heart Inst J. 2010;37(2):189–93.
Bashour TT, Alali AR, Mason DT, Saalouke M. Echinococcosis of the heart: clinical and echocardiographic features in 19 patients. Am Heart J. 1996;132(5):1028–30.
Ben-Hamda K, Maatouk F, Ben-Farhat M, Betbout F, Gamra H, Addad F, Fatima A, Abdellaoui M, Dridi Z, Hendiri T. Eighteen-year experience with echinococcosus of the heart: clinical and echocardiographic features in 14 patients. Int J Cardiol. 2003;91(2–3):145–51.
Birincioglu CL, Kervan U, Tufekcioglu O, Ozen A, Bardakci H, Kucuker SA, Saritas A. Cardiac echinococcosis. Asian Cardiovasc Thorac Ann. 2013;21(5):558–65.
Bouraoui H, Trimeche B, Mahdhaoui A, Majdoub A, Zaaraoui J, Hajri Ernez S, Gouider J, Ammar H. Echinococcosis of the heart: clinical and echocardiographic features in 12 patients. Acta Cardiol. 2005;60(1):39–41.
Erentuğ V, Bozbuğa N, Kirali K, Mataraci I, Kaymaz C, Balkanay M, Akinci E, Ipek G, Yakut C. Cardiac hydatid cysts: surgical treatment and results. J Card Surg. 2004;19(4):358–60.
Yan F, Huo Q, Abudureheman M, Qiao J, Ma S, Wen H. Surgical treatment and outcome of cardiac cystic echinococcosis. Eur J Cardiothorac Surg. 2015;47(6):1053–8.
Gormus N, Yeniterzi M, Telli HH, Solak H. The clinical and surgical features of right-sided intracardiac masses due to echinococcosis. Heart Vessels. 2004;19(3):121–4.
Jamli M, Cherif T, Ajmi N, Besbes T, Mgarrech I, Jerbi S, Kortas C, Tarmiz A. Surgical Management and Outcomes of Cardiac and Great Vessels Echinococcosis: a 16-Year experience. Ann Thorac Surg. 2020;110(4):1333–8.
Kabbani SS, Ramadan A, Kabbani L, Sandouk A, Nabhani F, Jamil H. Surgical experience with cardiac echinococcosis. Asian Cardiovasc Thorac Ann. 2007;15(5):422–6.
Kaplan M, Demirtas M, Cimen S, Ozler A. Cardiac hydatid cysts with intracavitary expansion. Ann Thorac Surg. 2001;71(5):1587–90.
Miralles A, Bracamonte L, Pavie A, Bors V, Rabago G, Gandjbakhch I, Cabrol C. Cardiac echinococcosis. Surgical treatment and results. J Thorac Cardiovasc Surg. 1994;107(1):184–90.
Murat V, Qian Z, Guo S, Qiao J. Cardiac and pericardial echinococcosis: report of 15 cases. Asian Cardiovasc Thorac Ann. 2007;15(4):278–9.
Tanyeli O, Dereli Y, Mercan I, Gormus N, Yuksek T. New World’s old disease: cardiac hydatid disease and surgical principles. Cardiovasc J Afr. 2017;28(5):304–8.
Taşdemir K, Emiroğullari ÖN, Ceyran H, Aşik R, Yasim A. Intracardiac Masses. Asian Cardiovasc Thorac Annals. 2000;8(4):378–80.
Onursal E, Elmaci TT, Tireli E, Dindar A, Atilgan D, Ozcan M. Surgical treatment of cardiac echinococcosis: report of eight cases. Surg Today. 2001;31(4):325–30.
Tasdemir K, Akcali Y, Gunebakmaz O, Kaya MG, Mavili E, Sarli B, Tasdemir A, Ceyran H. Surgical approach to the management of cardiovascular echinococcosis. J Card Surg. 2009;24(3):281–4.
Oliver JM, Sotillo JF, Domínguez FJ, López de Sá E, Calvo L, Salvador A, Paniagua JM. Two-dimensional echocardiographic features of echinococcosis of the heart and great blood vessels. Clinical and surgical implications. Circulation. 1988;78(2):327–37.
Oraha AY, Faqe DA, Kadoura M, Kakamad FH, Yaldo FF, Aziz SQ. Cardiac Hydatid cysts; presentation and management. A case series. Ann Med Surg (Lond). 2018;30:18–21.
Abid A, Ben Omrane S, Kaouel K, Marghli A, Dhiab M, Abid N, Ben Zarkouna S, Khayati A. Intracavitary cardiac hydatid cyst. Cardiovasc Surg. 2003;11(6):521–5.
Altaş O, Sarıkaya S, Saçlı H, Yerlikhan O, Kırali K. Cardiac cystic echinococcosis: report of three cases. Asian Pac J Trop Med. 2014;7(11):922–4.
Atilgan D, Kudat H, Tükek T, Ozcan M, Yildirim OB, Elmaci TT, Onursal E. Role of transesophageal echocardiography in diagnosis and management of cardiac hydatid cyst: report of three cases and review of the literature. J Am Soc Echocardiogr. 2002;15(3):271–4.
The research protocol was approved and supported by Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380). Also, this study was registered in International prospective register of systematic reviews (PROSPERO ID: CRD42022381204). Also, we very much appreciate Dr. Leila Nikniaz, Associate Professor of Tabriz University of Medical Sciences, for her kind supports and guidance in this study.
The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380).
Ethics approval and consent to participate
The ethics committee of Tabriz University of Medical Science, reviewed and approved the study protocol (Ethical Code: IR.TBZMED.VCR.REC.1401.154).
Consent for publication
The authors declare no competing of interest.
Conflict of interest
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Banisefid, E., Baghernezhad, K., Beheshti, R. et al. Cardiac hydatid disease; a systematic review. BMC Infect Dis 23, 600 (2023). https://doi.org/10.1186/s12879-023-08576-3
- Echinococcosis, Cardiac Echinococcosis
- Systematic review