Case of calcific tricuspid and pulmonary valve stenosis

Isolated right-sided valvular disease is a much less recognised entity when compared with left-sided valvular heart disease. Almost all the cases of combined pulmonary valve with tricuspid valve involvement are a consequence of underlying carcinoid heart disease. Moreover, severe calcification of tricuspid valve is an extremely unusual finding. We report a case of a severe calcific tricuspid valve stenosis along with severe pulmonary valve stenosis where the exact aetiology could not be established. On reviewing the literature, we did not find any reports describing such a morphology.

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Heart Valve Disease

10.1093/med/9780198713623.003.0007 ◽

2016 ◽

Author(s):

Patrizio Lancellotti ◽

Bernard Cosyns

Keyword(s):

Heart Disease ◽

Valvular Heart Disease ◽

Poor Prognosis ◽

Pulmonary Valve ◽

Transoesophageal Echocardiography ◽

Heart Valve Disease ◽

Valvular Regurgitation ◽

Pulmonary Valve Stenosis ◽

Valve Repair ◽

Embolic Risk

Echocardiography plays a major role in the evaluation, monitoring and decision making of patients with valvular heart disease. This chapter examines the aetiologies, haemodynamic measurements, and various consequences in aortic, mitral and pulmonary valve stenosis. It also describes how to assess patients with valvular regurgitation (mitral, aortic and pulmonary), valvular prosthesis and definite or suspected infective endocarditis. For each condition, echocardiographic features of poor prognosis, including complications, embolic risk, and the timing for surgery are discussed. Indications for transoesophageal echocardiography and 3D echocardiography are highlighted, especially when a decision of valve repair is envisioned. The timing echocardiographic monitoring of patients with valvular heart disease is also described.

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1640 Pulmonary valve in carcinoid disease: be suspicious of functional assessment

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1030 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A L Gamarra Lobato ◽

A M Rojas ◽

A Cecconi ◽

L Dominguez ◽

A Benedicto ◽

...

Keyword(s):

Heart Disease ◽

Right Ventricle ◽

Tricuspid Valve ◽

Functional Assessment ◽

Carcinoid Syndrome ◽

Pulmonary Valve ◽

Previous History ◽

Pulmonary Regurgitation ◽

Lower Limbs ◽

Carcinoid Heart Disease

Abstract Carcinoid heart disease occurs in 50% of patients with carcinoid syndrome, especially on serotonin-secreting neuroendocrine tumors (NET) [1, 2]. Carcinoid heart disease"s typical findings are carcinoid plaques, composed of smooth muscle, myofibroblasts and endothelium. These plaques, most frequently localized on the right side valvular cusps and leaflets, produce fixation and retraction, causing regurgitation and/or stenosis [3, 4, 5]. Left-sided heart disease is rare (<10%), as serotonin is purified in the pulmonary circulation [3, 6, 7]. We present the case of a 67 year old female patient with previous history of right ovarian NET. She presented with dyspnea (II-III NYHA functional class), and slight edema in lower limbs. She denied symptoms of carcinoid syndrome before or after the ovarian surgery. Examination showed an increased jugular venous pulse. Transthoracic echocardiography (TTE) showed severely dilated right cavities and a rigid, immobile tricuspid valve, with massive tricuspid regurgitation (Panel A, 1). Anatomy of pulmonary valve was not properly visualized but jet area of pulmonary regurgitation was small (Panel A, 2). Left cavities and valves were intact. As TTE was not anatomically conclusive, a cardiac magnetic resonance (CMR) and a cardiac computed tomography (CCT) were performed to assess the carcinoid involvement of pulmonary valve. CMR showed severely dilated right ventricle with mild impairment of systolic function (Panel A, 3). Based on phase contrast imaging, pulmonary regurgitation fraction was 14%, suggestive of a mild grade. However, CCT showed a diffuse thickening of the pulmonary valve, with complete opening during diastole (Panel A, 4, arrowhead). Finally, the patient underwent replacement of tricuspid valve and pulmonary valve for biological prosthesis without complications. Our case is remarkable because it highlights the limitations of the functional assessment of pulmonary regurgitation in the presence of a concomitant massive tricuspid valve regurgitation, since the rapid equalization of pressure between pulmonary artery and right ventricle reduces the expression of pulmonary regurgitation. For these reason, the anatomic assessment of the pulmonary valve is mandatory to stage the involvement of pulmonary valve in carcinoid disease. Abstract 1640 Figure. Panel A

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Transcatheter Pulmonary Valve Replacement in a Carcinoid Heart

Texas Heart Institute Journal ◽

10.14503/thij-15-5310 ◽

2016 ◽

Vol 43 (4) ◽

pp. 341-344 ◽

Cited By ~ 13

Author(s):

Pranav Loyalka ◽

Michael Schechter ◽

Angelo Nascimbene ◽

Ajay Sundara Raman ◽

Cezar A. Ilieascu ◽

...

Keyword(s):

Heart Disease ◽

Valve Replacement ◽

Pulmonary Valve ◽

Open Heart Surgery ◽

Pulmonary Valve Replacement ◽

Carcinoid Heart Disease ◽

Pulmonary Valve Stenosis ◽

Percutaneous Valve Replacement ◽

Surgical Valve Replacement ◽

Percutaneous Valve

Carcinoid heart disease presents as right-sided heart failure attributable to the dysfunction of the tricuspid and pulmonary valves. Although surgical valve replacement is the mainstay of treatment when patients become symptomatic, it is associated with substantial perioperative mortality rates. We present a case of severe pulmonary valve stenosis secondary to carcinoid heart disease, treated successfully with percutaneous valve replacement. A 67-year-old man with severe pulmonary valve stenosis was referred to our center for pulmonary valve replacement. The patient had a history of metastatic neuroendocrine tumor of the small bowel with carcinoid syndrome, carcinoid heart disease, and tricuspid valve regurgitation previously treated with surgical valve replacement. Because of the patient's severe chronic obstructive pulmonary disease and hostile chest anatomy seen on a computed tomographic scan dating from previous cardiothoracic surgery, we considered off-label percutaneous valve replacement a viable alternative to open-heart surgery. A 29-mm Edwards Sapien XT valve was successfully deployed over the native pulmonary valve. There were no adverse sequelae after the procedure, and the patient was discharged from the hospital the next day. This case report shows that percutaneous valve replacement can be a valid option in carcinoid heart disease patients who are not amenable to surgical valve replacement.

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Bioprosthetic tricuspid valve stenosis associated with extensive plaque deposition in carcinoid heart disease

American Heart Journal ◽

10.1016/0002-8703(91)90045-j ◽

1991 ◽

Vol 121 (6) ◽

pp. 1835-1838 ◽

Cited By ~ 30

Author(s):

Paul M Ridker ◽

Glenn M Chertow ◽

Elizabeth W Karlson ◽

Andrew S Neish ◽

Frederick J Schoen

Keyword(s):

Heart Disease ◽

Tricuspid Valve ◽

Carcinoid Heart Disease ◽

Plaque Deposition ◽

Tricuspid Valve Stenosis

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Carcinoid tumor with carcinoid heart disease: Tricuspid valve and pulmonary valve replacement in patients with Hedinger Syndrome and hepatic metastases

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297880 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

F Hahnel ◽

H Gulbins ◽

S Blankenberg ◽

H Reichenspurner

Keyword(s):

Heart Disease ◽

Valve Replacement ◽

Carcinoid Tumor ◽

Tricuspid Valve ◽

Pulmonary Valve ◽

Hepatic Metastases ◽

Pulmonary Valve Replacement ◽

Carcinoid Heart Disease

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Valve imaging

Cardiovascular Computed Tomography ◽

10.1093/med/9780198809272.003.0021 ◽

2019 ◽

pp. 313-350

Keyword(s):

Heart Disease ◽

Aortic Valve ◽

Tricuspid Valve ◽

Aortic Valve Stenosis ◽

Valvular Heart Disease ◽

Cardiac Ct ◽

Pulmonary Valve ◽

Prosthetic Valves ◽

Complementary Role

Cardiac CT is not the first nor the most frequently applied imaging technique in patients with suspected or established valvular heart disease. It has a complementary role in the management of valvular heart disease in specific situations. This chapter covers the role of cardiac CT, including scan protocols, limitations, and challenges, the mitral and aortic valve, stenosis, regurgitation, the tricuspid valve, pulmonary valve, and prosthetic valves.

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Carcinoid Heart Disease without Severe Tricuspid Valve Involvement

Cardiology ◽

10.1159/000441488 ◽

2015 ◽

Vol 133 (4) ◽

pp. 217-222 ◽

Cited By ~ 3

Author(s):

Ammar M. Killu ◽

Darrell B. Newman ◽

William R. Miranda ◽

Joseph J. Maleszewski ◽

Patricia Pellikka ◽

...

Keyword(s):

Heart Disease ◽

Liver Metastases ◽

Tricuspid Valve ◽

Valvular Heart Disease ◽

Carcinoid Syndrome ◽

The Other ◽

Valve Disease ◽

Carcinoid Heart Disease ◽

Rare Form

Carcinoid syndrome causes a rare form of acquired valvular heart disease which typically occurs in the setting of liver metastases. In carcinoid-induced valvular heart disease, the tricuspid valve is almost universally affected; left-sided valve disease occurs infrequently in affected patients. Herein, we report 2 cases of carcinoid-induced valvular heart disease; one case had no evidence of tricuspid valve involvement despite severe involvement of all other valves, while the other case was without severe tricuspid valve involvement.

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Valvular heart disease in autoimmune diseases in Mexico

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.071 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

J Aceituno Melgar ◽

JF Fritche-Salazar ◽

ME Soto-Lopez

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Aortic Valve ◽

Aortic Stenosis ◽

Autoimmune Diseases ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Valvular Heart Disease ◽

Valve Disease ◽

Calcium Deposit

Abstract Funding Acknowledgements Type of funding sources: None. Background The autoimmune diseases (AD) have high morbidity and mortality due to their affection to the heart. Purpose Our objective was to describe the valvular heart disease (VHD) in patients with AD. Methods Patients with systemic lupus erythematous (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SS) diagnosis were included, from January 1st 2008 to December 31th 2018. Prevalence rates of valve involvement were calculated. Results A total of 163 patients (57.6% with SLE, 23.3% with RA, 19.0% with SS) were included. The global prevalence of VHD was 5.4% in SLS, 23.6% en RA, and 15.9% in SS. The more affected valve in SLS was the tricuspid valve in 24% (12% with severe tricuspid regurgitation (STR), p = 0.028), in RA was the aortic valve in 26% (13% with severe aortic stenosis (SAS), p = 0.02), and with SS was the tricuspid valve in 48% (29% with moderate tricuspid regurgitation (MTR)). The calcium deposit was present in 66% in RA (37% in aortic valve, p < 0.001). The valve thickening (>5 mm) was higher in RA (50%, p < 0.001), with predominance in mitral valve (26%). Conclusions We found significant higher rates of STR in SLE, SAS in RA, and MTR in SS compared with the literature. Moreover, calcification and valve thickening were found more often in RA. Early diagnosis of subclinical VHD is mandatory to improve the long-term prognosis of these patients. Valvular heart disease. Autoimmune Disease (n = 163) P value* SLE (n = 94) RA (n = 38) ES (n = 31) Demographic characteristics Age, years. Gender, Male / Female, n Body Mass Index (kg/m2) Arterial hypertension, n (%) Diabetes Mellitus, n (%) 38.8 (12.6) 9/85 26.2 (5.9) 21(22.3%) 6 (6.3%) 62.45 (12.3) 7/31 26.6 (7.1) 14(36.8%) 4 (10.5%) 53.8 (13.3) 2/29 25.4 (4.7) 12 (38.7) 5 (16.1%) <0.001 NS NS NS NS Echocardiographic findings. Valve thickening Aortic Mitral 8 (9%) 1 (1%) 7 (7%) 19 (50%) 9 (24%) 10 (26%) 1 (3%) 0 1 (3%) <0.001 Calcium Deposit Aortic Mitral 4 (4%) 2 (2%) 2 (2%) 25 (66%) 14 (37%) 11 (29%) 8 (26%) 4 (12.8%) 4 (12.9%) <0.001 Aortic valve disease 4 (4%) 10 (26%) 0 Aortic stenosis Moderate Severe 0 0 0 7 (18%) 2 (5%) 5 (13%) 0 0 0 0,02 Moderate Aortic Regurgitation 4 (4%) 3 (8%) 0 NS Mitral valve disease 8 (9%) 2 (5%) 2 (6%) Mitral stenosis Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Mitral Regurgitation Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Tricuspid Regurgitation Moderate Severe 22 (24%) 11 (12%) 11 (12%) 8 (21%) 7 (18%) 1 (3%) 15 (48%) 9 (29%) 6 (19%) 0,028 Pulmonic valve disease Moderate Pulmonic Stenosis Moderate Pulmonic Regurgitation 6 (6%) 1 (1%) 5 (5%) 1 (3%) 0 1 (3%) 0 0 0 NS * Not Significant.

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