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Yong MS, Kong G, Ludhani P, Michael M, Morgan J, Hofman MS, Hicks RJ, Larobina M. Early Outcomes of Surgery for Carcinoid Heart Disease. Heart Lung Circ 2020; 29:742-747. [DOI: 10.1016/j.hlc.2019.05.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
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La Salvia A, Brizzi MP, Trevisi E, Parisi F, Muratori L, Atzeni F, Di Maio M, Scagliotti GV. Carcinoid heart failure in a duodenal neuroendocrine tumor: role of cardiac surgery in a challenging patient and brief review of the literature. Acta Oncol 2020; 59:315-319. [PMID: 31583924 DOI: 10.1080/0284186x.2019.1672891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anna La Salvia
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Maria Pia Brizzi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Elena Trevisi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | | | - Leonardo Muratori
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Francesco Atzeni
- Cardiac Surgery, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Massimo Di Maio
- Medical Oncology, Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Giorgio V. Scagliotti
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
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Balanescu DV, Donisan T, Lopez-Mattei J, Hassan S, Kim P, Dasari A, Halperin D, Yao J, Kar B, Gregoric I, Balanescu SM, Iliescu C. The 1, 2, 3, 4 of carcinoid heart disease: Comprehensive cardiovascular imaging is the mainstay of complex surgical treatment. Oncol Lett 2019; 17:4126-4132. [PMID: 30944605 PMCID: PMC6444330 DOI: 10.3892/ol.2018.9732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/10/2018] [Indexed: 12/29/2022] Open
Abstract
Carcinoid heart disease (CHD) is a rare complication of neuroendocrine tumors, most commonly involving the tricuspid and pulmonary valves. The mitral and aortic valves can also be affected, albeit rarely, in certain circumstances such as the presence of a patent foramen ovale. Transthoracic echocardiogram is generally considered the key imaging modality, but cardiac magnetic resonance can add valuable information, particularly in the assessment of pulmonary valve function or multivalvular disease. Previously, surgical management of CHD carried high mortality, as a result of less advanced surgical techniques and of late intervention, reserved for cases of severely symptomatic heart failure. Modern approaches are associated with significantly improved survival rates, even in multivalvular, complex cases. Valve replacement can provide survival benefits in patients with CHD, but the optimal timing for the intervention is uncertain, with data suggesting a trend of improved survival with earlier intervention. A comprehensive imaging assessment may contribute to establishing optimal surgical timing. This approach may shift the main driver of mortality from the cardiac involvement to the primary malignancy and lead to improved outcomes. We present a series of imaging findings in CHD patients who have successfully undergone simultaneous surgical replacement with bioprosthetic valves of 1 to 4 heart valves. The surgical decision in these patients was based on a multimodality cardiovascular approach, including transthoracic and transesophageal echocardiography and cardiac magnetic resonance. The patients had uncomplicated postoperative courses, significant symptomatic relief from heart failure symptoms, and there was no cardiovascular mortality. Early recognition of CHD with a multimodality approach may improve outcome, even in complex cases. Bioprosthetic valves are generally preferred in CHD due to decreased need for anticoagulation, despite concern for premature degeneration. A collaboration between the Oncology and Cardiology teams is essential for the long-term management of CHD patients.
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Affiliation(s)
- Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daniel Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - James Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Biswajit Kar
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Igor Gregoric
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Serban Mihai Balanescu
- Department of Cardiology, Elias Emergency University Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 011134, Romania
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ma QH, Fang JH. International normalized ratio for the guidance of warfarin treatment in elderly patients after cardiac valve replacement. Exp Ther Med 2018; 17:1486-1491. [PMID: 30680032 DOI: 10.3892/etm.2018.7078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/13/2018] [Indexed: 11/06/2022] Open
Abstract
Thus far, the target value for international normalized ratio (INR) has remained to be determined. The current study aimed to further explore the INR value of the anti-coagulation drug warfarin after cardiac valve replacement. The clinical data of 213 patients who underwent cardiac valve replacement at Linyi Central Hospital (Linyi, China) between January 2010 and May 2013 were retrospectively analyzed. The warfarin dosage, prothrombin time (PT) and INR were compared among patients with hemorrhage or embolism, and those with no complications. A total of 31 cases (14.6%) developed adverse reactions and complications during the medication period, including 21 cases with hemorrhage (9.9%, hemorrhage group) and 10 cases with embolism (4.7%, embolism group), while 182 patients did not (85.4%, normal group). The average dosage of warfarin was 2.0±0.6, 3.1±0.7 and 1.7±0.6 mg/day in the normal, hemorrhage and embolism groups, respectively. The dosage of warfarin, the PT and the INR in the hemorrhage group were all significantly greater than those in the normal group and the embolism group (all P<0.05). INR monitoring is recommended to ensure the safety of the anti-coagulant drug warfarin, but further study is still required to determine a reasonable target INR value.
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Affiliation(s)
- Qing-Hua Ma
- Department of Cardiology, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
| | - Jian-Hai Fang
- Department of Cardiology, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
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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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Warner RRP, Castillo JG. Carcinoid Heart Disease: The Challenge of the Unknown Known. J Am Coll Cardiol 2015; 66:2197-2200. [PMID: 26564597 DOI: 10.1016/j.jacc.2015.05.086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 05/26/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Richard R P Warner
- Department of Gastroenterology, Center for Carcinoid and Neuroendocrine Tumors, The Mount Sinai Hospital, New York, New York.
| | - Javier G Castillo
- Department of Cardiovascular Surgery, Center for Carcinoid and Neuroendocrine Tumors, The Mount Sinai Hospital, New York, New York
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