Carcinoid heart disease: outcomes after surgical valve replacement

Mokhles, Palwasha; Herwerden, Lex A. van; Jong, Peter L. de; Herder, Wouter W. de; Siregar, Sabrina; Constantinescu, Alina A.; Domburg, Ron T. van; Roos‐Hesselink, Jolien W.

doi:10.1093/ejcts/ezr227

Cited by 53 publications

(34 citation statements)

References 26 publications

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“…al suggested a stentless bioprosthesis for the pulmonary valve position to avoid anticoagulation prior to hepatic de-arterialization [ 8 ]. Contrary to that Mokhlesa and colleagues showed that mechanical valve prostheses are not accompanied by valve related complications such as bleeding or thrombosis [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Failing stentless Bioprostheses in patients with carcinoid heart valve disease

Schaefer¹,

Sill²,

Schoenebeck³

et al. 2015

J Cardiothorac Surg

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BackgroundCarcinoid tumor with consecutive endocardial fibroelastosis of the right heart, known as carcinoid heart valve disease (CHVD) or Hedinger’s syndrome, is accompanied by combined right-sided valvular dysfunction with regurgitation and stenosis of the affected valves. Cardiac surgery with replacement of the tricuspid and/or pulmonary valve is an established therapeutic option for patients with Hedinger’s syndrome. Little is known about the long term outcome and the choice of prosthesis for the pulmonal position is still a matter of debate.MethodsThe authors report three cases of pulmonary valve replacement with stentless bioprostheses (Medtronic Freestyle®, Medtronic PLC, Minneapolis, MN, USA) due to severe pulmonary valve degeneration in consequence of Hedinger’s syndrome.ResultsAll patients presented with re-stenosis of the pulmonal valve conduit at the height of the anastomoses in a premature fashion. Due to the increased risk for repeat surgical valve replacement, two patients were treated by transcatheter heart valves.ConclusionWe do not recommend the replacement of the pulmonary valve with stentless bioprostheses in patients with CHVD. These valves presented with an extreme premature degeneration and consecutive re-stenosis and heart failure.

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Section: Discussionmentioning

confidence: 99%

Failing stentless Bioprostheses in patients with carcinoid heart valve disease

Schaefer¹,

Sill²,

Schoenebeck³

et al. 2015

J Cardiothorac Surg

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“…Valve replacement surgery improves patients’ outcome 31,32 with postoperative median survival ranging from 6 to 11 years. 14 More recently, in a retrospective study of 195 patients, Connolly et al reported survival rates of 69%, 35%, and 24% at 1, 5, and 10 years, respectively.…”

Section: Discussionmentioning

confidence: 99%

Carcinoid Heart Disease: Starting From Heart Failure

Bertin

Favretto

Pelizzo

et al. 2017

Journal of Investigative Medicine High Impact Case Reports

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Carcinoid syndrome is the constellation of symptoms mediated by humoral factors produced by some carcinoid tumors. It consists primarily of vasomotor symptoms, gastrointestinal hypermotility, hypotension, and bronchospasm, due to the production and release of vasoactive substances. Carcinoid heart disease occurs in more than 50% of patients with carcinoid syndrome; in some cases, it represents the initial manifestation of the disease. We report the case of a 75-year-old woman with a metastatic neuroendocrine tumor admitted to the emergency room for fatigue and heart failure. Transthoracic echocardiography showed severe tricuspid and pulmonic regurgitation suggesting carcinoid heart disease. A hypervascular retroperitoneal mass was found on abdominal computed tomography, which seemed to arise from the mesenteric artery, anteriorly to the abdominal aorta. Unfortunately, our patient was neither a candidate for mass resection nor for cardiac surgery due to advanced metastatic disease and poor clinical condition. Additionally, we performed a systematic literature review of carcinoid heart disease focusing on typical echocardiographic findings.

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“…Postoperative management should focus on controlling hormone levels to prevent recurrent disease [77]. e perioperative mortality since 2000 is around 5% [86,87]. After surgery, the one-year survival is 70% and at 5 years, it was 40% [86,87].…”

Section: Complications: Carcinoid Heart Diseasementioning

confidence: 99%

“…e perioperative mortality since 2000 is around 5% [86,87]. After surgery, the one-year survival is 70% and at 5 years, it was 40% [86,87]. It is hypothesized that reducing serotonin levels may prevent the development of carcinoid heart disease and the need for valve replacement surgery and new treatments such as telotristat ethyl and PRRT may be contributing to this [15,72,78].…”

Section: Complications: Carcinoid Heart Diseasementioning

confidence: 99%

Update on Pathophysiology, Treatment, and Complications of Carcinoid Syndrome

Clement

Ramage

Srirajaskanthan

2020

Journal of Oncology

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Carcinoid syndrome (CS) develops in patients with hormone-producing neuroendocrine neoplasms (NENs) when hormones reach a significant level in the systemic circulation. The classical symptoms of carcinoid syndrome are flushing, diarrhoea, abdominal pain, and wheezing. Neuroendocrine neoplasms can produce multiple hormones: 5-hydroxytryptamine (serotonin) is the most well-known one, but histamine, catecholamines, and brady/tachykinins are also released. Serotonin overproduction can lead to symptoms and also stimulates fibrosis formation which can result in development of carcinoid syndrome-associated complications such as carcinoid heart disease (CaHD) and mesenteric fibrosis. Transforming growth factor beta (TGF-β) is one of the main factors in developing fibrosis, but platelet-derived growth factor (PDGF), basic fibroblast growth factor (FGF2), and connective tissue growth factor (CTGF or CCN2) are also related to fibrosis development. Treatment of CS focuses on reducing serotonin levels with somatostatin analogues (SSA’s). Telotristat ethyl and peptide receptor radionuclide therapy (PRRT) have recently become available for patients with symptoms despite being established on SSA’s. Screening for CaHD is advised, and early intervention prolongs survival. Mesenteric fibrosis is often present and associated with poorer survival, but the role for prophylactic surgery of this is unclear. Depression, anxiety, and cognitive impairment are frequently present symptoms in patients with CS but not always part of their care plan. The role of antidepressants, mainly SSRIs, is debatable, but recent retrospective studies show evidence for safe use in patients with CS. Carcinoid crisis is a life-threatening complication of CS which can appear spontaneously but mostly described during surgery, anaesthesia, chemotherapy, PRRT, and radiological procedures and may be prevented by octreotide administration.

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Carcinoid heart disease: outcomes after surgical valve replacement

Cited by 53 publications

References 26 publications

Failing stentless Bioprostheses in patients with carcinoid heart valve disease

Failing stentless Bioprostheses in patients with carcinoid heart valve disease

Carcinoid Heart Disease: Starting From Heart Failure

Update on Pathophysiology, Treatment, and Complications of Carcinoid Syndrome

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