title: Successful surgical treatment of protein-losing enteropathy complicating rheumatic tricuspid regurgitation.
abstract: Protein-losing enteropathy may uncommonly complicate cardiac disease. While well described as a complication for patients having undergone previous Fontan surgery for congenital heart disease, pericardial and valvular aetiologies are much less frequent. We report a 35-year-old female presenting with marked hypoalbuminaemia and peripheral oedema on a background of known rheumatic valvular heart disease. After extensive investigation for gastrointestinal, hepatic and renal causes of protein loss, echocardiography demonstrated severe tricuspid valve incompetence. Subsequent invasive testing confirmed severe tricuspid valve regurgitation in the absence of pericardial constriction. The patient proceeded to tricuspid valve repair with resolution of the protein-losing state and correction of hypoalbuminaemia. While cardiac causes of gastrointestinal protein loss are uncommon, they should be considered when initial diagnostic work up is negative. The importance of correction of haemodynamic precipitants of protein-losing enteropathy is also discussed.
authors.affiliation: Cardiovascular Unit, John Hunter Hospital, New Lambton, NSW 2305, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Hiew
authors.forename: N
authors.initials: N
authors.lastname: Collins
authors.forename: A
authors.initials: A
authors.lastname: Foy
authors.forename: D
authors.initials: D
authors.lastname: Thomson
authors.forename: B
authors.initials: B
authors.lastname: Bastian
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging; D006801:Humans; D011504:Protein-Losing Enteropathies / Q000150:complications* / Q000175:diagnosis; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*