Abstract 4369439: Concurrent Quadruple Valve Replacement and Patent Foramen Ovale Closure for Carcinoid Heart Disease

Abstract

Introduction: Carcinoid cancer is a rare neuroendocrine tumor (NET) secreting vasoactive substances. Case Presentation: A 66-year-old woman presented to cardiology clinic for evaluation of dyspnea with exertion and leg swelling. Comorbidities included chronic kidney disease and a history of jejunal neuroendocrine tumor (NET) with prior resection and recent recurrence complicated by peritoneal carcinomatosis. A transthoracic echocardiogram was obtained at time of recurrence (1 year prior to presentation) and showed mild mitral regurgitation (MR), mild bi-atrial enlargement, moderate tricuspid regurgitation (TR), and mild aortic regurgitation (AR) with preserved ejection fraction. In clinic, physical exam showed jugular venous distention with prominent V waves and a systolic and diastolic murmur. Transthoracic echocardiogram (TTE) demonstrated severe TR, moderate to severe AR, moderate MR, severe pulmonary valve regurgitation, and a right to left shunt with enlarged right ventricle and reduced function. Patient was diagnosed with left and right carcinoid heart disease involving all 4 cardiac valves in the setting of a patent foramen ovale (PFO). After multidisciplinary discussion, surgical intervention was recommended. She underwent successful cardiopulmonary bypass with mitral valve replacement, aortic valve, pulmonary valve replacement, and tricuspid valve replacement in addition to closure of PFO. She did well postoperatively and was stable for dismissal from the hospital after 12 days. Discussion: Rarely, carcinoid heart disease can involve the left side of the heart. Left sided involvement is typically seen in the presence of a right to left side cardiac shunt. In patients with severe valve dysfunction secondary to carcinoid heart syndrome, surgical intervention is the definitive treatment and has been found to improve quality of life and prolong survival