title: Failing stentless Bioprostheses in patients with carcinoid heart valve disease.
abstract: BACKGROUND
  Carcinoid tumor with consecutive endocardial fibroelastosis of the right heart, known as carcinoid heart valve disease (CHVD) or Hedinger's syndrome, is accompanied by combined right-sided valvular dysfunction with regurgitation and stenosis of the affected valves. Cardiac surgery with replacement of the tricuspid and/or pulmonary valve is an established therapeutic option for patients with Hedinger's syndrome. Little is known about the long term outcome and the choice of prosthesis for the pulmonal position is still a matter of debate.
  
  
  METHODS
  The authors report three cases of pulmonary valve replacement with stentless bioprostheses (Medtronic Freestyle, Medtronic PLC, Minneapolis, MN, USA) due to severe pulmonary valve degeneration in consequence of Hedinger's syndrome.
  
  
  RESULTS
  All patients presented with re-stenosis of the pulmonal valve conduit at the height of the anastomoses in a premature fashion. Due to the increased risk for repeat surgical valve replacement, two patients were treated by transcatheter heart valves.
  
  
  CONCLUSIONS
  We do not recommend the replacement of the pulmonary valve with stentless bioprostheses in patients with CHVD. These valves presented with an extreme premature degeneration and consecutive re-stenosis and heart failure.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. and.schaefer@uke.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schaefer
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. sill@uke.de.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Sill
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. j.schoenebeck@uke.de.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Schoenebeck
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. y.schneeberger@uke.de.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schneeberger
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. reichenspurner@uke.de.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. h.gulbins@uke.de.
authors.forename: Helmut
authors.initials: H
authors.lastname: Gulbins
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D002275:Carcinoid Heart Disease / Q000150:complications*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation