Carcinoid heart disease

Impact of pulmonary valve replacement in right ventricular function and remodeling

Heidi M. Connolly, Hartzell V Schaff, Charles J. Mullany, Martin D. Abel, Patricia Pellikka

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background - Carcinoid heart disease characteristically affects tricuspid (TV) and pulmonary valves (PV), and TV replacement is helpful in selected patients. There is uncertainty, however, regarding optimal surgical management of PV regurgitation. Methods and Results - We reviewed 22 patients having operation for carcinoid heart disease and compared those having TV and PV replacement (n = 12), to those who underwent TV replacement and excision of the PV (n = 10). Pre- and postoperative right ventricular (RV) size and dysfunction were assessed by consensus of 2 echocardiographers blinded to type of surgical treatment. RV dysfunction was graded as none (0), mild (1), moderate (2), or severe (3). RV size was graded as normal (0), or mild (1), moderate (2), or severe (3) enlargement. Preoperatively, RV size (2.2±0.8 [no PVR]versus 2.7±0.6 [with PVR], P=0.15), RV dysfunction (0.9±0.9 [no PVR]versus 1.4±0.7 [with PVR], P=0.14), and NYHA class were similar in the 2 groups. Postop RV size decreased inpatients with PVR, 2.7±0.6 to 1.7±1.0 (P=0.008), but did not change appreciably in those without PVR, 2.2±0.8 to 2.3±0.8 (P=0.67). There was no significant change in RV dysfunction after surgery, 1.4±0.7 to 1.8±0.9 with PVR (P=0.26) and 0.9±0.9 to 1.6±0.9 without PVR (P=0.07). Conclusions - PV replacement appears to have a beneficial effect on RV size in patients after surgery for carcinoid heart disease. This may have important implications for RV remodeling after PV replacement.

Original languageEnglish (US)
JournalCirculation
Volume106
Issue number13 SUPPL.
StatePublished - Sep 24 2002

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Carcinoid Heart Disease
Pulmonary Valve
Right Ventricular Function
Ventricular Remodeling
Right Ventricular Dysfunction
Pulmonary Valve Insufficiency
Tricuspid Valve
Uncertainty
Inpatients

Keywords

  • Carcinoid
  • Regurgitation
  • Surgery
  • Valves

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Carcinoid heart disease : Impact of pulmonary valve replacement in right ventricular function and remodeling. / Connolly, Heidi M.; Schaff, Hartzell V; Mullany, Charles J.; Abel, Martin D.; Pellikka, Patricia.

In: Circulation, Vol. 106, No. 13 SUPPL., 24.09.2002.

Research output: Contribution to journalArticle

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abstract = "Background - Carcinoid heart disease characteristically affects tricuspid (TV) and pulmonary valves (PV), and TV replacement is helpful in selected patients. There is uncertainty, however, regarding optimal surgical management of PV regurgitation. Methods and Results - We reviewed 22 patients having operation for carcinoid heart disease and compared those having TV and PV replacement (n = 12), to those who underwent TV replacement and excision of the PV (n = 10). Pre- and postoperative right ventricular (RV) size and dysfunction were assessed by consensus of 2 echocardiographers blinded to type of surgical treatment. RV dysfunction was graded as none (0), mild (1), moderate (2), or severe (3). RV size was graded as normal (0), or mild (1), moderate (2), or severe (3) enlargement. Preoperatively, RV size (2.2±0.8 [no PVR]versus 2.7±0.6 [with PVR], P=0.15), RV dysfunction (0.9±0.9 [no PVR]versus 1.4±0.7 [with PVR], P=0.14), and NYHA class were similar in the 2 groups. Postop RV size decreased inpatients with PVR, 2.7±0.6 to 1.7±1.0 (P=0.008), but did not change appreciably in those without PVR, 2.2±0.8 to 2.3±0.8 (P=0.67). There was no significant change in RV dysfunction after surgery, 1.4±0.7 to 1.8±0.9 with PVR (P=0.26) and 0.9±0.9 to 1.6±0.9 without PVR (P=0.07). Conclusions - PV replacement appears to have a beneficial effect on RV size in patients after surgery for carcinoid heart disease. This may have important implications for RV remodeling after PV replacement.",
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AB - Background - Carcinoid heart disease characteristically affects tricuspid (TV) and pulmonary valves (PV), and TV replacement is helpful in selected patients. There is uncertainty, however, regarding optimal surgical management of PV regurgitation. Methods and Results - We reviewed 22 patients having operation for carcinoid heart disease and compared those having TV and PV replacement (n = 12), to those who underwent TV replacement and excision of the PV (n = 10). Pre- and postoperative right ventricular (RV) size and dysfunction were assessed by consensus of 2 echocardiographers blinded to type of surgical treatment. RV dysfunction was graded as none (0), mild (1), moderate (2), or severe (3). RV size was graded as normal (0), or mild (1), moderate (2), or severe (3) enlargement. Preoperatively, RV size (2.2±0.8 [no PVR]versus 2.7±0.6 [with PVR], P=0.15), RV dysfunction (0.9±0.9 [no PVR]versus 1.4±0.7 [with PVR], P=0.14), and NYHA class were similar in the 2 groups. Postop RV size decreased inpatients with PVR, 2.7±0.6 to 1.7±1.0 (P=0.008), but did not change appreciably in those without PVR, 2.2±0.8 to 2.3±0.8 (P=0.67). There was no significant change in RV dysfunction after surgery, 1.4±0.7 to 1.8±0.9 with PVR (P=0.26) and 0.9±0.9 to 1.6±0.9 without PVR (P=0.07). Conclusions - PV replacement appears to have a beneficial effect on RV size in patients after surgery for carcinoid heart disease. This may have important implications for RV remodeling after PV replacement.

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