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Sidhu H, Kushwaha S, Cohen G, Chellakudam T, Ahmed S. Quadruple Valve Replacement for Carcinoid Heart Disease. CJC Open 2024; 6:82-85. [PMID: 38585678 PMCID: PMC10994968 DOI: 10.1016/j.cjco.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 04/09/2024] Open
Affiliation(s)
- Hasrit Sidhu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sameer Kushwaha
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gideon Cohen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tresa Chellakudam
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shaheeda Ahmed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Meir J, Michaud L, Frishman WH, Aronow WS. The Past, Present, and The Future of Carcinoid Heart Disease. Cardiol Rev 2023; 31:193-198. [PMID: 36515580 DOI: 10.1097/crd.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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.
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Affiliation(s)
- Juliet Meir
- From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Vaslhalla, NY
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Grozinsky‐Glasberg S, Davar J, Hofland J, Dobson R, Prasad V, Pascher A, Denecke T, Tesselaar MET, Panzuto F, Albåge A, Connolly HM, Obadia J, Riechelmann R, Toumpanakis C. European Neuroendocrine Tumor Society (ENETS) 2022 Guidance Paper for Carcinoid Syndrome and Carcinoid Heart Disease. J Neuroendocrinol 2022; 34:e13146. [PMID: 35613326 PMCID: PMC9539661 DOI: 10.1111/jne.13146] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Simona Grozinsky‐Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Organization and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Joseph Davar
- Carcinoid Heart Disease Clinic, Department of CardiologyRoyal Free Hospital & University College LondonLondonUK
| | - Johannes Hofland
- Department of Internal Medicine, Section of Endocrinology, ENETS Center of ExcellenceErasmus MC and Erasmus Cancer InstituteRotterdamThe Netherlands
| | - Rebecca Dobson
- Department of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Vikas Prasad
- Department of Nuclear MedicineUniversity UlmUlmGermany
| | - Andreas Pascher
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital MuensterMuensterGermany
| | - Timm Denecke
- Department of Diagnostic and Interventional RadiologyLeipzig University Medical CenterLeipzigGermany
| | | | - Francesco Panzuto
- Digestive Disease Unit, Department of Medical‐Surgical Sciences and Translational MedicineSapienza University of Rome, ENETS Center of ExcellenceRomeItaly
| | - Anders Albåge
- Department of Cardiothoracic Surgery and Anesthesiology, University Hospital, and Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Heidi M. Connolly
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
| | | | | | - Christos Toumpanakis
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondonUK
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Shah HA, Sagar V, Hughes S, Khanna A, Yim I, Lodge F, Singh H, Oelofse T, Ó'Súilleabháin C, Venkataraman H, Shetty S, Steeds R, Rooney S, Shah T. Surgical Correction of Carcinoid Heart Disease Improves Liver Function and 5-Hydroxyindoleacetic Acid Levels. Front Surg 2022; 9:791058. [PMID: 35465425 PMCID: PMC9023856 DOI: 10.3389/fsurg.2022.791058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Carcinoid heart disease (CHD) is a consequence of neuroendocrine tumors releasing 5-hydroxytryptamine (5-HT) into the systemic circulation, affecting right heart valves, causing fibrosis, and eventually right heart failure. The aim of this study was to determine the effect of valve-replacement on kidney function, liver function, and 5-hydroxyindoleacetic acid (5-HIAA) levels. Methods A Retrospective study of 17 patients with CHD who had undergone heart-valve replacement surgery between 2010 and 2019, from the Queen Elizabeth Hospital Birmingham. 5-HIAA levels, liver, and kidney function were measured in addition to hepatic inferior vena cava (IVC) diameter and its relationship to carcinoid symptoms. Results Eleven patients were male and six were female. At time of surgery, average age was 66.6 ± 8.1 years and average BMI was 25.8 ± 5.5 Kg/cm2. Three out of 17 patients had one valve replaced, 13/17 had two replaced (tricuspid and pulmonary), and 1/17 had three replaced (tricuspid, pulmonary and aortic). There was a 31% average decline in 5-HIAA [799.8 (343.6–1078.0) to 555.3 (275.8–817.9), p = 0.011], a 35% decline in bilirubin [20 (16–29) to 13 (10–19), p = < 0.001], and a 15% reduction in the short and long axes of the IVC after valve-replacement surgery [20.0 (18.0–25.0) and 36.5 (29.0–39.8) to 17.0 (14.5–19.3) and 31.0 (26.5–34.3) respectively, p = < 0.001 and 0.002 respectively]. Conclusion Valve replacement surgery improves 5-HIAA levels alongside improved liver function and hepatic IVC diameter. These findings are consistent with resolution of congestive hepatopathy, and therefore enhanced clearance of 5-HIAA. This suggests that valve-replacement surgery can indirectly have beneficial outcomes on hepatic function and is also associated with a drop in the circulating levels of tumor derived serotonin.
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Affiliation(s)
- Husnain Abbas Shah
- Department of Hepatology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Vandana Sagar
- Department of Hepatology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Simon Hughes
- Department of Imaging, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Amardeep Khanna
- Department of Hepatology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Ivan Yim
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Freya Lodge
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Harjot Singh
- Featherstone Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Tessa Oelofse
- Featherstone Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | - Hema Venkataraman
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Shishir Shetty
- Department of Hepatology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Richard Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Stephen Rooney
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Tahir Shah
- Department of Hepatology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- *Correspondence: Tahir Shah
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Flagiello M, Pozzi M, Francois L, Al Harthy A, Forestier J, Boccalini S, Rioufol G, Walter T, Obadia JF. Transcatheter pulmonary valve implantation in carcinoid heart disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:130-134. [DOI: 10.1016/j.carrev.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/10/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022]
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Alvarez-Villegas D, Giménez-Milà M, Sbraga F, Camprubí I, Gil A, Valchanov K, Shayan H, Castillo J, Weiner MM. Dealing With the Right Side: Carcinoid Heart Disease. J Cardiothorac Vasc Anesth 2021; 36:2793-2802. [PMID: 34863651 DOI: 10.1053/j.jvca.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Affiliation(s)
- David Alvarez-Villegas
- Department of Anesthesia and Critical Care,Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Giménez-Milà
- Department of Anesthesia and Critical Care,Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | - Fabrizio Sbraga
- Department of Cardiovascular Surgery and Transplantation, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Immaculada Camprubí
- Department of Anesthesia and Critical Care,Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Gil
- Department of Anesthesia and Critical Care,Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Kamen Valchanov
- Department of Anesthesia,Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Hossain Shayan
- Department of Cardiac Surgery, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Javier Castillo
- Heart & Lung Institute, Bayamon Medical Center, Bayamon, Puerto Rico
| | - Menachem M Weiner
- Department of Anesthesiology, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY
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Sunjic I, Shin D, Sunjic KM, Popat JV, Tran T, Chae SH, Caldeira CC, Strosberg JR, Sayad D. Incidence of Atrioventricular Block After Valve Replacement in Carcinoid Heart Disease. Cardiol Res 2020; 11:56-60. [PMID: 32095197 PMCID: PMC7011921 DOI: 10.14740/cr986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/15/2019] [Indexed: 11/11/2022] Open
Abstract
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 requirement, 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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Affiliation(s)
- Igor Sunjic
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA.,These authors contributed equally to this work
| | - Doosup Shin
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.,These authors contributed equally to this work
| | - Katlynd M Sunjic
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, FL 33606, USA
| | - Jesal V Popat
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA
| | - Thanh Tran
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA
| | - Sanders H Chae
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA
| | - Christiano C Caldeira
- Division of Cardiothoracic Surgery and Cardiology, Tampa General Hospital, Tampa, FL 33606, USA
| | - Jonathan R Strosberg
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Dany Sayad
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA
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Hassan SA, Palaskas NL, Agha AM, Iliescu C, Lopez-Mattei J, Chen C, Zheng H, Yusuf SW. Carcinoid Heart Disease: a Comprehensive Review. Curr Cardiol Rep 2019; 21:140. [PMID: 31745664 DOI: 10.1007/s11886-019-1207-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Carcinoid heart disease is a rare disorder that is associated with significant morbidity and mortality. In this review of the literature, we will present current concepts in diagnosis and management of carcinoid heart disease. RECENT FINDINGS Recent expert consensus guidelines highlight the role of echocardiography and screening with NT-proBNP for the evaluation of carcinoid heart disease. Advances in medical therapy along with better surgical outcomes highlight the experience and expertise that has been gained in the treatment of carcinoid heart disease. Carcinoid heart disease occurs in patients with neuroendocrine tumors who have carcinoid syndrome. Serotonin appears to play a central role in the development of carcinoid heart disease. Cardiac biomarkers and multimodality imaging can be used to aid in screening and diagnosis. The mainstay of treatment of carcinoid heart disease is surgery.
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Affiliation(s)
- Saamir A Hassan
- Department of Cardiology, Division of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Nicolas L Palaskas
- Department of Cardiology, Division of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ali M Agha
- Department of Cardiology, Division of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cezar Iliescu
- Department of Cardiology, Division of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, Division of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher Chen
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Henry Zheng
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Syed Wamique Yusuf
- Department of Cardiology, Division of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Uema D, Alves C, Mesquita M, Nuñez JE, Siepmann T, Angel M, Rego JFM, Weschenfelder R, Rocha Filho DR, Costa FP, Barros M, O'Connor JM, Illigens BM, Riechelmann RP. Carcinoid Heart Disease and Decreased Overall Survival among Patients with Neuroendocrine Tumors: A Retrospective Multicenter Latin American Cohort Study. J Clin Med 2019; 8:jcm8030405. [PMID: 30909590 PMCID: PMC6463128 DOI: 10.3390/jcm8030405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 01/22/2023] Open
Abstract
The background to this study was that factors associated with carcinoid heart disease (CHD) and its impacts on overall survival (OS) are scantly investigated in patients (pts) with neuroendocrine tumors (NETs). In terms of materials and methods, a retrospective multicenter cohort study was conducted of factors associated with CHD in advanced NET pts with carcinoid syndrome (CS) and/or elevated urinary 5-hidroxyindole acetic acid (u5HIAA). CHD was defined as at least moderate right valve alterations. The results were the following: Among the 139 subjects included, the majority had a midgut NET (54.2%), 81.3% had CS, and 93% received somatostatin analogues. In a median follow-up of 39 months, 48 (34.5%) pts developed CHD, with a higher frequency in pts treated in public (77.2%) versus private settings (22.9%). In a multivariate logistic regression, unknown primary or colorectal NETs (Odds Ratio (OR) 4.35; p = 0.002), at least 50% liver involvement (OR 3.45; p = 0.005), and being treated in public settings (OR 4.76; p = 0.001) were associated with CHD. In a Cox multivariate regression, bone metastases (Hazard Ratio {HR} 2.8; p = 0.031), CHD (HR 2.63; p = 0.038), and a resection of the primary tumor (HR 0.33; p = 0.026) influenced the risk of death. The conclusions were the following: The incidence of CHD was higher in pts with a high hepatic tumor burden and in those treated in a public system. Delayed diagnosis and limited access to effective therapies negatively affected the lives of NET patients.
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Affiliation(s)
- Deise Uema
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany.
| | - Carolina Alves
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil.
| | - Marcella Mesquita
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil.
| | - Jose Eduardo Nuñez
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil.
- Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil.
| | - Tim Siepmann
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany.
| | - Martin Angel
- Instituto Alexander Fleming, C1426ANZ Buenos Aires, Argentina.
| | - Julian F M Rego
- Hospital Universitário Onofre Lopes, Natal 59012-300, Brazil.
| | | | | | | | - Milton Barros
- Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil.
| | - Juan M O'Connor
- Hospital de Gastroenterología Bonorino Udaondo, C1264AAA Buenos Aires, Argentina.
| | - Ben M Illigens
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany.
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02114, USA.
| | - Rachel P Riechelmann
- Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil.
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Mujtaba SS, Clark S. Quadruple Valve Replacement for Carcinoid Heart Disease. Braz J Cardiovasc Surg 2019; 33:398-403. [PMID: 30184038 PMCID: PMC6122765 DOI: 10.21470/1678-9741-2017-0224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/26/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Carcinoid 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. METHODS All 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. RESULTS Mean 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. CONCLUSION Surgery 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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Affiliation(s)
- Syed Saleem Mujtaba
- Freeman Hospital Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Clark
- Freeman Hospital Newcastle, United Kingdom of Great Britain and Northern Ireland
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12
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Yuan SM. Valvular Disorders in Carcinoid Heart Disease. Braz J Cardiovasc Surg 2017; 31:400-405. [PMID: 27982350 PMCID: PMC5144560 DOI: 10.5935/1678-9741.20160079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/16/2016] [Indexed: 12/28/2022] Open
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.
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Affiliation(s)
- Shi-Min Yuan
- MMed, PhD. The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Fujian Province, China
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Castillo JG, Naib T, Zacks JS, Adams DH. Echocardiography in functional midgut neuroendocrine tumors: When and how often. Rev Endocr Metab Disord 2017; 18:411-421. [PMID: 29080935 DOI: 10.1007/s11154-017-9434-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The management of patients with midgut neuroendocrine tumors (MNET) is rapidly evolving. Current preoperative detection rates of primary tumor sites are higher than ever and progression-free survival in patients with already advanced disease is expanding due to the implementation of novel efficacious treatment strategies. This survival benefit may potentially translate into a need for a multidisciplinary approach to an even more heterogenous variety of clinical conditions, among these, carcinoid syndrome (CS) and carcinoid heart disease (CHD). The latter often triggers substantial morbidity and mortality, hence a systematic screening, an accurate diagnosis, as well as effective interventions are critically important. The rarity of the disease has result in a relative lack of statistically powerful evidence, which in turn may have rendered significant variability between practices. In this regard, despite recent guidelines, the optimal follow-up of patients with CHD remain debatable to some authors, perhaps due to the preponderance of certain schools throughout the manuscript. Herein, we present a concise and practical guidance document on clinical screening and echocardiographic surveillance of patients with CHD based on a comprehensive review of the literature, and complemented by our experience at the Center for Carcinoid and Neuroendocrine Tumors at The Mount Sinai Hospital.
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Affiliation(s)
- Javier G Castillo
- Department of Cardiovascular Surgery, Mount Sinai Health System, The Mount Sinai Hospital, 1190 Fifth Avenue, GP2 West, New York, NY, 10029-6574, USA.
- Center for Carcinoid and Neuroendocrine Tumors, Mount Sinai Health System, The Mount Sinai Hospital, New York, NY, USA.
| | - Tara Naib
- Department of Clinical Cardiology, Mount Sinai Health System, The Mount Sinai Hospital, New York, NY, USA
| | - Jerome S Zacks
- Center for Carcinoid and Neuroendocrine Tumors, Mount Sinai Health System, The Mount Sinai Hospital, New York, NY, USA
- Department of Clinical Cardiology, Mount Sinai Health System, The Mount Sinai Hospital, New York, NY, USA
| | - David H Adams
- Department of Cardiovascular Surgery, Mount Sinai Health System, The Mount Sinai Hospital, 1190 Fifth Avenue, GP2 West, New York, NY, 10029-6574, USA
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Castillo J, Silvay G, Weiner M. Anesthetic Management of Patients With Carcinoid Syndrome and Carcinoid Heart Disease: The Mount Sinai Algorithm. J Cardiothorac Vasc Anesth 2017; 32:1023-1031. [PMID: 29273478 DOI: 10.1053/j.jvca.2017.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Javier Castillo
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY; Center for Carcinoid and Neuroendocrine Tumors, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY.
| | - George Silvay
- Department of Anesthesiology, Division of Cardiac Anesthesia, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - Menachem Weiner
- Department of Anesthesiology, Division of Cardiac Anesthesia, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
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Abstract
The cardiac manifestations of a neuroendocrine tumour are referred to as carcinoid heart disease (CaHD) and are associated with a poor prognosis. Surgical intervention is the only proven therapeutic option and may prolong survival and quality of life. No consensus has been reached internationally with regard to screening for CaHD and the optimal timing for surgery. Although limited evidence is available on this matter, a trend towards early surgery and subsequent reduced mortality has been observed. In this review we provide an overview of the current understanding and propose a protocol to guide cardiologists in the screening for CaHD and the timing of referral to a specialised surgical centre.
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