169 results on '"Carcinoid Heart Disease complications"'
Search Results
2. Anesthetic key points in a patient with a terminal ileum neuroendocrine tumor and a rare carcinoid left heart disease presented for non-cardiac surgery: case report.
- Author
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Van Ussel K, Leonard D, Watremez C, and Robu CB
- Subjects
- Humans, Female, Adult, Anesthesia methods, Carcinoid Tumor complications, Somatostatin analogs & derivatives, Somatostatin administration & dosage, Somatostatin therapeutic use, Liver Neoplasms secondary, Carcinoid Heart Disease complications, Ileal Neoplasms complications, Neuroendocrine Tumors complications
- Abstract
Background: Carcinoid tumors are rare neuroendocrine malignancies presenting in an increasing number in our center. The incidence of carcinoid tumors is approximatively between 2.5 and 5 cases per 100,000 people of whom about 50% develop carcinoid syndrome. Once the carcinoid syndrome has developed, a carcinoid cardiomyopathy can occur. Carcinoid heart disease (CaHD) remains a serious and rare complication associated with a significant increase in morbidity and mortality. Although carcinoid tumors have been known and studied for several years, there are still scarce data on the anesthetic management and the peri operative period., Case Presentation: We describe a case of a Caucasian 44-year-old woman with an unusual presentation of left CaHD with an ileal neuroendocrine tumor and liver metastases. Our preoperative somatostatin administration protocol, limit the cardiac damage. The maintenance of stable hemodynamics, the use of balanced anesthetic technique, all along with a good understanding of the pathology, played a major role in the successful management of anesthesia. This case report allows us to introduce our decision algorithm for the management of this type of pathology in our tertiary hospital, Cliniques Universitaires Saint-Luc., Conclusion: Despite the paucity of data, anesthetic management of patients with carcinoid tumor can be safely performed with effective hemodynamic monitoring and a good understanding of the pathophysiology. Knowledge and application of a clear institutional algorithm for octreotide administration and multidisciplinary consultation at a referral center are essential for the management of these patients., (© 2024. The Author(s).)
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- 2024
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3. Late-onset multivalvular carcinoid heart disease.
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Rivera K, Zielonka M, Ramírez-Martínez T, Pueyo-Balsells N, and Fernández-Rodríguez D
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- Humans, Female, Middle Aged, Time Factors, Male, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis
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- 2024
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4. NET-Induced Carcinoid Heart Disease Affecting Both Tricuspid and Aortic Valves Due to Patent Foramen Ovale and Right/Left Shunt: A Multi-imaging Challenge to Nuclear Medicine.
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Laschinsky C, Welsner M, Mahabadi AA, Lahner H, and Hautzel H
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- Humans, Male, Middle Aged, Aortic Valve, Hypoxia complications, Positron Emission Tomography Computed Tomography, Serotonin, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Foramen Ovale, Patent complications, Foramen Ovale, Patent diagnostic imaging, Nuclear Medicine
- Abstract
Abstract: Carcinoid heart disease (Hedinger syndrome) is a long-term consequence in hormone-active neuroendocrine tumors with hepatic metastases and carcinoid syndrome. Because of serotonin, excess multiple cardiac and pulmonary symptoms evolve, which are further complicated by a patent foramen ovale due to right-left shunting. We present a 53-year-old man with an ileum-neuroendocrine tumor including gross liver metastases and long-term stable disease who subsequently developed Hedinger syndrome. Initially experiencing progressive dyspnea, he eventually experienced severe hypoxemia due to patent foramen ovale. 99mTc-MAA lung perfusion scintigraphy quantitatively identified the right-left shunting, whereas 68Ga-FAPI-46 PET/CT characterized the typical fibrous heart valve thickening due to serotonin-induced fibroblast proliferative properties., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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5. Carcinoid Heart Disease.
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Johnson S, Benz MR, and Ruchalski K
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- Humans, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation
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- 2024
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6. Management and outcomes of carcinoid heart disease with liver metastases of midgut neuroendocrine tumours.
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Suc G, Cachier A, Hentic O, Bazire B, Sannier A, Delhomme C, Nataf P, Laschet J, Deschamps L, Garbarz E, Ou P, Caligiuri G, Iung B, Ruszniewski P, de Mestier L, and Arangalage D
- Subjects
- Humans, Prospective Studies, Ventricular Remodeling, Carcinoid Heart Disease complications, Heart Valve Prosthesis Implantation methods, Neuroendocrine Tumors surgery, Neuroendocrine Tumors complications, Heart Failure complications, Liver Neoplasms complications
- Abstract
Objective: Despite recent advances in surgical and interventional techniques, knowledge on the management of carcinoid heart disease (CHD) remains limited. In a cohort of patients with liver metastases of midgut neuroendocrine tumours (NETs), we aimed to describe the perioperative management and short-term outcomes of CHD., Methods: From January 2003 to June 2022, consecutive patients with liver metastases of midgut NETs and severe CHD (severe valve disease with symptoms and/or right ventricular enlargement) were included at Beaujon and Bichat hospitals. All patients underwent clinical evaluation and echocardiography., Results: Out of 43 (16%) consecutive patients with severe CHD and liver metastases of midgut NETs, 79% presented with right-sided heart failure. Tricuspid valve replacement was performed in 26 (53%) patients including 19 (73%) cases of combined pulmonary valve replacement. The 30-day postoperative mortality rate was high (19%), and preoperative heart failure was associated with worse survival (p=0.02). Epicardial pacemakers were systematically implanted in operated patients and 25% were permanently paced. A postoperative positive right ventricular remodelling was observed (p<0.001). A greater myofibroblastic infiltration was observed in pulmonary versus tricuspid valves (p<0.001), suggesting that they may have been explanted at an earlier stage of the disease than the tricuspid valve, with therefore potential for evolution., Conclusions: We observed a high postoperative mortality rate and baseline right-sided heart failure was associated with worse outcome. In surviving patients, a positive right ventricular remodelling was observed. Prospective, multicentre studies are warranted to better define the management strategy and to identify biomarkers associated with outcome in CHD., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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7. Carcinoid heart disease: a potentially fatal complication of carcinoid syndrome.
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Bdiwi M, Ramaseshan K, Uddin M, Goel M, Razzaq S, Alrayyashi M, and Afonso L
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- Male, Middle Aged, Humans, Echocardiography, Octreotide therapeutic use, Echocardiography, Transesophageal, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Pulmonary Valve diagnostic imaging, Neuroendocrine Tumors complications
- Abstract
Carcinoid heart disease is a unique and serious cardiac complication of the neuroendocrine tumour that affects the right side of the heart, especially the tricuspid and pulmonic valves, eventually causing right heart failure. We present a middle-aged man with a history of well-differentiated neuroendocrine tumours of the small intestine with extensive metastases to the liver, mesentery and spine who is receiving monthly octreotide therapy. He presented with generalised fatigue, severe ascites and worsening dyspnoea. Both the transthoracic echocardiography and transoesophageal echocardiography revealed severe tricuspid and pulmonic regurgitations. He was considered a poor surgical candidate, underwent transcatheter pulmonic valve replacement with two bioprosthetic valve-in-valve implantations and was discharged in a stable condition., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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8. Patent foramen ovale in carcinoid heart disease: The potential role for and risks of percutaneous closure prior to cardiothoracic surgery.
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Douglas S, Oelofse T, Shah T, Rooney S, Arif S, and Steeds RP
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- Humans, Foramen Ovale, Patent complications, Foramen Ovale, Patent surgery, Carcinoid Heart Disease complications, Carcinoid Heart Disease surgery, Carcinoid Heart Disease epidemiology
- Abstract
Neuroendocrine tumours (NETs) are rare but once metastasised, can lead to the release of vasoactive substances into the systemic circulation, and the classical features of carcinoid syndrome (CS) such as flushing and diarrhoea. A consequence of CS is carcinoid heart disease (CHD) which primarily affects the right-sided heart valves and can eventually lead to right heart failure. In this cohort, tricuspid and/or pulmonary valve replacement provides symptomatic relief. A patent foramen ovale (PFO) in patients with CHD can lead to the shunting of oxygen deficient blood to the systemic circulation causing hypoxaemia and reduced exercise tolerance. Additionally, the haemodynamic changes caused by regurgitant right-sided heart valves can increase the patency of a PFO allowing the passage of vasoactive substances to the systemic circulation thereby affecting the left-sided heart valves. We present data on the incidence of PFO in patients referred for surgery at our centre, in which the standard approach is to close the defect at time of cardiothoracic surgery. In addition, we present a series of four cases that highlight how the option of percutaneous PFO closure prior to open valve surgery may reduce haemodynamic instability and open a window of opportunity to enhance preoperative status. Percutaneous PFO closure then acts as a bridge to definitive cardiothoracic surgery, although there are risks in such an approach., (© 2023 The Authors. Journal of Neuroendocrinology published by John Wiley & Sons Ltd on behalf of British Society for Neuroendocrinology.)
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- 2023
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9. The Past, Present, and The Future of Carcinoid Heart Disease.
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Meir J, Michaud L, Frishman WH, and Aronow WS
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- Humans, Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease therapy, Carcinoid Heart Disease complications
- Abstract
Carcinoid heart disease is a frequent manifestation of carcinoid syndrome. It results from the release of a large amount of serotonin and subsequently fibrosis of right sided heart valves, that is, tricuspid and pulmonic valve. This article reviews the pathogenesis, clinical symptoms, diagnosis, treatment and prognosis of carcinoid heart disease. Recent developments in treating carcinoid heart disease have improved the poor prognosis associated with the disease., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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10. A Case of Primary Insular Ovarian Carcinoid Tumor with Hyperandrogenism and Carcinoid Heart Disease.
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Mansour S, Anaka MR, and Al-Agha R
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- Adult, Chromogranin A, Chromogranins, Female, Humans, Hydroxyindoleacetic Acid, Intestinal Neoplasms, Ki-67 Antigen, Neuroendocrine Tumors, Octreotide, Pancreatic Neoplasms, Stomach Neoplasms, Synaptophysin, Testosterone, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Carcinoid Tumor complications, Carcinoid Tumor diagnosis, Carcinoid Tumor surgery, Hyperandrogenism complications, Ovarian Neoplasms pathology
- Abstract
BACKGROUND Carcinoid heart disease typically occurs in the presence of metastatic carcinoid tumor deposits in the liver, as vasoactive substances access the systemic circulation through the hepatic vein. Primary ovarian carcinoid tumors are rare neuroendocrine tumors, and can be associated with carcinoid syndrome and carcinoid heart disease. CASE REPORT We describe the case of a 40-year-old woman who presented with secondary amenorrhea, acne, hirsutism, and diarrhea. She was found to have a heart murmur on exam in the absence of severe symptoms of heart failure. Her investigations demonstrated elevated urinary 5-hydroxyindoleacetic acid (5-HIAA), chromogranin A, and free testosterone. Abdominal computed tomography enterography showed a large and hypervascular pelvic mass. Octreotide scintigraphy confirmed the diagnosis of primary ovarian carcinoid tumor in the setting of an intensely octreotide-avid mass with no evidence of distant metastases. Transesophageal echocardiography showed severe tricuspid regurgitation with severe dilation of the right heart chambers. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The pathology demonstrated a 14-cm carcinoid tumor of 'insular' type confined to the ovary, pT1apNX, grade 1, positive for chromogranin and synaptophysin (neuroendocrine markers) and positive mib-1 (Ki-67). Postoperatively, clinical and biochemical parameters improved significantly but her cardiac function regressed over time, resulting in a tricuspid valve replacement 6 years later. CONCLUSIONS Primary ovarian carcinoid tumors can result in carcinoid heart disease, even in the absence of liver metastases. Early diagnosis and treatment contribute to favorable outcomes.
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- 2022
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11. Chromogranin A (CgA) as a biomarker in carcinoid heart disease and NETG1/G2 neuroendocrine neoplasms of the small intestine (SI-NENs) related carcinoid syndrome.
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Konsek-Komorowska SJ, Pęczkowska M, Kolasińska-Ćwikła AD, Konka M, Chrapowicki E, and Ćwikła JB
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- Biomarkers, Biomarkers, Tumor, Chromogranin A, Humans, Intestine, Small pathology, Retrospective Studies, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Neuroendocrine Tumors complications, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors pathology, Pancreatic Neoplasms diagnosis
- Abstract
Introduction: Progression of carcinoid syndrome (CS) to carcinoid heart disease (CHD) is difficult to predict. This retrospective analysis evaluates the use of chromogranin A (CgA), a biomarker widely used in the diagnosis of neuroendocrine tumours (NET), in monitoring CS and disease progression., Patients and Methods: 108 patients with confirmed CS, selected from a group of 351 patients with neuroendocrine neoplasms of the small intestine (SI-NENs), including NETG1 well 40% and NETG2 60% moderately differentiated NET. CgA concentration was measured during initial diagnosis and clinical follow up in 84 patients, 27 of them subsequently developed CHD. The patient's overall survival (OS) was evaluated using the Kaplan-Meier method., Results: Patients with CHD, were found to have significantly shorter OS than patients with CS but without CHD (67.22 vs. 73.03 months). Univariate and multivariate analyses revealed that initial high concentration of CgA and/or increased concentration of CgA is significantly associated with decreased median OS in patients with CS (p<0.05)., Conclusion: CgA has potential as a clinically useful biomarker in reporting disease status and predicting outcome in patients with CS and with CHD., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)
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- 2022
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12. Transcatheter Pulmonary Valve Implantation in Carcinoid Heart Disease.
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Flagiello M, Pozzi M, Francois L, Al Harthy A, Forestier J, Boccalini S, Rioufol G, Walter T, and Obadia JF
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- Humans, Treatment Outcome, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease surgery, Heart Failure surgery, Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis Implantation adverse effects, Pulmonary Valve diagnostic imaging, Pulmonary Valve surgery, Pulmonary Valve Insufficiency diagnostic imaging, Pulmonary Valve Insufficiency etiology, Pulmonary Valve Insufficiency surgery
- Abstract
Carcinoid heart disease is a rare condition affecting mostly tricuspid and pulmonary valves causing right-sided heart failure. Surgical valve replacement is the mainstay of treatment when patients become symptomatic and/or in the presence of right heart remodeling. We present a case of severe pulmonary valve regurgitation secondary to carcinoid heart disease occurring 4 years after a surgical tricuspid replacement, successfully treated with direct transcatheter pulmonary valve implantation without pre-stenting., Competing Interests: Declaration of competing interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2022
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13. Pulsatile Inferior Vena Cava Contrast Material Reflux in Carcinoid Heart Disease.
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Jang S, Ferrero A, Foley TA, and Atwell TD
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- Contrast Media, Humans, Vena Cava, Inferior diagnostic imaging, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Esophagitis, Peptic, Gastroesophageal Reflux
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- 2022
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14. Ablation of typical atrial flutter as therapeutic component in carcinoid heart disease: a case report.
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Groschke S, Weinert R, Becker B, Richardt G, Tölg R, Iden L, and Borlich M
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- Aged, Female, Humans, Neoplasm Recurrence, Local, Atrial Flutter surgery, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease surgery, Catheter Ablation, Radiofrequency Ablation
- Abstract
Background: Carcinoid heart disease is the cardiac manifestation of carcinoid syndrome. There is limited research on rhythm management in patients with carcinoid heart disease. The association of typical atrial flutter and carcinoid heart disease in particular is poorly described., Case Presentation: Here we present a case of a 77-year-old German woman with carcinoid heart disease and recurrent typical atrial flutter complicating the postoperative course after tricuspid valve replacement and its successful long-term rhythm control by ablation therapy., Conclusion: There is limited evidence on rhythm management in patients with the rare diagnosis of carcinoid heart disease. Typical atrial flutter repeatedly complicated the postoperative course of our patient with carcinoid heart disease and could finally be treated curatively by ablation. Radiofrequency ablation should be considered as a valuable therapeutic component in the challenging therapy of this disease., (© 2022. The Author(s).)
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- 2022
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15. Staged treatment of carcinoid syndrome complicated with severe tricuspid regurgitation.
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Waligóra M, Suder B, Magoń W, Stępniewski J, Jonas K, Podolec P, and Kopeć G
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- Humans, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease surgery, Malignant Carcinoid Syndrome complications, Malignant Carcinoid Syndrome surgery, Tricuspid Valve Insufficiency complications, Tricuspid Valve Insufficiency diagnostic imaging
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- 2022
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16. Carcinoid heart disease: An immense challenge despite medical and surgical advances.
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Werner B, Franke M, Pietrzak R, and Książczyk TM
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- Humans, Carcinoid Heart Disease complications, Carcinoid Heart Disease surgery, Carcinoid Tumor
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- 2022
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17. Outcomes of cardiac surgical treatment for carcinoid heart disease.
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Konsek-Komorowska SJ, Kolasińska-Ćwikła AD, Różański J, Bartuś K, Kuriata J, Konka M, Sitkowska-Rysiak E, Michałowska I, Florczak E, Jaworska-Wilczyńska M, Januszewicz A, Hryniewiecki T, Ćwikła JB, and Pęczkowska M
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- Echocardiography, Humans, Carcinoid Heart Disease complications, Carcinoid Heart Disease surgery, Cardiac Surgical Procedures
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- 2022
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18. Clinical Features and Prognosis of Patients with Carcinoid Syndrome and Carcinoid Heart Disease: A Retrospective Multicentric Study of 276 Patients.
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Fijalkowski R, Reher D, Rinke A, Gress TM, Schrader J, Baum RP, Kaemmerer D, and Hörsch D
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- Adult, Aged, Aged, 80 and over, Diarrhea complications, Humans, Male, Middle Aged, Pain, Prognosis, Respiratory Sounds, Retrospective Studies, Weight Loss, Young Adult, Carcinoid Heart Disease complications, Carcinoid Tumor, Malignant Carcinoid Syndrome complications, Malignant Carcinoid Syndrome diagnosis
- Abstract
Introduction: Carcinoid syndrome is the most frequent functional syndrome of neuroendocrine neoplasia. It is characterized by flushing, diarrhea, wheezing, hypotension, and exanthema and may cause carcinoid heart disease., Methods: We assessed clinical characteristics and prognosis of patients with carcinoid syndrome and carcinoid heart disease in 276 patients from 3 referral centers., Results: Carcinoid syndrome patients had a mean age of 57 years (range 21-84) and a normal BMI of 24.9 (SD 4.5; range 13.8-39.6). Most primaries were of small bowel or unknown primaries with distant metastasis in 94.6%. Flushing was the most frequent symptom in 74.3% of patients, followed by diarrhea in 68.8%, and wheezing in 40.9%. Pain was described by 45.3%, weakness by 23.5%, and weight loss of >10% in 6 months by 30.1% of patients. Carcinoid heart disease was diagnosed in 37.3% of patients (n = 104) by echocardiography and involved predominantly in the tricuspid valve. Combinations with other valve defects were common. Somatostatin analogs were taken by 80.4% of patients and 17% needed additional loperamide/opium tincture. Surgery and peptide receptor radiotherapy were most frequent treatments. The median survival of patients with carcinoid syndrome after diagnosis was 9 years. Prognosis was significantly impaired by male sex and diagnosis of carcinoid heart disease but surprisingly significantly increased by the presence of symptoms flushing and weakness., Discussion/conclusion: Carcinoid syndrome is associated with extensive disease and primaries in small bowels or of unknown primary. Weight loss, weakness, and pain are frequent, and carcinoid heart disease is diagnosed in more than one-third of patients., (© 2021 S. Karger AG, Basel.)
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- 2022
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19. Staged treatment of carcinoid syndrome complicated with severe tricuspid regurgitation. Author's reply.
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Konsek-Komorowska SJ and Pęczkowska M
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- Humans, Tricuspid Valve Insufficiency complications, Tricuspid Valve Insufficiency diagnostic imaging, Malignant Carcinoid Syndrome, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease surgery
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- 2022
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20. Outcomes and periprocedural management of cardiac implantable electronic devices in patients with carcinoid heart disease.
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Ward RC, Luis SA, Shabtaie SA, Pellikka PA, Connolly HM, Miranda W, Schaff H, Shen WK, Killu AM, Cha YM, Asirvatham SJ, Deshumkh AJ, and DeSimone CV
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- Aged, Cardiac Surgical Procedures methods, Cardiac Surgical Procedures statistics & numerical data, Female, Humans, Male, Mortality, Outcome and Process Assessment, Health Care, Perioperative Period adverse effects, Perioperative Period statistics & numerical data, Risk Adjustment methods, Risk Assessment, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease physiopathology, Carcinoid Heart Disease surgery, Heart Block etiology, Heart Block therapy, Heart Valve Diseases diagnosis, Heart Valve Diseases etiology, Heart Valve Diseases mortality, Heart Valve Diseases surgery, Pacemaker, Artificial, Perioperative Care adverse effects, Perioperative Care methods, Postoperative Complications diagnosis, Postoperative Complications etiology, Prosthesis Implantation adverse effects, Prosthesis Implantation instrumentation, Prosthesis Implantation methods
- Abstract
Background: Carcinoid heart disease (CHD) is a rare complication of hormonally active neuroendocrine tumors that often requires surgical intervention. Data on cardiac implantable electronic device (CIED) implantation in patients with CHD are limited., Objective: The purpose of this study was to evaluate the experience of CIED implantation in patients with CHD., Methods: Patients with a diagnosis of CHD and a CIED procedure from January 1, 1995, through June 1, 2020, were identified using a Mayo Clinic proprietary data retrieval tool. Retrospective review was performed to extract relevant data, which included indications for implant, procedural details, complications, and mortality., Results: A total of 27 patients (55.6% male; mean age at device implant 65.6 ± 8.8 years) with cumulative follow-up of 75 patient-years (median 1.1 years; interquartile range 0.4-4.6 years) were included for analysis. The majority of implanted devices were dual-chamber permanent pacemakers (63%). Among all CHD patients who underwent any cardiac surgery, the incidence of CIED implantation was 12%. The most common indication for implantation was high-grade heart block (66.7%). Device implant complication rates were modest (14.8%). No patient suffered carcinoid crisis during implantation, and there was no periimplant mortality. Median time from implant to death was 2.5 years, with 1-year mortality of 15%., Conclusion: CHD is a morbid condition, and surgical valve intervention carries associated risks, particularly a high requirement for postoperative pacing needs. Our data suggest that CIED implantation can be performed relatively safely. Clinicians must be aware of the relevant carcinoid physiology and take appropriate precautions to mitigate risks., (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2021
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21. Carcinoid syndroma - diagnosis and management.
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Kiňová S and Koreň M
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- Humans, Somatostatin, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease therapy, Carcinoid Tumor complications, Carcinoid Tumor diagnosis, Carcinoid Tumor therapy, Neuroendocrine Tumors complications, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors therapy
- Abstract
Neuroendocrine tumors (NETs, originally termed “carcinoids”) create a relatively rare group of neoplasms with an approximate incidence rate of 5 to 8 cases per 10 000 persons. NETs predominantly demonstrate indolent disease biology for many years. They become symptomatic when they are large enough or when they metastasize to the liver or the lungs, bones, or other sites. Roughly 30% to 40% of subjects with NETs develop carcinoid syndrome. Signs and symptoms of carcinoid syndrome are bronchospasm, flushing, diarrhea and cramping, cyanosis and pellagra. White plaque-like deposits on the endocardial surface of heart structures are characteristic for carcinoid heart disease. The treatment of patients with carcinoid syndrome is multi-faceted due to the necessity to manage simultaneously the systemic cancer disease as well as the signs of carcinoid syndrome and includes resection or debulking of tumor mass, biological treatment with somatostatin analogues and peptide receptor radionuclide treatment.
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- 2021
22. Managing carcinoid heart disease in patients with neuroendocrine tumors.
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Koffas A and Toumpanakis C
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- Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease epidemiology, Diagnostic Techniques, Endocrine, Endocrinology methods, Humans, Morbidity, Neuroendocrine Tumors complications, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors epidemiology, Carcinoid Heart Disease therapy, Neuroendocrine Tumors therapy
- Abstract
Carcinoid heart disease is a complex clinical entity frequently complicating the course of neuroendocrine tumors and carcinoid syndrome and is associated with significant morbidity and mortality. Although the pathogenesis of carcinoid heart disease remains poorly understood, it appears that the exposure to excessive circulating levels of serotonin contribute a key role, triggering a cascade of events that ultimately results in the development of plaque-like material on the endocardial surfaces of the valve leaflets. The occurrence of carcinoid heart disease may initially run an asymptomatic period, followed by the development of symptoms of congestive cardiac failure. The diagnosis of carcinoid heart disease is suspected by raised biomarkers, such as serum NT-pro-BNP and confirmed by imaging modalities, with echocardiogram being the gold standard to date. Carcinoid heart disease treatment remains challenging as in addition to cardiac dysfunction, tumor burden needs to be tackled with, hence requiring a multidisciplinary approach. Therapy comprises watchful waiting during the first initial stages of the disease; medications for heart failure; optimal control of serotonin secretion from the NET with pharmacotherapy, interventional means or even surgical techniques; and, in selected patients, cardiac valve replacement. The current review summarizes the literature on the diagnosis and management of carcinoid heart disease., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
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- 2021
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23. Surgical aspects of valve replacement in carcinoid heart disease.
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Albåge A and Montibello M
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- Humans, Prognosis, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease surgery, Cardiac Surgical Procedures, Heart Failure, Heart Valve Prosthesis Implantation
- Abstract
Tricuspid and pulmonary valve replacement in patients with advanced carcinoid heart disease (CaHD) reduces right heart failure and improves prognosis. The surgical literature is limited concerning description of technical aspects of valve replacement in CaHD. Although a dedicated multidisciplinary care is required for these frail patients, optimization of surgical technique is important and may lead to better postoperative outcomes., (© 2020 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.)
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- 2021
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24. New murmur.
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Hayes D, Morgan H, and Brown N
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- Carcinoid Heart Disease complications, Diagnosis, Differential, Echocardiography, Female, Heart Murmurs diagnosis, Humans, Magnetic Resonance Imaging, Cine methods, Middle Aged, Neuroendocrine Tumors diagnosis, Ovarian Neoplasms diagnosis, Positron Emission Tomography Computed Tomography methods, Carcinoid Heart Disease diagnosis, Heart Murmurs etiology, Neuroendocrine Tumors complications, Ovarian Neoplasms complications
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2020
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25. Timing of peptide receptor radiotargeted therapy in relation to cardiac valve surgery for carcinoid heart disease in patients with neuroendocrine metastases and cardiac syndrome. A single-centre study from a centre of excellence.
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Davis LM, Nicou N, Martin W, Corcoran B, Mulholland N, Srirajaskanthan R, Ramage J, Wendler O, and Vivian G
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Neoplasm Metastasis, Neuroendocrine Tumors metabolism, Neuroendocrine Tumors radiotherapy, Octreotide analogs & derivatives, Octreotide therapeutic use, Organometallic Compounds therapeutic use, Retrospective Studies, Safety, Time Factors, Treatment Outcome, Carcinoid Heart Disease complications, Carcinoid Heart Disease surgery, Heart Valves surgery, Neuroendocrine Tumors complications, Neuroendocrine Tumors pathology, Receptors, Peptide metabolism
- Abstract
Introduction: Perioperative mortality of patients who undergo heart valve surgery for carcinoid heart valve disease has been observed to be high (5%-10%). We investigated whether peptide receptor radiotherapy with lutetium-177 dotatate can be used safely in patients with neuroendocrine neoplasm carcinoid heart valve disease and if there is associated survival advantage by reducing overall exposure of the valves to high doses of vasoactive peptides., Method: Retrospective case notes review was performed on 18 neuroendocrine neoplasm patients (mean 60 years), who underwent heart valve surgery between 2003 and 2017 for carcinoid heart valve disease, 9 of whom received peptide receptor radiotherapy in addition to surgery., Results: All patients were treated with somatostatin receptor antagonists and underwent cardiac valvular surgery (mean two valves replaced) and three benefitted from additional coronary bypass grafting. Nine patients underwent surgery alone: in this group, the time from surgery to progression was 14 months (mean; SD 13.5 months). Nine were treated with peptide receptor radiotherapy in addition to surgery. Six underwent surgery with peptide receptor radiotherapy on progression. Time to progression from surgery to first peptide receptor radiotherapy was mean 25.1 months (SD 23.6 months). No patients developed peritreatment cardiac complications. There were no deaths within the 30-day postoperative period. Average time from surgery to last follow-up/death was 41 months (6-79) in the surgery + lutetium group and in the surgery only group 17 months (1-24). Nine patients died, five in the surgery + lutetium group and four in the surgery only group, all at greater than 1-year postsurgery., Discussion: Peptide receptor radiotherapy is safe in the setting of Carcinoid valvular heart disease in patients with controlled heart failure, PPRT can be use in the pre- and post-valve surgery period. There appears to be a survival benefit of having peptide receptor radiotherapy. Further evidence for peptide receptor radiotherapy in the neoadjuvant setting prior to cardiothoracic surgery is required.
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- 2020
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26. Carcinoid Tricuspid Valve Disease: Applications of Three Dimensional Transesophageal Echocardiography.
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Miyasaka R, Mehta A, Pettersson GB, and Desai MY
- Subjects
- Carcinoid Heart Disease complications, Carcinoid Heart Disease physiopathology, Female, Hemodynamics, Humans, Middle Aged, Predictive Value of Tests, Severity of Illness Index, Tricuspid Valve physiopathology, Tricuspid Valve Insufficiency etiology, Tricuspid Valve Insufficiency physiopathology, Carcinoid Heart Disease diagnostic imaging, Echocardiography, Doppler, Color, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Tricuspid Valve diagnostic imaging, Tricuspid Valve Insufficiency diagnostic imaging
- Published
- 2019
- Full Text
- View/download PDF
27. Improving outcome of valve replacement for carcinoid heart disease.
- Author
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Nguyen A, Schaff HV, Abel MD, Luis SA, Lahr BD, Halfdanarson TR, and Connolly HM
- Subjects
- Aged, Carcinoid Heart Disease mortality, Carcinoid Heart Disease physiopathology, Databases, Factual, Female, Humans, Male, Middle Aged, Pulmonary Valve Insufficiency etiology, Pulmonary Valve Insufficiency mortality, Pulmonary Valve Insufficiency physiopathology, Pulmonary Valve Stenosis etiology, Pulmonary Valve Stenosis mortality, Pulmonary Valve Stenosis physiopathology, Recovery of Function, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Tricuspid Valve Insufficiency etiology, Tricuspid Valve Insufficiency mortality, Tricuspid Valve Insufficiency physiopathology, Carcinoid Heart Disease complications, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Pulmonary Valve Insufficiency surgery, Pulmonary Valve Stenosis surgery, Tricuspid Valve Insufficiency surgery
- Abstract
Objective: Carcinoid heart disease is characterized by tricuspid valve regurgitation and varying degrees of pulmonary valve regurgitation or stenosis. Valve replacement procedures may be complicated by systemic effects of carcinoid syndrome, as well as hepatic dysfunction and right heart failure. This study was performed to identify factors that might be associated with improving early mortality rates and late outcomes., Methods: Between November 1985 and January 2018, 240 adult patients underwent surgery for carcinoid heart disease at the Mayo Clinic. We analyzed the association of multiple clinical and echocardiographic variables on early mortality and late survival., Results: The median (interquartile range) age of patients was 63 years (55-69), and 117 patients (49%) were male. Before operation, 157 patients (70%) had New York Heart Association class III or IV limitation. Somatostatin analogs were used in 221 patients (92%), and long-acting somatostatins were used in 130 patients (54%). Loop diuretic therapy was used preoperatively in 125 patients (52%). Early mortality rate was 29% (9/22) between 1985 and 1994, but decreased to 7% (6/81) during 1995 to 2004, and to 5% (7/128) from 2005 onward. Overall survival estimates at 1, 3, and 5 years were 69%, 48%, and 34%, respectively. Older age, advanced New York Heart Association class, and a nonlinear effect of creatinine were independently associated with overall mortality., Conclusions: Valve replacement for carcinoid heart disease has acceptable short-term mortality, and early risk has decreased in the current era. Earlier intervention may improve overall survival., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
28. When right heart valves are open 24/7.
- Author
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Avci Demir F, Theodoropoulos KC, Papachristidis A, Zhou C, Demetrescu C, and Monaghan M
- Subjects
- Aged, Carcinoid Heart Disease complications, Carcinoma complications, Carcinoma diagnostic imaging, Carcinoma secondary, Diagnosis, Differential, Echocardiography, Fatigue etiology, Humans, Intestinal Neoplasms complications, Intestinal Neoplasms diagnostic imaging, Intestinal Neoplasms pathology, Liver Neoplasms complications, Liver Neoplasms diagnostic imaging, Liver Neoplasms secondary, Male, Neoplasm Metastasis, Video Recording, Carcinoid Heart Disease diagnostic imaging, Pulmonary Valve diagnostic imaging, Tricuspid Valve diagnostic imaging
- Published
- 2019
- Full Text
- View/download PDF
29. Anesthetic management of carcinoid heart disease after cardiac surgery. A possible use of veno-arterial extracorporeal membrane oxygenation support.
- Author
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Di Tomasso N, Carcò F, Arangino C, De Luca M, Bove T, Zangrillo A, and Monaco F
- Subjects
- Carcinoid Heart Disease complications, Cardiac Surgical Procedures methods, Female, Femoral Artery surgery, Femoral Vein surgery, Humans, Male, Middle Aged, Postoperative Complications etiology, Treatment Outcome, Ventricular Dysfunction, Right etiology, Carcinoid Heart Disease surgery, Cardiac Surgical Procedures adverse effects, Extracorporeal Membrane Oxygenation methods, Postoperative Complications therapy, Ventricular Dysfunction, Right therapy
- Published
- 2018
- Full Text
- View/download PDF
30. Exercise cardiac magnetic resonance imaging with pulmonary artery catheter monitoring in carcinoid heart disease: a shift towards early intervention?
- Author
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Timmermans P Jr, Rega F, Bogaert J, and Herregods MC
- Subjects
- Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease physiopathology, Female, Humans, Middle Aged, Pulmonary Artery, Tricuspid Valve Insufficiency complications, Tricuspid Valve Insufficiency diagnosis, Carcinoid Heart Disease complications, Catheterization, Swan-Ganz methods, Magnetic Resonance Imaging, Cine methods, Monitoring, Physiologic methods, Pulmonary Wedge Pressure physiology, Tricuspid Valve Insufficiency physiopathology
- Abstract
Neuroendocrine tumours are a rare malignancy, which can be complicated by a carcinoid syndrome and, in more rare cases, also valve destruction. The correct timing for surgical repair remains unknown. We report the first-in-men exercise cardiac magnetic resonance imaging with pulmonary artery catheter measurements in order to better understand the haemodynamic impact of isolated tricuspid valve insufficiency in a low symptomatic patient. Not pressure but volume overload is the key factor in the development of symptoms, as long as the right ventricular function is intact. Based on our findings, we referred the patient for tricuspid valve replacement. This case, together with the review of all carcinoid heart disease cases in our hospital (a large tertiary cardiology and oncology centre) since 2000, indicates a potential benefit for early intervention in carcinoid heart disease., (© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)
- Published
- 2018
- Full Text
- View/download PDF
31. Peptide Receptor Radionuclide Therapy with 177 Lu-DOTATATE in Carcinoid Heart Disease: A Contraindication or a Promising Treatment Approach Bettering Chances for Corrective Surgery?
- Author
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Ramesh S, Kudachi S, and Basu S
- Subjects
- Adult, Carcinoid Heart Disease complications, Contraindications, Humans, Male, Neuroendocrine Tumors complications, Octreotide therapeutic use, Carcinoid Heart Disease radiotherapy, Octreotide analogs & derivatives, Organometallic Compounds therapeutic use, Receptors, Peptide metabolism
- Abstract
We report the gratifying response of functioning metastatic neuroendocrine tumor with carcinoid heart disease (uncontrolled by long-acting octreotide) to treatment with
177 Lu-DOTATATE. This response favorably altered the clinical course of the patient, enabling corrective valvular surgery, enhancing health-related quality of life, improving symptoms (from New York Heart Association grade III at baseline to grade I after 6 cycles), stabilizing the disease, and substantially reducing the level of 5-hydroxyindole acetic acid. Avoiding concerns about volume overload by administering amino acids over a relatively prolonged period of 7.5-8 h during peptide receptor radionuclide therapy could be particularly helpful and could be conveniently adopted in this clinical setting. Considering the significantly shortened overall survival of patients with carcinoid heart disease, the relative paucity of available treatment options, and the risk of complications during corrective surgery on poorly controlled functioning disease,177 Lu-DOTATATE can emerge as a potent option in this group of patients., (© 2018 by the Society of Nuclear Medicine and Molecular Imaging.)- Published
- 2018
- Full Text
- View/download PDF
32. Hypoxemia from patent foramen ovale in a 65-year-old woman with carcinoid heart disease.
- Author
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Yang C and Sharma A
- Subjects
- Aged, Cardiac Catheterization, Echocardiography, Doppler, Color, Female, Foramen Ovale, Patent complications, Foramen Ovale, Patent surgery, Humans, Septal Occluder Device, Tricuspid Valve Insufficiency complications, Tricuspid Valve Insufficiency surgery, Carcinoid Heart Disease complications, Foramen Ovale, Patent diagnosis, Hypoxia etiology, Tricuspid Valve Insufficiency diagnosis
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2018
- Full Text
- View/download PDF
33. Carcinoid Heart Disease: Early Outcomes after Surgical Valve Replacement in Nine Patients.
- Author
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Mujtaba SS and Clark S
- Subjects
- Aged, Carcinoid Heart Disease diagnosis, Female, Follow-Up Studies, Heart Valve Diseases etiology, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Carcinoid Heart Disease complications, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation methods, Pulmonary Valve surgery
- Abstract
Aim: To describe the early outcomes of carcinoid patients undergoing surgical heart valve replacement., Methods: In a retrospective study, records of patients with symptomatic carcinoid heart disease referred for valve surgery between 2012 and 2016 were reviewed. The perioperative and early postoperative outcomes were analyzed., Results: Nine patients, with a mean age of 61 years (range 55-70 years) underwent cardiac surgery for carcinoid syndrome. 3 patients had quadruple valve replacement, 5 had tricuspid and pulmonary valves changed, while one had tricuspid, pulmonary, and aortic valves replaced. Right-sided valves were replaced with biological valves in 8 patients and a mechanical valve in 1 patient. Left-sided valves were replaced with a mechanical valve in 2 patients and with a biological valve in 1 patient. Mean postoperative follow-up was 24 months (range 6-50 months, median 16 months). All patients had a good left ventricle except one, in whom it was mildly impaired. The right ventricle was severely dilated in 4 patients, moderately in 2, and mildly in 3. One patient died of heart failure 10 days postoperatively. Functional improvement was noted in all survivors, and they were in New York Heart Association class I at last follow up., Conclusion: Although carcinoid syndrome is a rare and progressive disease, valve replacement in symptomatic patients is a reasonable option with survival benefit, low early postoperative mortality, without valve-related complications, and with functional improvement. Cardiac assessment is required in all patients with carcinoid disease from the earliest time of medical treatment to improve patients' result.
- Published
- 2018
- Full Text
- View/download PDF
34. Right and left-sided carcinoid heart disease.
- Author
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Michałowska IM, Kolasinska-Ćwikla A, Ćwikla J, Zakrzewski D, and Pęczkowska M
- Subjects
- Carcinoid Heart Disease complications, Carcinoid Heart Disease surgery, Cardiac Surgical Procedures, Echocardiography, Female, Humans, Middle Aged, Mitral Valve Insufficiency etiology, Mitral Valve Insufficiency surgery, Tomography, X-Ray Computed, Tricuspid Valve Insufficiency etiology, Tricuspid Valve Insufficiency surgery, Carcinoid Heart Disease diagnosis, Heart Ventricles diagnostic imaging, Mitral Valve Insufficiency diagnosis, Tricuspid Valve Insufficiency diagnosis
- Published
- 2018
- Full Text
- View/download PDF
35. Lower-Extremity Vasospasm Caused by Carcinoid Syndrome.
- Author
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Kridis WB, Guermazi Z, Mnif H, Toumi N, Khanfir A, Boudawara T, and Frikha M
- Subjects
- Adult, Antineoplastic Agents, Hormonal therapeutic use, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease drug therapy, Computed Tomography Angiography, Echocardiography, Female, Foot diagnostic imaging, Heart diagnostic imaging, Humans, Octreotide therapeutic use, Spasm etiology, Vascular Diseases etiology, Carcinoid Heart Disease complications, Foot blood supply, Spasm diagnostic imaging, Vascular Diseases diagnostic imaging
- Published
- 2017
- Full Text
- View/download PDF
36. Carcinoid Syndrome Complicating a Pancreatic Neuroendocrine Tumor: A Case Report.
- Author
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Gerson JN, Witteles RM, Chang DT, Beygui RE, Iagaru AH, and Kunz PL
- Subjects
- Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease therapy, Diagnosis, Differential, Humans, Male, Middle Aged, Syndrome, Carcinoid Heart Disease complications, Neuroendocrine Tumors complications, Pancreatic Neoplasms complications
- Abstract
Neuroendocrine tumors (NETs) comprise a heterogeneous group of neoplasms. These tumors can produce a wide variety of hormones that can lead to syndromes of hormone excess, such as carcinoid syndrome. We present the case of a 47-year-old man who presented with right upper quadrant abdominal pain and emesis. He was found to have metastatic pancreatic NET and was treated with systemic chemotherapy. He subsequently developed dyspnea on exertion and was found to have severe right-sided heart disease secondary to elevated levels of serum serotonin. He was successfully treated with surgical tricuspid and pulmonic valve replacement. True carcinoid syndrome with pancreatic NETs is rare, but, as a treatable complication of the disease, is an important entity for which oncologists should be familiar.
- Published
- 2017
- Full Text
- View/download PDF
37. mTOR Kinase Inhibition Effectively Decreases Progression of a Subset of Neuroendocrine Tumors that Progress on Rapalog Therapy and Delays Cardiac Impairment.
- Author
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Orr-Asman MA, Chu Z, Jiang M, Worley M, LaSance K, Koch SE, Carreira VS, Dahche HM, Plas DR, Komurov K, Qi X, Mercer CA, Anthony LB, Rubinstein J, and Thomas HE
- Subjects
- Animals, Carcinoid Heart Disease complications, Carcinoid Heart Disease genetics, Carcinoid Heart Disease pathology, Cell Line, Tumor, Drug Resistance, Neoplasm drug effects, Everolimus administration & dosage, Gene Expression Regulation, Neoplastic drug effects, Humans, Mice, Neuroendocrine Tumors complications, Neuroendocrine Tumors genetics, Neuroendocrine Tumors pathology, Pancreatic Neoplasms complications, Pancreatic Neoplasms genetics, Pancreatic Neoplasms pathology, Protein Kinase Inhibitors administration & dosage, Pyrazines administration & dosage, Sirolimus administration & dosage, TOR Serine-Threonine Kinases antagonists & inhibitors, Xenograft Model Antitumor Assays, Carcinoid Heart Disease drug therapy, Neuroendocrine Tumors drug therapy, Pancreatic Neoplasms drug therapy, TOR Serine-Threonine Kinases genetics
- Abstract
Inhibition of mTOR signaling using the rapalog everolimus is an FDA-approved targeted therapy for patients with lung and gastroenteropancreatic neuroendocrine tumors (NET). However, patients eventually progress on treatment, highlighting the need for additional therapies. We focused on pancreatic NETs (pNET) and reasoned that treatment of these tumors upon progression on rapalog therapy, with an mTOR kinase inhibitor (mTORKi), such as CC-223, could overcome a number of resistance mechanisms in tumors and delay cardiac carcinoid disease. We performed preclinical studies using human pNET cells in vitro and injected them subcutaneously or orthotopically to determine tumor progression and cardiac function in mice treated with either rapamycin alone or switched to CC-223 upon progression. Detailed signaling and RNA sequencing analyses were performed on tumors that were sensitive or progressed on mTOR treatment. Approximately 57% of mice bearing pNET tumors that progressed on rapalog therapy showed a significant decrease in tumor volume upon a switch to CC-223. Moreover, mice treated with an mTORKi exhibited decreased cardiac dilation and thickening of heart valves than those treated with placebo or rapamycin alone. In conclusion, in the majority of pNETs that progress on rapalogs, it is possible to reduce disease progression using an mTORKi, such as CC-223. Moreover, CC-223 had an additional transient cardiac benefit on valvular fibrosis compared with placebo- or rapalog-treated mice. These results provide the preclinical rationale to further develop mTORKi clinically upon progression on rapalog therapy and to further test their long-term cardioprotective benefit in those NET patients prone to carcinoid syndrome. Mol Cancer Ther; 16(11); 2432-41. ©2017 AACR ., (©2017 American Association for Cancer Research.)
- Published
- 2017
- Full Text
- View/download PDF
38. Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms.
- Author
-
Sagar VM, Steeds RP, Doshi SN, and Shah T
- Subjects
- Aged, Antineoplastic Agents therapeutic use, Antineoplastic Agents, Hormonal therapeutic use, Carcinoid Heart Disease complications, Carcinoid Heart Disease psychology, Carcinoid Heart Disease surgery, Echocardiography methods, Fatal Outcome, Female, Heart Valve Prosthesis standards, Heart Valve Prosthesis Implantation methods, Humans, Liver pathology, Neuroendocrine Tumors drug therapy, Neuroendocrine Tumors pathology, Neuroendocrine Tumors surgery, Octreotide administration & dosage, Octreotide therapeutic use, Peptides, Cyclic administration & dosage, Peptides, Cyclic therapeutic use, Quality of Life, Somatostatin administration & dosage, Somatostatin analogs & derivatives, Somatostatin therapeutic use, Tricuspid Valve Insufficiency surgery, Carcinoid Heart Disease diagnostic imaging, Neuroendocrine Tumors complications, Tricuspid Valve Insufficiency complications, Vena Cava, Inferior surgery
- Abstract
Severe carcinoid syndrome and carcinoid heart disease in neuroendocrine tumours can have a significant impact on a patient's quality of life and are a major cause of morbidity and mortality. We present a novel approach to managing a patient with medically uncontrollable carcinoid syndrome. Inferior and superior vena cava placement of transcatheter heart valves has been used to treat patients with right heart failure due to severe tricuspid and pulmonary regurgitation. However, this procedure has not been attempted to specifically reduce hormone secretion, primarily from the liver, in order to control carcinoid syndrome symptoms. We attempted this procedure in a patient with severe carcinoid disease and tricuspid regurgitation as a bridge to later definitive therapy. The procedure was technically successful, but did not improve carcinoid symptoms. The possible reasons for the failure are discussed here., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2017
- Full Text
- View/download PDF
39. Noninvasive evaluation of right hemodynamics in carcinoid heart disease: A case report.
- Author
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Nardozza M, Mele D, and Ferrari R
- Subjects
- Aged, Carcinoid Heart Disease complications, Fatal Outcome, Female, Humans, Intestinal Perforation complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease physiopathology, Echocardiography, Hemodynamics physiology
- Abstract
We report the case of a 67-year-old woman with a carcinoid tumor of midgut origin who developed carcinoid heart disease and died because of bowel perforation. Echocardiography allowed the diagnosis, recognizing the typical abnormalities of tricuspid and pulmonary valve leaflets. The sonographic examination also evidenced peculiar alterations of the right heart hemodynamics: end-diastolic reversal of flow at the level of the pulmonary valve, reduced respiratory excursion without enlargement of the inferior vena cava, and biphasic hepatic venous flow without respiratory variation. Echocardiography allowed both the diagnosis and the accurate assessment of the hemodynamic consequences of the disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:355-361, 2017., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
40. Again, Two Melodies in Concert: Transcatheter Double Valve Replacement in Hedinger Syndrome.
- Author
-
De Rosa R, Schranz D, Zeiher AM, and Fichtlscherer S
- Subjects
- Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease surgery, Echocardiography, Doppler, Female, Humans, Middle Aged, Prosthesis Design, Pulmonary Valve Stenosis diagnosis, Pulmonary Valve Stenosis etiology, Syndrome, Tricuspid Valve Stenosis diagnosis, Tricuspid Valve Stenosis etiology, Bioprosthesis, Carcinoid Heart Disease complications, Cardiac Catheterization methods, Heart Valve Prosthesis Implantation methods, Pulmonary Valve surgery, Pulmonary Valve Stenosis surgery, Tricuspid Valve Stenosis surgery
- Abstract
Transcatheter pulmonary valve implantation is established as a valuable option to reconstruct failing right ventricular outflow tract function. Percutaneous tricuspid valve-in-valve or valve-in-ring reconstruction is even applied with increasing acceptance. A 46-year-old woman with a diagnosis of carcinoid-dependent right heart failure underwent surgical bioprosthetic tricuspid and pulmonary valve replacement. Almost 1 year later, she presented again with markedly dilatated and reduced right heart function caused by degeneration of both biologic valves. We report a successful two-stage percutaneous transcatheter double-valve replacement with the use of a Melody valve in pulmonary and tricuspid positions., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
41. Curious Case of Wheezing: Carcinoid Heart Disease.
- Author
-
Desai D, Jan MF, Stenzel N, Werner P, and Tajik AJ
- Subjects
- Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease surgery, Echocardiography, Female, Humans, Middle Aged, Positron-Emission Tomography, Carcinoid Heart Disease complications, Respiratory Sounds etiology
- Published
- 2017
- Full Text
- View/download PDF
42. Carcinoid Valve Disease: A Case Report and Review.
- Author
-
Heikali D, Chang N, and Tabibiazar R
- Subjects
- Bioprosthesis, Cardiac Catheterization instrumentation, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Humans, Middle Aged, Prosthesis Failure, Treatment Outcome, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Heart Disease pathology, Carcinoid Heart Disease surgery, Pulmonary Valve diagnostic imaging, Pulmonary Valve pathology, Pulmonary Valve surgery, Pulmonary Valve Insufficiency diagnostic imaging, Pulmonary Valve Insufficiency etiology, Pulmonary Valve Insufficiency pathology, Pulmonary Valve Insufficiency surgery, Tricuspid Valve diagnostic imaging, Tricuspid Valve pathology, Tricuspid Valve surgery, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency etiology, Tricuspid Valve Insufficiency pathology, Tricuspid Valve Insufficiency surgery
- Abstract
In patients with carcinoid syndrome, the development of carcinoid valve disease typically carries an unfavorable prognosis. We present the case of a patient with significant valvular dysfunction secondary to carcinoid valve disease. Valve replacement surgery was complicated by the development of prosthetic valve degeneration, ultimately requiring percutaneous valve implantation in a valve-in-valve fashion. The technical details of the case, as well as a review of carcinoid valve disease, including its pathophysiology, clinical manifestations, diagnostic features and management considerations, are presented.
- Published
- 2017
43. Diagnosing and Managing Carcinoid Heart Disease in Patients With Neuroendocrine Tumors: An Expert Statement.
- Author
-
Davar J, Connolly HM, Caplin ME, Pavel M, Zacks J, Bhattacharyya S, Cuthbertson DJ, Dobson R, Grozinsky-Glasberg S, Steeds RP, Dreyfus G, Pellikka PA, and Toumpanakis C
- Subjects
- Algorithms, Humans, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease therapy, Diagnostic Imaging methods, Disease Management, Neuroendocrine Tumors complications, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors therapy
- Abstract
Carcinoid heart disease is a frequent occurrence in patients with carcinoid syndrome and is responsible for substantial morbidity and mortality. The pathophysiology of carcinoid heart disease is poorly understood; however, chronic exposure to excessive circulating serotonin is considered one of the most important contributing factors. Despite recognition, international consensus guidelines specifically addressing the diagnosis and management of carcinoid heart disease are lacking. Furthermore, there is considerable variation in multiple aspects of screening and management of the disease. The aim of these guidelines was to provide succinct, practical advice on the diagnosis and management of carcinoid heart disease as well as its surveillance. Recommendations and proposed algorithms for the investigation, screening, and management have been developed based on an evidence-based review of the published data and on the expert opinion of a multidisciplinary consensus panel consisting of neuroendocrine tumor experts, including oncologists, gastroenterologists, and endocrinologists, in conjunction with cardiologists and cardiothoracic surgeons., (Copyright © 2017 American College of Cardiology Foundation. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
44. Carcinoid heart disease in an elderly female patient: the value of transthoracic echocardiography.
- Author
-
Stougiannos P, Michas G, Evdoridis C, Arapantoni-Dadioti P, Tolios P, Kaplanis I, and Trikas A
- Subjects
- Aftercare, Aged, Ascites drug therapy, Ascites surgery, Carcinoid Heart Disease complications, Carcinoid Heart Disease drug therapy, Carcinoid Heart Disease pathology, Carcinoid Tumor complications, Female, Humans, Liver diagnostic imaging, Liver pathology, Neuroendocrine Tumors pathology, Neuroendocrine Tumors secondary, Paracentesis methods, Somatostatin analogs & derivatives, Somatostatin metabolism, Treatment Outcome, Carcinoid Heart Disease diagnostic imaging, Carcinoid Tumor pathology, Echocardiography methods, Neuroendocrine Tumors complications
- Published
- 2017
- Full Text
- View/download PDF
45. Inoperable Primary Ovarian Carcinoid Led to the Progression of Carcinoid Heart Disease From Right-Sided to Both-Sided Involvement.
- Author
-
Tadokoro T, Katsuki S, Ito K, Onitsuka K, Nakashima A, Sasaguri T, Miyata K, Yamamoto H, and Mohri M
- Subjects
- Aged, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnostic imaging, Carcinoid Tumor complications, Carcinoid Tumor diagnostic imaging, Disease Progression, Female, Heart Valve Diseases diagnostic imaging, Humans, Ovarian Neoplasms diagnosis, Treatment Outcome, Carcinoid Heart Disease surgery, Carcinoid Tumor surgery, Heart Valve Diseases surgery, Ovarian Neoplasms surgery
- Published
- 2017
- Full Text
- View/download PDF
46. A 51-year-old patient with carcinoid heart disease and severe tricuspid regurgitation.
- Author
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Florczak E, Pęczkowska M, Konka M, Różański J, and Kolasińska-Ćwikła A
- Subjects
- Bioprosthesis, Carcinoid Heart Disease drug therapy, Female, Humans, Ileal Neoplasms pathology, Liver Neoplasms complications, Liver Neoplasms secondary, Middle Aged, Somatostatin therapeutic use, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency surgery, Carcinoid Heart Disease complications, Heart Valve Prosthesis Implantation, Tricuspid Valve, Tricuspid Valve Insufficiency etiology
- Published
- 2017
- Full Text
- View/download PDF
47. "Eyeing" the Cause of Heart Failure: Visible Telltale Clues.
- Author
-
Fred HL and Thangam M
- Subjects
- Adult, Amyloidosis complications, Amyloidosis diagnosis, Arteriovenous Fistula complications, Arteriovenous Fistula diagnosis, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Endocarditis complications, Endocarditis diagnosis, Fabry Disease complications, Fabry Disease diagnosis, Female, Hemochromatosis complications, Hemochromatosis diagnosis, Humans, Hyperthyroidism complications, Hyperthyroidism diagnosis, Male, Melanoma complications, Melanoma diagnosis, Melanoma secondary, Myotonic Dystrophy complications, Myotonic Dystrophy diagnosis, Predictive Value of Tests, Pseudoxanthoma Elasticum complications, Risk Factors, Sarcoidosis complications, Sarcoidosis diagnosis, Skin Neoplasms complications, Skin Neoplasms diagnosis, Skin Neoplasms pathology, Heart Failure diagnosis, Heart Failure etiology, Physical Examination, Pseudoxanthoma Elasticum diagnosis
- Published
- 2016
- Full Text
- View/download PDF
48. Incremental value of live/real time three-dimensional transthoracic echocardiography over the two-dimensional technique in assessing carcinoid heart disease involving the aortic valve.
- Author
-
Bulur S, Hsiung MC, Nanda NC, Hardas S, Mohamed A, ElKaryoni A, Srialluri S, Barssoum K, Elsayed M, Wei J, and Yin WH
- Subjects
- Aged, Aortic Valve Insufficiency etiology, Carcinoid Heart Disease complications, Computer Systems, Echocardiography methods, Female, Humans, Severity of Illness Index, Aortic Valve diagnostic imaging, Aortic Valve Insufficiency diagnosis, Carcinoid Heart Disease diagnosis, Echocardiography, Three-Dimensional methods
- Abstract
We present a case of an adult with metastatic carcinoid heart disease, in whom live/real time three-dimensional transthoracic echocardiography provided incremental value over two-dimensional transthoracic echocardiography in assessing involvement of the aortic valve., (© 2016, Wiley Periodicals, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
49. Valvular Disorders in Carcinoid Heart Disease.
- Author
-
Yuan SM
- Subjects
- Disease Progression, Echocardiography, Heart Valve Diseases diagnosis, Heart Valve Diseases etiology, Heart Valve Prosthesis Implantation, Humans, Carcinoid Heart Disease complications, Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease therapy
- Abstract
Carcinoid heart disease is a rare but important cause of intrinsic right heart valve disorders leading to right heart failure. Occasionally, left-sided heart valves may also be involved. The characteristic cardiac pathological findings of carcinoid heart disease are endocardial thickening as a result of fibrous deposits on the endocardium. Echocardiographic examination and right heart catheterization are very useful for the diagnosis of the lesion. If more cardiac valves are affected, multiple valve replacement should be considered. The management of the pulmonary valve lesion depends on the extent of the diseased valve, either by valvulotomy, valvectomy, or valve replacement. Percutaneous valve implantations in the pulmonary and in the inferior vena cava positions have been advocated for high-risk patients.
- Published
- 2016
- Full Text
- View/download PDF
50. Transcatheter Pulmonary Valve Replacement in a Carcinoid Heart.
- Author
-
Loyalka P, Schechter M, Nascimbene A, Raman AS, Ilieascu CA, Gregoric ID, and Kar B
- Subjects
- Aged, Carcinoid Heart Disease diagnostic imaging, Cardiac Catheterization instrumentation, Computed Tomography Angiography, Coronary Angiography methods, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Humans, Male, Prosthesis Design, Pulmonary Valve diagnostic imaging, Pulmonary Valve Stenosis diagnostic imaging, Pulmonary Valve Stenosis etiology, Severity of Illness Index, Treatment Outcome, Carcinoid Heart Disease complications, Cardiac Catheterization methods, Heart Valve Prosthesis Implantation methods, Pulmonary Valve surgery, Pulmonary Valve Stenosis surgery
- Abstract
Carcinoid heart disease presents as right-sided heart failure attributable to the dysfunction of the tricuspid and pulmonary valves. Although surgical valve replacement is the mainstay of treatment when patients become symptomatic, it is associated with substantial perioperative mortality rates. We present a case of severe pulmonary valve stenosis secondary to carcinoid heart disease, treated successfully with percutaneous valve replacement. A 67-year-old man with severe pulmonary valve stenosis was referred to our center for pulmonary valve replacement. The patient had a history of metastatic neuroendocrine tumor of the small bowel with carcinoid syndrome, carcinoid heart disease, and tricuspid valve regurgitation previously treated with surgical valve replacement. Because of the patient's severe chronic obstructive pulmonary disease and hostile chest anatomy seen on a computed tomographic scan dating from previous cardiothoracic surgery, we considered off-label percutaneous valve replacement a viable alternative to open-heart surgery. A 29-mm Edwards Sapien XT valve was successfully deployed over the native pulmonary valve. There were no adverse sequelae after the procedure, and the patient was discharged from the hospital the next day. This case report shows that percutaneous valve replacement can be a valid option in carcinoid heart disease patients who are not amenable to surgical valve replacement.
- Published
- 2016
- Full Text
- View/download PDF
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