Carcinoid Heart Disease

Abstract

Carcinoid tumors are rare, indolent neuroendocrine tumors that are often associated with a syndrome characterized by episodic flushing, secretory diarrhea, bronchospasm, and hypotension-the carcinoid syndrome. Cardiac involvement occurs in one-half to two-thirds of patients with carcinoid syndrome and is associated with a worse clinical outcome. Carcinoid heart disease is characterized by endocardial plaque-like deposits found predominantly on right-sided heart valves, leading to the combination of valvular stenosis and regurgitation. Left-sided cardiac involvement can also occur in <10% of patients. Somatostatin analogs form the therapeutic cornerstone in the medical management of these patients. Cytotoxic chemotherapy has had only limited success in the treatment of metastatic carcinoid tumors. Hepatic resection or palliative cytoreduction may be of benefit in patients with limited hepatic disease. Hepatic artery embolization is usually applied if a patient is not eligible for surgical debulking. The development and progression of carcinoid heart disease are associated with an unfavorable outcome. In those patients having severe cardiac involvement and well-controlled systemic disease, valve replacement surgery has been found to be an effective treatment that can both relieve intractable symptoms and contribute to improved clinical outcomes.

Carcinoid heart disease

“…A pulmonalis billentyűbetegség rendszerint nem önállóan, hanem a tricuspidalis vitium kísérőjeként jelenik meg. Echo kardiográfi a során a billentyűk morfológiai adatain túl szá-mos információ nyerhető a jobb kamra szisztolés funkciójáról [11]. A carcinoid szívbetegség diagnózisát a mágneses magrezonanciás vizsgálat (MRI) is segítheti.…”

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

“…The prognosis for patients with CHD and severe heart failure (NYHA classes III and IV) is unfavourable; the mean survival rate for patients without cardiosurgical treatment is 11 months. The gold standard in CHD diagnosis is echocardiography, which should be performed in all patients with carcinoid syndrome [19][20][21][22][23][24].…”

Rarity and review: evidence-based practice for uncommon diseases

“…Fibrous endocardial plaques associated with high circulating levels of serotonin are deposited in the right heart and lead to dysfunction of the tricuspid and pulmonic valves. 11 The frequent use of exogenous catecholamines during and after cardiopulmonary bypass raises the particular concern of triggering carcinoid crisis when these lesions are repaired. It is unclear if it was concern over pharmacological triggers or simply local practice pattern that contributed to the large doses of octreotide reported in this study.…”

“…Des plaques endocardiaques fibreuses associées à des niveaux élevés de sérotonine circulante se déposent dans le coeur droit et entraînent un dysfonctionnement des valves tricuspide et pulmonaire. 11 L'utilisation fréquente de catécholamines exogènes pendant et après la circulation extracorporelle soulève le problème particulier qu'elles déclenchent une crise carcinoïde lorsque ces lésions sont réparées. Nous ne savons pas si les doses élevées d'octréotide rapportées dans cette étude ont été dictées par des inquiétudes quant aux déclencheurs pharmacologiques ou par la pratique locale de l'établissement.…”