A 64-year-old woman was scheduled for a diagnostic laparoscopy to explore two ovarian masses that were recently discovered during a workup for diarrhea, abdominal pain, and weight loss (Fig. 1A). She presented with progressive dyspnea and hypoxemia on arterial blood gas (pO 2 48 mmHg and saturation 87% on room air). Transthoracic (movie clip S1, Fig. 2) and transesophageal (movie clips S2-S4, Figs. 3 and 4) echocardiography were performed. 1,2 There was no evidence of left-sided valvular involvement. There were no lesions in the liver on positron emission tomography-computed tomography (PET-CT). A positive octreotide scan (Fig. 1B) and elevated urinary 5-hydroxyindoleacetic acid level confirmed the diagnosis of carcinoid heart disease due to an ovarian carcinoid tumor. Although in 95% of cases the primary tumor is located in the gastrointestinal tract and hepatic inactivation of serotonin prevent symptoms from occurring until liver metastases are present, 3 carcinoid heart disease in patients with primary ovarian carcinoid tumors may develop in the absence of liver metastases as the venous drainage of the ovaries bypasses the portal circulation. Sandostatin intramuscular was initiated Figure 1. A. CT abdomen indicating two nodular masses (maximal diameter 12 cm), originating from both ovaries. B. Octreotide scan indicating the presence of somatostatine receptors in these masses and confirming the diagnosis of ovarian carcinoid tumor.