Staged treatment of carcinoid syndrome complicated with severe tricuspid regurgitation

Staged treatment of carcinoid syndrome complicated with severe tricuspid regurgitation. Author’s reply

“…We thank Dr. Konsek-Komorowska and Prof. Pęczkowska for their interest [1] in our case report about a patient with carcinoid heart disease (CHD) [2]. We agree that management of CHD is complex, not always predictable, and requires multidisciplinary cooperation.…”

Carcinoid heart disease: An immense challenge despite medical and surgical advances

“…This might be due to decreased production of vasoactive substances and a reduction in potentially fatal consequences such as intestinal obstruction generated by tumor progression and occlusion [5]. Accordingly, we wonder if the authors of the presented case [1] could provide more information on tumor characteristics, echocardiographic findings, as well as on levels of 5-HIAA and chromogranin A after primary tumor resection.…”

“…In their recently published clinical vignette, Waligóra et al [1] reported an interesting case of symptomatic carcinoid heart disease (CHD) in a 49-year-old male, after successful treatment of severe tricuspid regurgitation with implantation of a bioprosthesis followed by resection of the primary tumor localized in the ileum. The authors also reported tricuspid valve deterioration throughout the follow-up period, which they linked to the interval between the abdomen and cardiac surgery and the exposure of the prosthetic valve to high levels of serotonin metabolites before initial tumor resection [1]. As CHD is the most serious consequence of carcinoid syndrome [2] and serotonin activity appears to be crucial in the development of valvular CHD [3], we would like to write a short comment.…”

“…Other essential biomarkers used in disease diagnosis and monitoring include urinary 5-hydroxyindoleacetic acid (u5-HIAA), chromogranin A, and activin A [2]. Accordingly, we wonder whether the patient [1] had other biomarkers tested before the final diagnosis of carcinoid syndrome and CHD.…”

“…CHD treatment is complicated since both the systemic malignant disease and cardiac involvement should be managed at the same time However, it is not always as simple as in the guidelines. The reported case by Waligóra et al [1] emphasized that patient management requires involvement of a multidisciplinary team to adequately select patients for valve or primary tumor surgeries, and plan preoperative and perioperative treatment procedures. It should be highlighted that the authors took up this extremely difficult challenge and that the cardiac surgery and primary tumor resection were successful without any complications [2].…”