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Case Reports
. 2024 Apr 10;29(10):102335.
doi: 10.1016/j.jaccas.2024.102335. eCollection 2024 May 15.

Carcinoid Heart Disease With Hypoxemia

Tomohiro Suenaga  1 , Kenichi Ishizu  1 , Miho Nakamura  1 , Toru Morofuji  1 , Takashi Morinaga  1 , Masaomi Hayashi  1 , Akihiro Isotani  1 , Shinichi Shirai  1 , Kenji Ando  1
Affiliations
Case Reports

Carcinoid Heart Disease With Hypoxemia

Tomohiro Suenaga et al. JACC Case Rep. .

Abstract

Patent foramen ovale (PFO) complicated with carcinoid heart disease (CHD) can cause severe hypoxia and worsening clinical conditions. We report the case of a patient with CHD in poor general condition with multiple severe valve regurgitations and PFO, who underwent successful percutaneous closure of the PFO.

Keywords: carcinoid heart disease; patent foramen ovale.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Transthoracic Echocardiography Transthoracic echocardiography showing (A and B) torrential tricuspid regurgitation with the coaptation loss of leaflets, (C) severe pulmonary regurgitation, (D) moderate aortic regurgitation, (E) tricuspid regurgitation velocity profile using continuous-wave Doppler (white arrow), and (F) flow reversal in the hepatic veins (yellow arrow). Ao = aorta; LA = left atrium; LV = left ventricle; PA = pulmonary artery; RA = right atrium; RV = right ventricle.
Figure 2
Figure 2
Electrocardiogram-Gated Cardiac Computed Tomography (A) Three-dimensional and (B) cross-sectional e-dimensional computed tomography images showing a thickened and retracted tricuspid valve (TV) in the late systolic phase (yellow arrowheads). (C) The thickened and retracted pulmonary valves in the diastole phase (yellow arrowheads). (D) Patent foramen ovale (white arrow). (E) Abdominal computed tomography showing multiple liver metastases (black arrows). RAA = right atrial appendage;; other abbreviations as in Figure 1.
Figure 3
Figure 3
Intraprocedural Hemodynamic Changes (A) Induction of general anesthesia and initiation of positive pressure ventilation. (B) Deployment of a 25-mm Amplatzer PFO Occluder (Abbott Vascular). (C) Reversal of neuromuscular blockage with sugammadex. (D) Weaning from ventilator management. (E) The patient was treated with intravenous volume replacement with 2,000 mL and administration of norepinephrine of 0.3 μg/kg/min and dobutamine of 3 μg/kg/min. ART(D) = diastolic arterial blood pressure; ART(S) = systolic arterial blood pressure; DOB = dobutamine; HR = heart rate; NAD = norepinephrine; NIBP = noninvasive blood pressure; Spo2 = oxygen saturation.
See this image and copyright information in PMC

References

    1. Davar J., Connolly H.M., Caplin M.E., et al. Diagnosing and managing carcinoid heart disease in patients with neuroendocrine tumors: an expert statement. J Am Coll Cardiol. 2017;69:1288–1304. - PubMed
    1. Mansencal N., Mitry E., Pillière R., et al. Prevalence of patent foramen ovale and usefulness of percutaneous closure device in carcinoid heart disease. Am J Cardiol. 2008;101:1035–1038. - PubMed
    1. Douglas S., Oelofse T., Shah T., et al. Patent foramen ovale in carcinoid heart disease: the potential role for and risks of percutaneous closure prior to cardiothoracic surgery. J Neuroendocrinol. 2023;35 - PubMed
    1. Mottram P.M., McGaw D.J., Meredith I.T., et al. Profound hypoxaemia corrected by PFO closure device in carcinoid heart disease. Eur J Echocardiogr. 2008;9:47–49. - PubMed

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