Clues to Diagnosing Carcinoid Heart Disease as the Cause of Isolated Right-Sided Heart Failure

• Published in: The American journal of cardiology Vol. 114; no. 10; pp. 1623 - 1626
• Main Authors: Roberts, Carey Camille, BS, Parmar, Rohit J., MD, Grayburn, Paul A., MD, Patankar, Gautam R., MD, Ko, Jong Mi, BA, Hamman, Baron L., MD, Roberts, William Clifford, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.11.2014; Elsevier Limited
• Subjects: Aged; Carcinoid Heart Disease - complications; Carcinoid Heart Disease - diagnosis; Cardiac Catheterization - methods; Cardiology; Cardiomyopathy; Cardiovascular; Cardiovascular disease; Dextrocardia - complications; Dextrocardia - diagnosis; Diagnosis, Differential; Echocardiography, Transesophageal - methods; Electrocardiography; Female; Follow-Up Studies; Heart attacks; Heart failure; Heart Failure - diagnosis; Heart Failure - etiology; Humans; Postoperative period; Pulmonary arteries; Pulmonary hypertension; Tomography, X-Ray Computed - methods; Ultrasonic imaging
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2014.08.005

Described herein is a 67-year-old woman who underwent replacement of both tricuspid and pulmonic valves because of severe isolated right-sided systolic heart failure. The cause of the heart failure preoperatively was believed to be the result of left breast radiation a year earlier. At operation, however, the pulmonic valve was excised and a biopsy of the stiff-walled right atrium was performed, and histologic examination of each was classic of carcinoid heart disease. She never awoke postoperatively. Postoperatively, computed tomography disclosed numerous masses in the liver. Retrospectively, clues to the presence of carcinoid heart disease include thickening of both the tricuspid and pulmonic valve leaflets by echocardiogram, a pressure gradient, albeit small, across the pulmonic valve, the plastering of the septal tricuspid-valve leaflet to the ventricular septum, the total absence of left-sided heart disease, and the presence of extremely low 12-lead QRS electrocardiographic voltage.