title: Clues to diagnosing carcinoid heart disease as the cause of isolated right-sided heart failure.
abstract: Described herein is a 67-year-old woman who underwent replacement of both tricuspid and pulmonic valves because of severe isolated right-sided systolic heart failure. The cause of the heart failure preoperatively was believed to be the result of left breast radiation a year earlier. At operation, however, the pulmonic valve was excised and a biopsy of the stiff-walled right atrium was performed, and histologic examination of each was classic of carcinoid heart disease. She never awoke postoperatively. Postoperatively, computed tomography disclosed numerous masses in the liver. Retrospectively, clues to the presence of carcinoid heart disease include thickening of both the tricuspid and pulmonic valve leaflets by echocardiogram, a pressure gradient, albeit small, across the pulmonic valve, the plastering of the septal tricuspid-valve leaflet to the ventricular septum, the total absence of left-sided heart disease, and the presence of extremely low 12-lead QRS electrocardiographic voltage.
authors.affiliation: Second Year, Georgetown University School of Medicine, Washington, DC; The Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
authors.forename: Carey Camille
authors.initials: CC
authors.lastname: Roberts
authors.affiliation: The Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Dallas, Texas.
authors.forename: Rohit J
authors.initials: RJ
authors.lastname: Parmar
authors.affiliation: The Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Dallas, Texas.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grayburn
authors.affiliation: The Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Dallas, Texas.
authors.forename: Gautam R
authors.initials: GR
authors.lastname: Patankar
authors.affiliation: The Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
authors.forename: Jong Mi
authors.initials: JM
authors.lastname: Ko
authors.affiliation: Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas.
authors.forename: Baron L
authors.initials: BL
authors.lastname: Hamman
authors.affiliation: The Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Dallas, Texas. Electronic address: wc.roberts@baylorhealth.edu.
authors.forename: William Clifford
authors.initials: WC
authors.lastname: Roberts
mesh_terms: D000368:Aged; D002275:Carcinoid Heart Disease / Q000150:complications / Q000175:diagnosis*; D006328:Cardiac Catheterization / Q000379:methods*; D003914:Dextrocardia / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D014057:Tomography, X-Ray Computed / Q000379:methods*