Abstract
BACKGROUND: Cardiac involvement by Echinococcus granulosus is extremely rare, accounting for less than 2% of all hydatid disease cases. When it occurs, it commonly affects the left ventricle, while valvular involvement is exceedingly unusual. CASE PRESENTATION: We present the case of a 74-year-old woman from rural Georgia who developed progressive exertional dyspnoea and fatigue. Physical examination revealed multiple murmurs, and transthoracic echocardiography identified a mobile, hyperechoic mass attached to the posterior mitral valve leaflet. Transoesophageal echocardiography raised suspicion for a myxoma or vegetation, and surgical excision was pursued due to embolic risk. Intraoperatively, a teardrop-shaped cystic mass containing multiple daughter cysts was found on the P2 segment of the mitral valve. Histopathology confirmed a hydatid cyst, consistent with cardiac echinococcosis. The patient underwent successful segmental excision of the cyst with mitral valve repair and tricuspid annuloplasty. Her postoperative course was complicated by atrial fibrillation and new-onset type 2 diabetes mellitus. She was treated with albendazole and discharged in stable condition. CONCLUSION: This report highlights a rare instance of isolated mitral valve echinococcosis, initially misdiagnosed as a myxoma. It underscores the importance of considering parasitic aetiologies in the differential diagnosis of intracardiac masses, particularly in patients with rural backgrounds. LEARNING POINTS: Mitral valve involvement in cardiac echinococcosis is exceedingly rare and may clinically and radiographically mimic myxomas or vegetations.Hydatid disease should be considered in the differential diagnosis of intracardiac masses, especially in patients with epidemiologic exposure to livestock or dogs.Early recognition and surgical intervention, coupled with antiparasitic therapy, are essential for optimal outcomes in rare valvular hydatid disease.