Surgical management of left-sided carcinoid heart disease

H. M. Connolly, Hartzell V Schaff, C. J. Mullany, J. Rubin, M. D. Abel, Patricia Pellikka

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Background - Carcinoid involvement of left-sided heart valves has been reported in patients with a patent foramen ovale, carcinoid tumor of the lung, and active carcinoid syndrome with high levels of serotonin. The present study details the clinical features and surgical management of patients with carcinoid heart disease affecting both left- and right-sided valves. Methods and Results - Eleven patients (7 men, 4 women) with symptomatic carcinoid heart disease underwent surgery for left- and right-sided valve disease between 1989 and 1999. Mean age was 57±9 years, and median preoperative NYHA class was 3. All patients had metastatic carcinoid tumors and were on somatostatin analog. Of 11 patients, 5 (45%) had a patent foramen ovale; I of these also had a primary lung carcinoid tumor. Surgery included tricuspid valve replacement in all patients, pulmonary valve replacement in 3 and valvectomy in 7, mitral valve replacement in 6 and repair in 1, aortic valve replacement in 4 and repair in 2, CABG in 2, and patent foramen ovale closure in 5. One myocardial metastatic carcinoid tumor was removed. There were 2 perioperative deaths. At a mean follow-up of 41 months, 4 additional patients were dead. All but 1 surgical survivor initially improved ≥1 functional class. No patient required reoperation. Conclusions - Carcinoid heart disease may affect left and right-sided valves and occurred without intracardiac shunting in 55% of this surgical series. Despite metastatic disease that limits longevity, operative survivors had improvement in functional capacity. Cardiac surgery should be considered for select patients with carcinoid heart disease affecting left-and right-sided valves.

Original languageEnglish (US)
JournalCirculation
Volume104
Issue numberSUPPL. 1
StatePublished - Sep 18 2001

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Carcinoid Heart Disease
Carcinoid Tumor
Patent Foramen Ovale
Survivors
Pulmonary Valve
Lung
Tricuspid Valve
Heart Valves
Somatostatin
Aortic Valve
Mitral Valve
Reoperation
Thoracic Surgery
Serotonin

Keywords

  • Carcinoid
  • Surgery
  • Valves

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Connolly, H. M., Schaff, H. V., Mullany, C. J., Rubin, J., Abel, M. D., & Pellikka, P. (2001). Surgical management of left-sided carcinoid heart disease. Circulation, 104(SUPPL. 1).

Surgical management of left-sided carcinoid heart disease. / Connolly, H. M.; Schaff, Hartzell V; Mullany, C. J.; Rubin, J.; Abel, M. D.; Pellikka, Patricia.

In: Circulation, Vol. 104, No. SUPPL. 1, 18.09.2001.

Research output: Contribution to journalArticle

Connolly, HM, Schaff, HV, Mullany, CJ, Rubin, J, Abel, MD & Pellikka, P 2001, 'Surgical management of left-sided carcinoid heart disease', Circulation, vol. 104, no. SUPPL. 1.
Connolly HM, Schaff HV, Mullany CJ, Rubin J, Abel MD, Pellikka P. Surgical management of left-sided carcinoid heart disease. Circulation. 2001 Sep 18;104(SUPPL. 1).
Connolly, H. M. ; Schaff, Hartzell V ; Mullany, C. J. ; Rubin, J. ; Abel, M. D. ; Pellikka, Patricia. / Surgical management of left-sided carcinoid heart disease. In: Circulation. 2001 ; Vol. 104, No. SUPPL. 1.
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abstract = "Background - Carcinoid involvement of left-sided heart valves has been reported in patients with a patent foramen ovale, carcinoid tumor of the lung, and active carcinoid syndrome with high levels of serotonin. The present study details the clinical features and surgical management of patients with carcinoid heart disease affecting both left- and right-sided valves. Methods and Results - Eleven patients (7 men, 4 women) with symptomatic carcinoid heart disease underwent surgery for left- and right-sided valve disease between 1989 and 1999. Mean age was 57±9 years, and median preoperative NYHA class was 3. All patients had metastatic carcinoid tumors and were on somatostatin analog. Of 11 patients, 5 (45{\%}) had a patent foramen ovale; I of these also had a primary lung carcinoid tumor. Surgery included tricuspid valve replacement in all patients, pulmonary valve replacement in 3 and valvectomy in 7, mitral valve replacement in 6 and repair in 1, aortic valve replacement in 4 and repair in 2, CABG in 2, and patent foramen ovale closure in 5. One myocardial metastatic carcinoid tumor was removed. There were 2 perioperative deaths. At a mean follow-up of 41 months, 4 additional patients were dead. All but 1 surgical survivor initially improved ≥1 functional class. No patient required reoperation. Conclusions - Carcinoid heart disease may affect left and right-sided valves and occurred without intracardiac shunting in 55{\%} of this surgical series. Despite metastatic disease that limits longevity, operative survivors had improvement in functional capacity. Cardiac surgery should be considered for select patients with carcinoid heart disease affecting left-and right-sided valves.",
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AB - Background - Carcinoid involvement of left-sided heart valves has been reported in patients with a patent foramen ovale, carcinoid tumor of the lung, and active carcinoid syndrome with high levels of serotonin. The present study details the clinical features and surgical management of patients with carcinoid heart disease affecting both left- and right-sided valves. Methods and Results - Eleven patients (7 men, 4 women) with symptomatic carcinoid heart disease underwent surgery for left- and right-sided valve disease between 1989 and 1999. Mean age was 57±9 years, and median preoperative NYHA class was 3. All patients had metastatic carcinoid tumors and were on somatostatin analog. Of 11 patients, 5 (45%) had a patent foramen ovale; I of these also had a primary lung carcinoid tumor. Surgery included tricuspid valve replacement in all patients, pulmonary valve replacement in 3 and valvectomy in 7, mitral valve replacement in 6 and repair in 1, aortic valve replacement in 4 and repair in 2, CABG in 2, and patent foramen ovale closure in 5. One myocardial metastatic carcinoid tumor was removed. There were 2 perioperative deaths. At a mean follow-up of 41 months, 4 additional patients were dead. All but 1 surgical survivor initially improved ≥1 functional class. No patient required reoperation. Conclusions - Carcinoid heart disease may affect left and right-sided valves and occurred without intracardiac shunting in 55% of this surgical series. Despite metastatic disease that limits longevity, operative survivors had improvement in functional capacity. Cardiac surgery should be considered for select patients with carcinoid heart disease affecting left-and right-sided valves.

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