Patient with carcinoid syndrome and severe tricuspidian disease

Introduction: Carcinoid tumors are rare and aggressive malignancies. Once metastatic to the liver, this neuroendocrine malignancy secrets numerous vasoactive substances, which directly affect the right-sided heart valves. Unfortunately, by the time carcinoid syndrome surfaces clinically, the likelihood of cardiac involvement is 50%. The additional burden of cardiac dysfunction heralds a steep decline in quality of life and survival, the prompt recognition of this disease being therefore of the utmost importance. Methods: We report the case of a 59 year old patient, diagnosed in 2012 at Institutul de Boli Cardiovasculare „Prof. dr. George I. M. Georgescu”,with atrial flutter and, in february 2014, with carcinoid tumor of the terminal ileum and liver metastasis, returns in our clinic, accusing for the last four months the appearance of dyspnea on moderate exertion and dry caugh. Clinical examination reveald the presence of a third heart sound, emphasized with inspiration and simetric peripheral edema. The ECG described sinus rhythm, QRS axis + 30 degrees, inverted T waves in D III and flattened T waves in aVF. The transthoracic echocardiography detected the presence of severe tricuspidian disease, diagnosis confirmed by the transesophageal echocardiography Results: The carcinoid syndrome was considered to be the cause of the tricuspidian disease, regarding the fact that the echocardiography performed in 2012 didn’t reveal any hemodynamically significant valvulopathy and, despite the similar clinical cases described in the literature, when the surgical cure of the valvulopathy was practiced, obtaining symptomatic improvement, in our case, the conservatory treatment of the tricuspidian lesion was decided. After discharge, the patient went to the Oncology Institute in Cluj-Napoca, where, the systemic treatment of the carcinoid syndrome with somatostatin analogues was started. Conclusions: The particularities of this case are: the fact that the patient was diagnosed with advanced carcinoid tumor, tumor which represented the trigger of the tricuspidian disease and the fact that, only the tricuspid valve was affected, without pulmonary valve involvement, as it oft en happens in cases of carcinoid heart disease.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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