Carcinoid Heart Disease
Malignant Carcinoid Syndrome
Carcinoid Tumor
Tricuspid Valve Stenosis
Heart Valves
Tricuspid Valve Insufficiency
Heart Valve Diseases
Tricuspid Valve
Hydroxyindoleacetic Acid
Bioprosthesis
Echocardiography
Carcinoid heart disease from ovarian primary presenting with acute pericarditis and biventricular failure. (1/47)
A case is described of a 54 year old woman who had acute pericarditis with large exudative effusion accompanied by severe right and left ventricular failure. The patient was finally diagnosed with carcinoid heart disease from an ovarian carcinoid teratoma. She was treated with octreotide--a somatostatin analogue--followed by radical surgical resection of the neoplasm. At one year follow up only mild carcinoid tricuspid regurgitation remained. Only 16 cases of carcinoid heart disease from an ovarian primary have been described in literature. Moreover clinically manifest acute, nonmetastatic pericarditis and left heart failure are not considered as possible presentations of carcinoid heart disease, whatever the origin. In a recent series a small pericardial effusion was considered an infrequent and unexpected echocardiographic finding in carcinoid heart patients. One case of "carcinoid pericarditis" has previously been described as a consequence of pericardial metastasis. Left sided heart involvement is usually caused by bronchial carcinoids or patency of foramen ovale; both were excluded in the case presented. (+info)Balloon pulmonary valvuloplasty in carcinoid syndrome. (2/47)
Half of all patients with carcinoid syndrome develop cardiac involvement. Patients who have cardiac involvement have a significantly worse prognosis than those without, and death can occur directly as a result of cardiac involvement. A case of carcinoid syndrome in a 38 year old woman with lesions in the liver, who presented with right sided valvar abnormalities, a dilated right ventricle, and right ventricular pressure overload, is presented. In order to palliate the patient's symptoms and to decrease right sided pressures before major abdominal surgery, balloon pulmonary valvuloplasty was performed at the time of cardiac catheterisation. This resulted in a reduction in the pulmonary gradient and right ventricular pressure. Following the procedure, the patient's symptoms were completely relieved. She went on to laparotomy where the lesions in the liver were excised without complication. (+info)Tricuspid and pulmonary valve involvement in carcinoid disease. (3/47)
We report the case of a 62-year-old woman in whom carcinoid disease had been diagnosed 6 years earlier. She subsequently developed tricuspid and pulmonary valve disease. Both valves were incompetent and mildly stenotic. The tricuspid valve required surgery; the pulmonary vaive was explored but not treated. Valve surgery in patients with carcinoid disease is discussed in light of the prognosis of these patients, the timing of valvular lesion presentation, and the choice of prosthesis. The justification for multiple-valve procedures in such cases is also considered. (+info)Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours. (4/47)
Patients with metastatic carcinoid tumours often undergo surgical procedures to reduce the tumour burden and associated debilitating symptoms. These procedures and anaesthesia can precipitate a life-threatening carcinoid crisis. To assess perioperative outcomes, we studied retrospectively the medical records of adult patients from 1983 to 1996 who underwent abdominal surgery for metastatic carcinoid tumours. Preoperative risk factors, intraoperative complications and complications occurring in the 30 days after surgery were recorded. Perioperative complications or death occurred in 15 of 119 patients (12.6%, exact confidence interval 7.2-19.9). None of the 45 patients who received octreotide intraoperatively experienced intraoperative complications compared with eight of the 73 patients (11.0%) who did not receive octreotide (P=0.023). The presence of carcinoid heart disease and high urinary output of 5-hydroxyindoleacetic acid preoperatively were statistically significant risk factors for perioperative complications. (+info)Surgical management of left-sided carcinoid heart disease. (5/47)
BACKGROUND: Carcinoid involvement of left-sided heart valves has been reported in patients with a patent foramen ovale, carcinoid tumor of the lung, and active carcinoid syndrome with high levels of serotonin. The present study details the clinical features and surgical management of patients with carcinoid heart disease affecting both left- and right-sided valves. METHODS AND RESULTS: Eleven patients (7 men, 4 women) with symptomatic carcinoid heart disease underwent surgery for left- and right-sided valve disease between 1989 and 1999. Mean age was 57+/-9 years, and median preoperative NYHA class was 3. All patients had metastatic carcinoid tumors and were on somatostatin analog. Of 11 patients, 5 (45%) had a patent foramen ovale; 1 of these also had a primary lung carcinoid tumor. Surgery included tricuspid valve replacement in all patients, pulmonary valve replacement in 3 and valvectomy in 7, mitral valve replacement in 6 and repair in 1, aortic valve replacement in 4 and repair in 2, CABG in 2, and patent foramen ovale closure in 5. One myocardial metastatic carcinoid tumor was removed. There were 2 perioperative deaths. At a mean follow-up of 41 months, 4 additional patients were dead. All but 1 surgical survivor initially improved >/=1 functional class. No patient required reoperation. CONCLUSIONS: Carcinoid heart disease may affect left- and right-sided valves and occurred without intracardiac shunting in 55% of this surgical series. Despite metastatic disease that limits longevity, operative survivors had improvement in functional capacity. Cardiac surgery should be considered for select patients with carcinoid heart disease affecting left- and right-sided valves. (+info)Carcinoid heart disease: successful tricuspid valve replacement. (6/47)
A woman aged 46 was found to have severe tricuspid valve disease 14 years after the diagnosis of a malignant carcinoid tumour of the ileum and 33 years after the onset of symptoms attributable to the disease. Increasing ascites requiring repeated paracentesis had not responded to chemotherapy including infusion of 5-fluorouracil and vincristine into the coeliac artery. The tricuspid valve was replaced by a Bjork-Shiley prosthesis. After operation there was no recurrence of ascites or oedema. She remains well one year and 11 months later. It is suggested that valve replacement surgery should be considered more often in patients with carcinoid heart disease. Hepatomegaly and ascites sould not be attributed too readily to advancing malignant disease without careful consideration of the role of right-sided valvar lesions in the production of these signs. (+info)Cardiovascular abnormalities in patients with a carcinoid syndrome. (7/47)
BACKGROUND: Heart failure is an important reason for morbidity and mortality in patients with carcinoid. Carcinoid heart disease is caused by increased levels of circulating serotonin. Because carcinoids also produce catecholamines, we evaluated cardiovascular manifestations of autonomic dysfunction in patients with a carcinoid syndrome. METHODS: Twenty patients with a midgut carcinoid, who had a carcinoid syndrome with a median duration of 72 months, and markedly elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion were studied. RESULTS: Ten patients had no symptoms of heart failure, i.e. New York Heart Association (NYHA) functional class I, 6 had class II, and 4 class III heart failure. Transthoracic echocardiography (TTE) showed right-sided valvular abnormalities in 13 of 19 evaluable patients (mild n=8, severe n=5). Fourteen of the 20 patients (70%) had an elevated concentration of plasma N-terminal atrial natriuretic peptide (N-ANP), which correlated with NYHA class, TTE abnormalities, and increased urinary metanephrine excretion. Heart rate variability (HRV) parameters, in particular those associated with increased sympathetic activity (low frequency power, p=0.002 versus healthy individuals), were impaired but were independent of NYHA class and TTE findings and correlated with urinary metanephrine excretion (r=-0.49, p<0.05). CONCLUSION: In these 20 carcinoid patients with substantial secretory activity of the tumour, overt cardiac morphological changes were present in a minority of patients. However, N-ANP values and HRV profile were markedly abnormal, and related to enhanced urinary excretion of catecholamine and metabolites, suggesting autonomic derangement. These abnormalities possibly herald the development of more severe cardiac dysfunction and may be indicative of the need for preventive drug treatment. (+info)Echocardiographic diagnosis in carcinoid heart disease. (8/47)
In this case report the typical echocardiographic features of carcinoid heart disease are presented. Newer treatments such as the use of a somatostatin analogue, interferon and hepatic de-arterialisation have improved the prognosis in patients with carcinoid syndrome. Nevertheless this syndrome portends a poor prognosis in patients with cardiac involvement. Cardiac lesions are mainly located in the right side of the heart. Regurgitation and stenosis of the tricuspid and pulmonary valve, leading to right heart failure, are the most common cardiac manifestations of the disease. Elevated levels of serotonin are probably responsible for the development of these cardiac lesions. Despite treatment resulting in significant reductions of urinary levels of 5-HIAA, regression of the cardiac manifestations in carcinoid syndrome has not been observed. Two-dimensional and Doppler echocardiography are the main tools to establish the diagnosis and severity of carcinoid heart disease. Cardiac surgery for carcinoid heart disease might improve symptoms and longevity, but the scarce data report on early mortality of over 35%. (+info)Carcinoid heart disease is a rare complication that occurs in some people with carcinoid tumors, which are slow-growing tumors that typically originate in the digestive tract. These tumors can release hormones and other substances into the bloodstream, which can cause various symptoms. In carcinoid heart disease, these substances cause fibrous plaques to form on the heart valves, leading to thickening and stiffening of the valve leaflets. This can result in leakage or obstruction of the heart valves, causing symptoms such as shortness of breath, fatigue, and fluid retention. Carcinoid heart disease is most commonly affects the tricuspid and pulmonary valves, which are located on the right side of the heart. If left untreated, carcinoid heart disease can lead to serious complications, including heart failure. Treatment typically involves a combination of medications to manage symptoms and control the growth of the tumor, as well as surgery to repair or replace damaged heart valves.
Malignant carcinoid syndrome is a complex of symptoms that occur in some people with malignant tumors (carcinoids) that secrete large amounts of hormone-like substances, particularly serotonin. These symptoms can include flushing of the face and upper body, diarrhea, rapid heartbeat, difficulty breathing, and abdominal pain and distention. In addition, these individuals may have chronic inflammation of the heart valves (endocarditis) leading to heart failure. It is important to note that not all people with carcinoid tumors will develop malignant carcinoid syndrome, but those who do require specific treatment for their symptoms and hormonal imbalances.
A carcinoid tumor is a type of slow-growing neuroendocrine tumor that usually originates in the digestive tract, particularly in the small intestine. These tumors can also arise in other areas such as the lungs, appendix, and rarely in other organs. Carcinoid tumors develop from cells of the diffuse endocrine system (also known as the neuroendocrine system) that are capable of producing hormones or biologically active amines.
Carcinoid tumors can produce and release various hormones and bioactive substances, such as serotonin, histamine, bradykinins, prostaglandins, and tachykinins, which can lead to a variety of symptoms. The most common syndrome associated with carcinoid tumors is the carcinoid syndrome, characterized by flushing, diarrhea, abdominal cramping, and wheezing or difficulty breathing.
Carcinoid tumors are typically classified as functional or nonfunctional based on whether they produce and secrete hormones that cause symptoms. Functional carcinoid tumors account for approximately 30% of cases and can lead to the development of carcinoid syndrome, while nonfunctional tumors do not produce significant amounts of hormones and are often asymptomatic until they grow large enough to cause local or distant complications.
Treatment options for carcinoid tumors depend on the location, size, and extent of the tumor, as well as whether it is functional or nonfunctional. Treatment may include surgery, medications (such as somatostatin analogs, chemotherapy, or targeted therapies), and radiation therapy. Regular follow-up with imaging studies and biochemical tests is essential to monitor for recurrence and assess treatment response.
Tricuspid valve stenosis is a cardiac condition characterized by the narrowing or stiffening of the tricuspid valve, which is located between the right atrium and right ventricle in the heart. This narrowing or stiffening restricts the normal flow of blood from the right atrium into the right ventricle, causing increased pressure in the right atrium and reduced blood flow to the lungs.
The tricuspid valve typically has three leaflets or cusps that open and close to regulate the flow of blood between the right atrium and right ventricle. In tricuspid valve stenosis, these leaflets become thickened, calcified, or fused together, leading to a reduced opening size and impaired function.
The most common causes of tricuspid valve stenosis include rheumatic heart disease, congenital heart defects, carcinoid syndrome, and infective endocarditis. Symptoms may include fatigue, shortness of breath, swelling in the legs and abdomen, and irregular heartbeats. Treatment options depend on the severity of the condition and underlying causes but may involve medications, surgical repair or replacement of the valve, or catheter-based procedures.
Heart valves are specialized structures in the heart that ensure unidirectional flow of blood through its chambers during the cardiac cycle. There are four heart valves: the tricuspid valve and the mitral (bicuspid) valve, located between the atria and ventricles, and the pulmonic (pulmonary) valve and aortic valve, located between the ventricles and the major blood vessels leaving the heart.
The heart valves are composed of thin flaps of tissue called leaflets or cusps, which are supported by a fibrous ring. The aortic and pulmonic valves have three cusps each, while the tricuspid and mitral valves have three and two cusps, respectively.
The heart valves open and close in response to pressure differences across them, allowing blood to flow forward into the ventricles during diastole (filling phase) and preventing backflow of blood into the atria during systole (contraction phase). A properly functioning heart valve ensures efficient pumping of blood by the heart and maintains normal blood circulation throughout the body.
Tricuspid valve insufficiency, also known as tricuspid regurgitation, is a cardiac condition in which the tricuspid valve located between the right atrium and right ventricle of the heart does not close properly, allowing blood to flow back into the right atrium during contraction of the right ventricle. This results in a portion of the blood being pumped inefficiently, which can lead to volume overload of the right side of the heart and potentially result in symptoms such as fatigue, weakness, shortness of breath, and fluid retention. The condition can be congenital or acquired, with common causes including dilated cardiomyopathy, infective endocarditis, rheumatic heart disease, and trauma.
Heart valve diseases are a group of conditions that affect the function of one or more of the heart's four valves (tricuspid, pulmonic, mitral, and aortic). These valves are responsible for controlling the direction and flow of blood through the heart. Heart valve diseases can cause the valves to become narrowed (stenosis), leaky (regurgitation or insufficiency), or improperly closed (prolapse), leading to disrupted blood flow within the heart and potentially causing symptoms such as shortness of breath, fatigue, chest pain, and irregular heart rhythms. The causes of heart valve diseases can include congenital defects, age-related degenerative changes, infections, rheumatic heart disease, and high blood pressure. Treatment options may include medications, surgical repair or replacement of the affected valve(s), or transcatheter procedures.
The tricuspid valve is the heart valve that separates the right atrium and the right ventricle in the human heart. It is called "tricuspid" because it has three leaflets or cusps, which are also referred to as flaps or segments. These cusps are named anterior, posterior, and septal. The tricuspid valve's function is to prevent the backflow of blood from the ventricle into the atrium during systole, ensuring unidirectional flow of blood through the heart.
Hydroxyindoleacetic acid (5HIAA) is a major metabolite of the neurotransmitter serotonin, formed in the body through the enzymatic degradation of serotonin by monoamine oxidase and aldehyde dehydrogenase. 5HIAA is primarily excreted in the urine and its measurement can be used as a biomarker for serotonin synthesis and metabolism in the body.
Increased levels of 5HIAA in the cerebrospinal fluid or urine may indicate conditions associated with excessive serotonin production, such as carcinoid syndrome, while decreased levels may be seen in certain neurodegenerative disorders, such as Parkinson's disease. Therefore, measuring 5HIAA levels can have diagnostic and therapeutic implications for these conditions.
The pulmonary valve, also known as the pulmonic valve, is a semilunar valve located at the exit of the right ventricle of the heart and the beginning of the pulmonary artery. It has three cusps or leaflets that prevent the backflow of blood from the pulmonary artery into the right ventricle during ventricular diastole, ensuring unidirectional flow of blood towards the lungs for oxygenation.
A bioprosthesis is a type of medical implant that is made from biological materials, such as heart valves or tendons taken from animals (xenografts) or humans (allografts). These materials are processed and sterilized to be used in surgical procedures to replace damaged or diseased tissues in the body.
Bioprosthetic implants are often used in cardiac surgery, such as heart valve replacement, because they are less likely to cause an immune response than synthetic materials. However, they may have a limited lifespan due to calcification and degeneration of the biological tissue over time. Therefore, bioprosthetic implants may need to be replaced after several years.
Bioprostheses can also be used in other types of surgical procedures, such as ligament or tendon repair, where natural tissue is needed to restore function and mobility. These prostheses are designed to mimic the properties of native tissues and provide a more physiological solution than synthetic materials.
Echocardiography is a medical procedure that uses sound waves to produce detailed images of the heart's structure, function, and motion. It is a non-invasive test that can help diagnose various heart conditions, such as valve problems, heart muscle damage, blood clots, and congenital heart defects.
During an echocardiogram, a transducer (a device that sends and receives sound waves) is placed on the chest or passed through the esophagus to obtain images of the heart. The sound waves produced by the transducer bounce off the heart structures and return to the transducer, which then converts them into electrical signals that are processed to create images of the heart.
There are several types of echocardiograms, including:
* Transthoracic echocardiography (TTE): This is the most common type of echocardiogram and involves placing the transducer on the chest.
* Transesophageal echocardiography (TEE): This type of echocardiogram involves passing a specialized transducer through the esophagus to obtain images of the heart from a closer proximity.
* Stress echocardiography: This type of echocardiogram is performed during exercise or medication-induced stress to assess how the heart functions under stress.
* Doppler echocardiography: This type of echocardiogram uses sound waves to measure blood flow and velocity in the heart and blood vessels.
Echocardiography is a valuable tool for diagnosing and managing various heart conditions, as it provides detailed information about the structure and function of the heart. It is generally safe, non-invasive, and painless, making it a popular choice for doctors and patients alike.
In medical terms, the heart is a muscular organ located in the thoracic cavity that functions as a pump to circulate blood throughout the body. It's responsible for delivering oxygen and nutrients to the tissues and removing carbon dioxide and other wastes. The human heart is divided into four chambers: two atria on the top and two ventricles on the bottom. The right side of the heart receives deoxygenated blood from the body and pumps it to the lungs, while the left side receives oxygenated blood from the lungs and pumps it out to the rest of the body. The heart's rhythmic contractions and relaxations are regulated by a complex electrical conduction system.