Effect of Valvular Surgery in Carcinoid Heart Disease: An Observational Cohort Study

Edwards, Nicola C.; Yuan, Meng; Nolan, Olivia; Pawade, Tania; Oelofse, Tessa; Singh, Harjot; Mehrzad, Homoyon; Zia, Zahra; Geh, J I; Palmer, D; May, Christine; Ayuk, John; Shah, Tahir; Rooney, Stephen J.; Steeds, Richard P.

doi:10.1210/jc.2015-3295

Cited by 31 publications

(29 citation statements)

References 15 publications

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“…Post-operative mortality is mainly due to the carcinoid disease itself. 15,16 conclusIon Our case represents an unusual and early presentation of carcinoid syndrome in a 27-year-old woman who had severe pulmonary and tricuspid disease with right atrial enlargement at the time of diagnosis. She underwent successful valvular replacement.…”

Section: Discussionmentioning

confidence: 83%

Metastatic carcinoid tumor with severe double valve disease at diagnosis: Case report and review of literature

et al. 2017

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A 27-year-old woman with a history of anxiety presented with three months of diarrhea. Onphysical examination, she had a grade 3/6 systolic heart murmur at the lower left sternal borderwhich increased with inspiration, a grade 2/6 decrescendo diastolic murmur at the left sternalborder, and lower extremity edema. Stool studies were negative. The abdominal ultrasounddemonstrated multiple complex liver cysts. Transthoracic echocardiogram reported tricuspidvalvular thickening with stenosis and regurgitation, severe pulmonary stenosis, and mild aorticregurgitation with valvular thickening. 5-hydroxyindole acetic acid and chromogranin A levelswere elevated. The patient’s symptoms improved after octreotide therapy, and she underwenttricuspid and pulmonary valve replacement.The incidence of carcinoid tumors is 1.2 to 2.1 per 100,000 people in the general population.Carcinoid heart disease occurs in one-half to two-thirds of patients with carcinoid syndromeand is associated with poorer clinical outcomes. Left side cardiac involvement occurs in lessthan 10% of patients. The presence of both left and right sided valvular disease in the contextof gastrointestinal carcinoid is associated with severe and poorly controlled disease. Up to4% of these cases have metastatic disease on the valves, and 3.8% have direct myocardialinvolvement.

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Section: Discussionmentioning

confidence: 83%

Metastatic carcinoid tumor with severe double valve disease at diagnosis: Case report and review of literature

et al. 2017

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“…On the other hand, anasarca edema and the need for intravenous diuretics prior to cardiac surgery independently predicted perioperative mortality. The lack of prognostic significance in the time from diagnosis to surgery has been reported elsewhere [33]. A possible explanation for this phenomenon is that it may reflect the progression of the underlying malignancy, which affects survival to a greater extent than the progression of RHF.…”

Section: Current Trends and Unresolved Issuesmentioning

confidence: 87%

“…In another recently published study, Edwards et al [33] reported the outcomes of patients who underwent cardiac surgery for CHD at a single center between 2005 and 2015. Patients with CHD were referred for surgery if they had 1 of the following indications: (a) a stable carcinoid tumor load, (b) severe valvular dysfunction, or (c) exercise-limiting symptoms.…”

Section: Chd Treatmentmentioning

confidence: 99%

“…Given that uncontrolled carcinoid disease and comorbidities represent contraindications for heart valve surgery in a significant proportion of patients with CHD [33,36,42], innovative, minimally invasive interventions may be implemented for this subpopulation. The first cases demonstrating the feasibility and safety of such techniques have been recently reported [54,55].…”

Section: Future Perspectivesmentioning

confidence: 99%

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Cardiac Surgery for Carcinoid Heart Disease: A Weapon Not to Be Misused

Bonou

Kapelios²,

Kaltsas³

et al. 2016

Cardiology

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Carcinoid heart disease (CHD) complicates approximately 25% of patients with a carcinoid tumor and carcinoid syndrome and leads to heart valve degeneration with mixed-stenotic and regurgitation pathology and consequent heart failure (HF) leading to significant morbidity and mortality. Cardiac surgery in symptomatic, severe CHD leads to significantly better functional capacity and prolonged survival when compared to medical treatment alone. Recent studies have shown improvement in postoperative outcomes of patients undergoing surgery for CHD over the last decades. The trend for early diagnosis and application of surgery prior to the manifestation of HF symptoms, which tended to develop during the previous years, does not seem justifiable based on the findings of recent studies. Therefore, the optimal timing of intervention in CHD and the type of valve that should preferably be used remain issues of controversy. This review comprehensively examines the existing literature on the treatment options for patients with CHD, with a special focus on short- and long-term survival after cardiac surgery, and discusses the selection of the exact patient profile and intervention timing that are more likely to optimize the benefit-to-risk ratio for surgical intervention.

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“…In CaHD, the right-sided heart valves are primarily affected because of their direct exposure to circulating blood serotonin, leading to right heart failure. Once patients with CaHD develop heart failure symptoms, the only effective treatment option is valve surgery, which has shown to decrease mortality and improve functional symptoms [3][4][5][6][7][8]. Majority of those patients required both tricuspid valve (TV) and pulmonary valve (PV) surgeries, preferably replacement [7,9].…”

Section: Introductionmentioning

confidence: 99%

Incidence of Atrioventricular Block After Valve Replacement in Carcinoid Heart Disease

et al. 2020

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Background: Carcinoid heart disease (CaHD) is a rare condition that has a high impact on the morbidity and mortality of its patients. Once heart failure symptoms develop in the patient with CaHD, cardiac valve surgery is often the only effective treatment. Although atrioventricular block (AVB) is a known postoperative complication of the valve surgery, the incidence of AVB in this population has not been well described. Methods:Comprehensive records were collected retrospectively on consecutive patients with CaHD who underwent a valve surgery at a tertiary medical center from January 2001 to December 2015. We excluded patients with pre-existing permanent pacemaker (PPM). Results:Nineteen consecutive patients were included in this study and 18 of them underwent at least dual valve (tricuspid and pulmonary valve) replacement surgery. Our 30-day post-surgical mortality was 0%. During the 6-month observation period following the surgery, 31.5% (n = 6) required PPM implantation due to complete AVB. There was no statistical difference in baseline characteristics and electrocardiographic and echocardiographic parameters between the patients who did or did not require PPM placement. Conclusions:Our study revealed that almost one-third of CaHD patients who underwent a valve replacement surgery developed AVB requiring PPM implantation. Due to high incidence of PPM require-ment, we believe that prophylactic placement of an epicardial lead during the valve surgery can be helpful in these patients to reduce serious complication from placement of pacemaker lead on a later date through a prosthetic valve.

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Effect of Valvular Surgery in Carcinoid Heart Disease: An Observational Cohort Study

Cited by 31 publications

References 15 publications

Metastatic carcinoid tumor with severe double valve disease at diagnosis: Case report and review of literature

Metastatic carcinoid tumor with severe double valve disease at diagnosis: Case report and review of literature

Cardiac Surgery for Carcinoid Heart Disease: A Weapon Not to Be Misused

Incidence of Atrioventricular Block After Valve Replacement in Carcinoid Heart Disease

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