Staged Catheter-Based Valve Treatment of Severe Carcinoid Heart Disease

Laule, Michael; Pschowski, René; Pape, Ulrich‐Frank; Pavel, Marianne; Stangl, Verena; Baumann, Gert; Wiedenmann, Bertram; Stangl, Karl

doi:10.1159/000437167

Cited by 11 publications

(4 citation statements)

References 9 publications

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“…There has been one case report recently that has demonstrated an overall beneficial outcome to the patient where two Edwards Sapien valves were implanted percutaneously into the pulmonary valve and into the IVC valve to treat the effects secondary to TR 10. These promising findings are being further evaluated through two clinical trials, TRICAVAL and HOVER, looking at the use of IVC valves in severe TR.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms

Sagar¹,

Steeds

Doshi

et al. 2017

BMJ Case Reports

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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.

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Section: Discussionmentioning

confidence: 99%

Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms

Sagar¹,

Steeds

Doshi

et al. 2017

BMJ Case Reports

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“…Bioprosthetic valves are generally preferred over a mechanical prosthesis, which requires anticoagulation for life and then exposes patients with liver metastases to the risk of bleeding in addition to the risk of prosthesis thrombosis in tricuspid position [ 23 ]. Percutaneous valve implantation is a novel option in high-risk patients with severe CaHD, who have poor performance status and comorbidities that do not allow open surgery [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Carcinoid heart disease revealed by cyanosis with both right and left valvular involvement: a case report

Khay¹,

Arous²,

Bentaoune³

et al. 2018

J Med Case Reports

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BackgroundCarcinoid heart disease is a frequent complication of carcinoid syndrome. It is related to the release by the carcinoid tumor and/or its metastases of bioactive substances such as serotonin. It is characterized by right-sided valvular involvement and can lead to right-sided heart failure. It is a prognostic factor of carcinoid syndrome.Case presentationWe report the case of a 53-year-old African woman with an endocrine tumor of her small intestine complicated by carcinoid heart disease, revealed by right-sided heart failure. The diagnosis was confirmed by transthoracic echocardiography, which showed a severe tricuspid regurgitation with a patent foramen ovale, and by increased serum chromogranin A and urinary 5-hydroxyindoleacetic acid.Initially she was treated with medical therapy (furosemide and injection of somatostatin). Afterwards she was proposed for surgery. The evolution of her treatment was good.ConclusionsCarcinoid syndrome is complicated in 60% of the cases of a heart disease, and is responsible for an important morbidity and mortality. The prognosis of patients with carcinoid heart disease has improved in recent years through somatostatin analogues and the cardiac surgery.

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“…Although surgical valve replacement is the gold standard treatment for symptomatic carcinoid heart valve disease, transcatheter pulmonary valve replacement should be considered as an alternative approach in high-risk candidates [20] . Percutaneous valve implantation in the pulmonary and in the inferior vena cava positions may offer minimally invasive alternative in the high-risk patients [21] .…”

Section: Discussionmentioning

confidence: 99%

Quadruple Valve Replacement for Carcinoid Heart Disease

Mujtaba¹,

Clark²

2018

Braz J Cardiovasc Surg

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IntroductionCarcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature.MethodsAll three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours.ResultsMean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases.ConclusionSurgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement.

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Staged Catheter-Based Valve Treatment of Severe Carcinoid Heart Disease

Cited by 11 publications

References 9 publications

Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms

Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms

Carcinoid heart disease revealed by cyanosis with both right and left valvular involvement: a case report

Quadruple Valve Replacement for Carcinoid Heart Disease

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