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Lookup NU author(s): Stephen Clark
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© 2018, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved. 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.
Author(s): Mujtaba SS, Clark S
Publication type: Review
Publication status: Published
Journal: Brazilian Journal of Cardiovascular Surgery
Year: 2018
Volume: 33
Issue: 4
Pages: 398-403
Online publication date: 01/07/2018
Acceptance date: 26/02/2018
ISSN (print): 0102-7638
ISSN (electronic): 1678-9741
Publisher: Sociedade Brasileira de Cirurgia Cardiovascular
URL: https://doi.org/10.21470/1678-9741-2017-0224
DOI: 10.21470/1678-9741-2017-0224
