Carcinoid Heart Disease with Right to Left Shunt across a Patent Foramen Ovale: A Case Report and Review of Literature

2014 ◽  
Vol 32 (1) ◽  
pp. 165-169 ◽  
Author(s):  
Mohammed Andaleeb Chowdhury ◽  
Mohammed Taleb ◽  
Mashhood Ajaz Kakroo ◽  
Jodi Tinkel
Keyword(s):  
Heart Disease ◽  
Case Report ◽  
Patent Foramen Ovale ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale ◽  
Review Of Literature

scholarly journals Flow-driven right-to-left cardiac shunting in a patient with carcinoid heart disease and patent foramen ovale without elevated right atrial pressure: a case report and literature review

2020 ◽  
Author(s):  
Parinita Dherange ◽  
Nelson Telles ◽  
Kalgi Modi
Keyword(s):  
Heart Disease ◽  
Patent Foramen Ovale ◽  
Atrial Septum ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale ◽  
Arterial Blood

Abstract Background Carcinoid heart disease is present in approximately 20% of the patients with carcinoid syndrome and is associated with poor prognosis. It usually manifests with right-sided valvular involvement including tricuspid insufficiency and pulmonary stenosis. Patent foramen ovale (PFO) is present in approximately 50% of the patients with carcinoid heart disease which is twice higher than the general population. Right-to-left shunting through a PFO can occur either due to higher right atrial pressure than left (pressure-driven) or when the venous flow is directed towards the PFO (flow-driven) in the setting of normal intracardiac pressures. We report a rare case of flow-driven right-to-left atrial shunting via PFO in a patient with carcinoid heart disease. Case summary A 54-year-old male with a metastatic neuroendocrine tumour to liver presented with progressive shortness of breath for 5 months. Patient was found to be hypoxic with oxygen saturation of 78% and examination revealed a holosystolic murmur. Arterial blood gas showed oxygen tension of 43 mmHg. A transthoracic and transoesophageal echocardiogram showed aneurysmal inter-atrial septum with a PFO, severe tricuspid regurgitation directed anteriorly towards the inter-atrial septum leading to a marked right-to-left shunt. Right heart catheterization showed right atrial pressure of 8 mmHg, mean pulmonary artery pressure of 12 mmHg, and normal oxygen saturations in the right atrium, right ventricle, and pulmonary arteries. The patient then underwent closure of the PFO along with tricuspid valve and pulmonary valve replacement at an experienced cardiovascular surgical centre and has been asymptomatic since. Conclusion Right-to-left shunting through a PFO in patients with normal right atrial pressure can be successfully treated with closure of the PFO. Thus, understanding the mechanism of intracardiac shunts is important to accurately diagnose and treat this rare and fatal condition.

scholarly journals 878 Patent foramen ovale: a new factor associated with progression of right and left carcinoid heart disease

2003 ◽  
Vol 4 ◽  
pp. S110
Author(s):  
N MANSENCAL ◽  
F DIGNE ◽  
E MITRY ◽  
J FORISSIER ◽  
T JOSEPH ◽  
...  
Keyword(s):  
Heart Disease ◽  
Patent Foramen Ovale ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale

scholarly journals 1030-140 Patent foramen ovale: A new factor associated with progression of carcinoid heart disease

2004 ◽  
Vol 43 (5) ◽  
pp. A429
Author(s):  
Nicolas Mansencal ◽  
Emmanuel Mitry ◽  
Franck Digne ◽  
Jean-François Forissier ◽  
Thierry Joseph ◽  
...  
Keyword(s):  
Heart Disease ◽  
Patent Foramen Ovale ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale

Prevalence of Patent Foramen Ovale and Usefulness of Percutaneous Closure Device in Carcinoid Heart Disease

2008 ◽  
Vol 101 (7) ◽  
pp. 1035-1038 ◽  
Author(s):  
Nicolas Mansencal ◽  
Emmanuel Mitry ◽  
Rémy Pillière ◽  
Céline Lepère ◽  
Benoît Gérardin ◽  
...  
Keyword(s):  
Heart Disease ◽  
Patent Foramen Ovale ◽  
Percutaneous Closure ◽  
Closure Device ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale

scholarly journals Carcinoid heart disease of gonadal primary presenting with hypoxia: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Ronan O’Driscoll ◽  
Abhisheik Prashar ◽  
George Youssef ◽  
Mark Sader
Keyword(s):  
Heart Disease ◽  
Patent Foramen Ovale ◽  
Neuroendocrine Tumour ◽  
Carcinoid Tumour ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale ◽  
The Right ◽  
Metastatic Neuroendocrine Tumour

Abstract Background Carcinoid heart disease is a potential sequela of metastatic neuroendocrine tumour that has characteristic valve appearances. Patients can present with symptoms of carcinoid syndrome or be relatively asymptomatic until symptoms of progressive heart failure manifest. Case summary We present a case of a 54-year-old male who was admitted to the hospital for investigation of hypoxia. Transthoracic echocardiogram was suggestive of carcinoid heart disease which subsequently led to a diagnosis of metastatic neuroendocrine (carcinoid) tumour of the testicular primary. Work-up revealed a patent foramen ovale with evidence of the right to left interatrial shunt from severe tricuspid regurgitation as the cause of his hypoxia. Prior to surgical excision of the primary tumour, percutaneous patent foramen ovale closure was performed resulting in improved arterial oxygen saturation and symptomatic improvement. Discussion Carcinoid heart disease typically affects the right-sided cardiac valves and the tricuspid valve appearances were critical in leading to a diagnosis of a metastatic neuroendocrine tumour in our patient. This case demonstrates that percutaneous patent foramen ovale closure can be an effective intervention for hypoxia in those not managed surgically. A high index of suspicion should be maintained for gonadal primary carcinoid tumour when there is carcinoid heart disease in the absence of liver metastases.

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