Failure of balloon dilatation of the pulmonary valve in carcinoid pulmonary stenosis.
BACKGROUND
Carcinoid heart disease typically results in pulmonary stenosis and tricuspid incompetence. Percutaneous balloon dilatation is an effective treatment for congenital pulmonary stenosis and has been applied successfully to tricuspid stenosis caused by carcinoid heart disease. The value of balloon dilatation of the pulmonary valve in carcinoid pulmonary stenosis was assessed.


METHODS
Two patients with severe congestive heart failure secondary to carcinoid heart disease and with documented pulmonary stenosis had balloon dilatation of the pulmonary valve. In both cases tricuspid regurgitation was also present together with reduced cardiac output.


RESULTS
The procedure was technically successful in both patients. One patient experienced symptomatic benefit for two months and the other experienced no improvement. Both patients subsequently required combined tricuspid and pulmonary valve replacement from which good results and symptomatic improvement were obtained.


CONCLUSIONS
Though balloon dilatation of the pulmonary valve is technically feasible it is unlikely to provide useful palliation in carcinoid heart disease. Valve surgery should be considered in patients in whom the malignancy is controlled but carcinoid heart disease is producing drug resistant congestive heart failure.
Grant
S C
SC
Wythenshawe Hospital, Manchester.
Scarffe
J H
JH
Levy
R D
RD
Brooks
N H
NH
D002275:Carcinoid Heart Disease / Q000150:complications*; D002404:Catheterization; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011666:Pulmonary Valve Stenosis / Q000209:etiology / Q000628:therapy*; D014262:Tricuspid Valve Insufficiency / Q000209:etiology