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

Abstract

Carcinoid heart disease typically affects the tricuspid and pulmonary valves, causing severe regurgitation and/or stenosis. Valve surgery has been shown to reduce right heart failure and improve long-term prognosis in these patients. We report a severe case of a patient with all 4 heart valves involved who underwent successful quadruple bioprosthetic valve replacement. ( Level of Difficulty: Intermediate. )

European Neuroendocrine Tumor Society (ENETS) 2022 Guidance Paper for Carcinoid Syndrome and Carcinoid Heart Disease

“…There is marked symptomatic improvement after valve replacement surgery in CHD patients, with majority of patients being re‐classified as NYHA class I post‐operatively 67,72,73 Patients undergoing combined tricuspid valve replacement (TVR) and pulmonary valve replacement (PVR) had significantly higher survival compared to operations without PVR, when involvement of PV into CHD led to more than mild PR 71 The feasibility of quadruple valve replacement leading to marked functional improvement has also been reported by several groups 66 In a recent metanalysis 74 consisting of 416 pre‐operative patients, 97% had moderate or severe TR, 72% moderate or severe PR, and 33% with PS with or without regurgitation.…”

“…71 • The feasibility of quadruple valve replacement leading to marked functional improvement has also been reported by several groups. 66 • In a recent metanalysis 74 TR is usually the predominant lesion in CHD, and all patients with severe TR are candidates for TVR unless surgery is contraindicated.…”

“…Those cases should be discussed in detail by the CHD MDT, as well as with the patient, and a decision should be made on a case‐by‐case basis. 3bA Timing of surgery The optimal timing of valve replacement should be individualised and decided when the patient has a clear indication (see above), under optimal treatment following MDT assessment and has provided informed consent 66 . 3aA In a large cohort of 240 operated patients from the Mayo Clinic, survival was significantly better in patients with any lower pre‐operative NYHA class.…”

Surgical aspects of valve replacement in carcinoid heart disease

“…In our experience, carefully selected patients can tolerate and benefit even from quadruple valve replacement. 10 F I G U R E 2 (A) Opened RA showing a fibrotic retracted TV. Suggested black lines for leaflet incisions to augment valve opening.…”

Surgical aspects of valve replacement in carcinoid heart disease

“…Repair of the mitral and aortic valves have also been reported. In our experience, carefully selected patients can tolerate and benefit even from quadruple valve replacement 10. F I G U R E 2 (A) Opened RA showing a fibrotic retracted TV.…”