Quadruple Valve Replacement for Carcinoid Heart Disease

Abstract

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.

Quadruple Bioprosthetic Valve Replacement in a Patient With Severe Carcinoid Heart Disease

“…Seven patients were reported from the Mayo Clinic ( 6 ), almost all of whom had mechanical valves implanted. To the best of the present authors’ knowledge, quadruple valve replacement with all bioprosthetic valves has been reported in only 1 previous patient ( 7 ). Conventionally, the present authors use bioprosthetic valves in CaHD patients who have limited life expectancy and may not manage warfarin therapy well due to hepatic tumor burden.…”

“…Quadruple valve surgery in CaHD has previously been described in only a few case series ( 5 , 6 , 7 ). Castillo et al.…”

Right and Left-sided Valve Disease: A Case of Subclinical Intrapulmonary Shunt in an Adult with Malignant Carcinoid

“…Cardiac involvement in carcinoid syndrome portends a worse prognosis and overall mortality with an estimated three-year survival is 31% with cardiac involvement compared to 68% [2]. When identified, surgery has shown to improve morbidity with post-operative reductions in NYHA heart failure class [6]. The second unique feature of this case was early imaging findings that confounded the final diagnosis of intrapulmonary shunt.…”

Compromiso cardiovascular secundario a tumor carcinoide metastásico

“…En casos avanzados, refractarios a la terapia médica y en quienes el compromiso valvular severo contraindique procedimientos quirúrgicos (cirugías hepáticas), la cirugía cardiovascular es una opción (22)(23)(24)(25). La decisión entre bioprótesis o prótesis mecánica debe ser individualizada; sin embargo, debido al alto riesgo de sangrado (aún más ante la presencia de metástasis hepáticas), las bioprótesis son más usadas y recientemente, el reemplazo valvular percutáneo comienza a mostrarse como una opción adicional (4,26).…”