Multimodality imaging in the diagnostic approach to a patient with carcinoid heart disease involving four heart valves

Abstract

Carcinoid syndrome represents symptoms caused by neuroendocrine tumors-mainly in the gut-resulting in cardiac involvement in about 20% of patients. The disease usually affects the right heart, and the left heart remains spared, as the lungs metabolize the vasoactive substances causing the disease. However, several conditions may lead to both right-and left-sided involvement. These conditions include primary lung neoplasms, any intracardiac shunts, that is, atrial septal defect (ASD), patent foramen ovale (PFO), etc. and the presence of large burden of neoplastic tissue overwhelming the lung inactivation capacity by releasing notable amount of vasoactive substances. 1 Transthoracic echocardiography (TTE) is the first imaging modality used in most cardiac patients. Screening for heart disease in those patients with carcinoid syndrome is of great importance since the patient may have no significant signs or symptoms in the early stages. Based on current evidence, TTE is the recommended modality to screen and monitor carcinoid heart disease. 2