RESUMO
Abstract Introduction: Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature. Methods: All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours. Results: Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases. Conclusion: Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement.
Assuntos
Humanos , Doença Cardíaca Carcinoide/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Doenças das Valvas Cardíacas/cirurgia , Bioprótese , Índice de Gravidade de Doença , Próteses Valvulares Cardíacas , Doença Cardíaca Carcinoide/diagnóstico por imagem , Ecocardiografia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagemRESUMO
Carcinoid is a rare neuroendocrine tumor typically arising in the gastrointestinal tract that can cause heart valve involvement. We report two patients with carcinoid syndrome and tricuspid/pulmonary valve lesions. A 33-year-old male presenting with fatigue and weight loss: A tumor in the tail of the pancreas was found on an abdominal CAT scan. The percutaneous biopsy was informed as a carcinoid tumor. A trans-esophageal echocardiogram showed a tricuspid and pulmonary valve involvement, which was replaced surgically. The biopsy informed an extensive fibrous and myxoid degeneration of the valves. A 35-year-old male with a carcinoid syndrome and cardiac failure: An echocardiogram showed a severe tricuspid stenosis and severe pulmonary regurgitation. The patient was subjected to a double surgical valve replacement. The pathology report of the excised valve showed a deforming fibrous and myxoid valvulopathy.
Assuntos
Adulto , Humanos , Masculino , Doença Cardíaca Carcinoide/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Valva Pulmonar , Valva Tricúspide , Doença Cardíaca Carcinoide/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Pulmonar/cirurgia , Valva Tricúspide/cirurgiaRESUMO
O comprometimento cardíaco na síndrome carcinoide ocorre em 50% dos pacientes, sendo o ecocardiograma um importante meio diagnóstico da doença. Os achados de exame físico podem passar despercebidos, como o sopro tricúspide e pulmonar, em virtude dabaixa pressão no território pulmonar. Apesar de alguns casos responderem bem aos análogos da somastotina, como o octeotride, a doença cardíaca evolui, inexoravelmente, para insuficiência cardíaca, sendo a indicação cirúrgica uma opção para determinados casos.