title: Features of carcinoid heart disease identified by 2- and 3-dimensional echocardiography and cardiac MRI.
abstract: BACKGROUND
  Carcinoid heart disease is a rare form of valvular heart disease. We sought describe the spectrum of carcinoid heart disease identified by echocardiography and cardiac MRI.
  
  
  RESULTS
  Two hundred fifty-two patients with carcinoid syndrome underwent a range of investigations including 2D transthoracic echocardiography, 3D transthoracic echocardiography and transesophageal echocardiography, and cardiac MRI. Fifty-two patients had evidence of carcinoid heart disease. Involvement of the tricuspid, pulmonary, mitral, and aortic valves were found in 47 (90%), 36 (69%), 15 (29%), and 14 (27%), respectively. Myocardial metastases were found in 2 (3.8%) patients. Several patterns of disease were identified depending on the extent and severity to which each leaflet and its associated subvalvular apparatus was affected. Thirteen of 15 (87%) patients with left-sided carcinoid involvement had a patent foramen ovale. Three patients with severe degree of shunting had severe valvular regurgitation. Patients with mild/moderate degree of shunting had mild or moderate valvular regurgitation. Three-dimensional transthoracic echocardiography/transesophageal echocardiography provided detailed anatomic information particularly for the tricuspid and pulmonary valves. Cardiac MRI allowed complementary assessment of valvular heart disease and delineation of myocardial metastases. Gallium-68 octreotide positron emission tomography identified neuroendocrine metastases.
  
  
  CONCLUSIONS
  Carcinoid heart disease is a heterogeneous disease with a wide spectrum of echocardiographic findings. A multimodality approach is needed in patients with this complex pathology.
authors.affiliation: Department of Cardiology, Carcinoid Heart Disease Clinic, Royal Free Hospital, London, United Kingdom.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhattacharyya
authors.forename: Christos
authors.initials: C
authors.lastname: Toumpanakis
authors.forename: Margaret
authors.initials: M
authors.lastname: Burke
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Martyn E
authors.initials: ME
authors.lastname: Caplin
authors.forename: Joseph
authors.initials: J
authors.lastname: Davar
mesh_terms: D000368:Aged; D002275:Carcinoid Heart Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D006351:Heart Valves / Q000000981:diagnostic imaging / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index