title: Staged Catheter-Based Valve Treatment of Severe Carcinoid Heart Disease.
abstract: OBJECTIVE
  Carcinoid heart disease (CHD) with severe valve destruction represents the major cause of high morbidity and mortality in patients with carcinoid syndrome. In this paper, we present a novel interventional treatment approach and report the first clinical result achieved in a patient with extensive CHD.
  
  
  RESULTS
  A woman with an ileal neuroendocrine tumour (G2, Ki67: 5%) presented with severe CHD (NYHA IV) affecting both the pulmonary and the tricuspid valve. First, a balloon-expandable 23-mm Edwards SAPIEN™ was successfully implanted percutaneously into the pulmonary valve. Since no catheter-based techniques were available for the replacement of the native tricuspid valve, we implanted an Edwards SAPIEN 26-mm valve into the vena cava inferior between the right atrium and the ostium of the hepatic veins to reduce abdominal congestion. The implantation was technically successful and completely prevented regurgitation into the vena cava inferior and abdominal veins. After this procedure, the patient's clinical condition improved significantly, and she achieved near-normal exercise tolerance (VO2 max: 24.4 ml O2/kg/min, NYHA II).
  
  
  CONCLUSIONS
  We demonstrated that percutaneous valve implantation may offer a novel, minimally invasive option in high-risk patients with severe CHD.
authors.affiliation: Department of Cardiology and Angiology, Campus Mitte, Charitx00E9; - University Medicine Berlin, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
authors.forename: René
authors.initials: R
authors.lastname: Pschowski
authors.forename: Ulrich-Frank
authors.initials: UF
authors.lastname: Pape
authors.forename: Marianne
authors.initials: M
authors.lastname: Pavel
authors.forename: Verena
authors.initials: V
authors.lastname: Stangl
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.forename: Bertram
authors.initials: B
authors.lastname: Wiedenmann
authors.forename: Karl
authors.initials: K
authors.lastname: Stangl
mesh_terms: D000368:Aged; D002275:Carcinoid Heart Disease / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D018358:Neuroendocrine Tumors / Q000150:complications / Q000601:surgery; D014261:Tricuspid Valve / Q000601:surgery*