Primary cardiac hydatid disease

transmural ulceration and perforation ofthe oesophagus we have seen. The clinical and histological evidence suggests that the leak occurred during the second week after sclerotherapy, by which time most patients will have been discharged from hospital. Minor side-effects ofsclerotherapy are seen regularly but usually disappear within 48 hours. These include retrosternal discomfort, dysphagia and odynophagia, fever, tachycardia and arrhythmias, changes in the prothrombin index and partial thromboplastin time, and small pleural effusions. They are presumably related to the sclerosant entering the general circulation and to local efIects.16 Sclerotherapy does therefore seem to be associated with certain problems, but ifwe are prepared to accept these, as well as the high incidence of recurrent bleeding and the need for continuous follow-up and repeat procedures, it may still be the treatment ofchoice when major surgical procedures pose a high risk because of severely compromised liver function.