title: Transcatheter Pulmonary Valve Replacement in a Carcinoid Heart.
abstract: Carcinoid heart disease presents as right-sided heart failure attributable to the dysfunction of the tricuspid and pulmonary valves. Although surgical valve replacement is the mainstay of treatment when patients become symptomatic, it is associated with substantial perioperative mortality rates. We present a case of severe pulmonary valve stenosis secondary to carcinoid heart disease, treated successfully with percutaneous valve replacement. A 67-year-old man with severe pulmonary valve stenosis was referred to our center for pulmonary valve replacement. The patient had a history of metastatic neuroendocrine tumor of the small bowel with carcinoid syndrome, carcinoid heart disease, and tricuspid valve regurgitation previously treated with surgical valve replacement. Because of the patient's severe chronic obstructive pulmonary disease and hostile chest anatomy seen on a computed tomographic scan dating from previous cardiothoracic surgery, we considered off-label percutaneous valve replacement a viable alternative to open-heart surgery. A 29-mm Edwards Sapien XT valve was successfully deployed over the native pulmonary valve. There were no adverse sequelae after the procedure, and the patient was discharged from the hospital the next day. This case report shows that percutaneous valve replacement can be a valid option in carcinoid heart disease patients who are not amenable to surgical valve replacement.
authors.forename: Pranav
authors.initials: P
authors.lastname: Loyalka
authors.forename: Michael
authors.initials: M
authors.lastname: Schechter
authors.forename: Angelo
authors.initials: A
authors.lastname: Nascimbene
authors.forename: Ajay Sundara
authors.initials: AS
authors.lastname: Raman
authors.forename: Cezar A
authors.initials: CA
authors.lastname: Ilieascu
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
mesh_terms: D000368:Aged; D002275:Carcinoid Heart Disease / Q000150:complications* / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Carcinoid heart disease/therapy; heart valve prosthesis implantation, percutaneous; treatment outcome