Three‐dimensional echocardiography assessment of carcinoid valvular heart disease: Images of each and all

Abstract

A 54-year-old male with neuroendocrine carcinoma was admitted for syncope. Computed tomography showed a mesenteric mass with internal calcification, consistent with a primary carcinoid tumor ( Figure 1A), and hepatic metastasis ( Figure 1B). Two-dimensional (2D) transthoracic echocardiography (TTE) showed severely dilated right ventricle (RV) and right atrium (RA) (Figure 2A,B). Color and continuous-wave Doppler showed severe tricuspid regurgitation (TR, Figure 2C,D) and pulmonary regurgitation (PR, Figure 2E,F). Threedimensional (3D) TTE en-face views of each of the four valves were displayed (Figure 3A-H, A-D systole and E-H diastole, and Movies S1-S4). The mitral valve (MV) and aortic valve (AV) were normal. The tricuspid valve (TV) and pulmonic valve (PV) leaflets were thickened, retracted, and fixed. All four valves were simultaneously displayed in one plane with en-face view of the TV, MV, and AV (Figure 3I,J), and a longitudinal dissection view of the PV. This unique view demonstrated normal closing and opening of the MV and AV during cardiac cycles. However, the TV and PV remained widely open throughout the cardiac cycle (Movie S5). TV and PV leaflets were found to be completely eroded during open-heart surgery (Figure 4A,B). The patient underwent TV and PV replacements. Abstract A 54-year-old male was found to have neuroendocrine carcinoma with hepatic metastasis. Two-dimensional (2D) transthoracic echocardiography (TTE) demonstrated dilated right ventricle and right atrium, and severe tricuspid and pulmonary regurgitation. Three-dimensional (3D) TTE en-face views showed thickened, retracted, and fixed tricuspid valve and pulmonic valve which remained widely open throughout the cardiac cycle. 3D TTE, particularly en-face views, demonstrates incremental value over 2D TTE by providing precise valvular anatomic details comparable to surgical findings. 3D TTE also offers a unique opportunity to assess all four valves simultaneously with en-face views to delineate their relationships with surrounding structures.