Tarek Elshazly, MD
University Hospitals Cleveland Medical Center
Cleveland, Ohio
Disclosure information not submitted.
Dane Coyne, MD
Assistant Professor
University Hospitals of Cleveland - Case Western Reserve University, Ohio, United States
Disclosure information not submitted.
Title: Tricuspid Valve Replacement In a Patient With Carcinoid Heart Disease 30 Years After Diagnosis.
Case Report Body:
Introduction: Carcinoid heart disease, which eventually occurs in up to 50% of patients with carcinoid syndrome can be the initial presentation, with right-sided valvular pathology being more common. We present in our case the surgical management and considerations for carcinoid heart disease involving the tricuspid valve, which appeared many years later in life after the initial diagnosis of carcinoid syndrome.
Case: 72 YOM PMHx CAD, MI (s/p PCIx2), thrombocytopenia, HTN, hypothyroidism, and neuroendocrine tumor of the small bowel diagnosed 30 years prior, complicated by liver metastasis requiring radiation, who presented with lower extremity edema, dyspnea on exertion, and abdominal bloating. Echocardiography was significant for normal EF, severely dilated right atrium, dilated tricuspid valve annulus with restricted tricuspid valve leaflets and severe tricuspid regurgitation, consistent with right-sided carcinoid heart disease. The patient underwent CABG (LIMA-LAD), tricuspid valve replacement, and a permanent pacemaker placement. His intraoperative course was complicated by hypotension requiring octreotide, his postoperative ICU course was uncomplicated; and the patient was eventually discharged in good condition.
Discussion: Right-sided valvular involvement in carcinoid heart disease is largely due to inactivation of humoral substances by the lungs prior to reaching the left heart. Valve replacement surgery (commonly bivalvular replacement of tricuspid and pulmonic valves) can prevent progression to frank heart failure.