Features of Carcinoid Heart Disease Identified By Two- and Three- Dimensional Echocardiography and Cardiac Magnetic Resonance Imaging.
Circ Cardiovasc Imaging. 2009 Nov 17;
BACKGROUND: -Carcinoid heart disease is a rare form of valvular heart disease (VHD). We sought describe the spectrum of carcinoid heart disease identified by echocardiography and cardiac magnetic resonance imaging. Method and Results-252 patients with carcinoid syndrome underwent a range of investigations including two-dimensional (2D) transthoracic echocardiography (TTE), three-dimensional (3D) TTE and transoespheageal echocardiography (TEE) and cardiac magnetic resonance imaging (CMR). 52 patients had evidence of carcinoid heart disease. Involvement of the tricuspid, pulmonary, mitral and aortic valves were found in 47(90%), 36(69%), 15(29%) and 14(27%) respectively. Myocardial metastases were found in 2 (3.8%) of patients. Several patterns of disease were identified depending on the extent and severity to which each leaflet and its associated sub-vavlular apparatus was affected. 13 out of 15 (87%) patients with left sided carcinoid involvement had a patent foramen ovale. Three patients with severe degree of shunting had severe valvular regurgitation. Patients with mild/moderate degree of shunting had mild or moderate valvular regurgitation. 3D TTE/TEE provided detailed anatomical information particularly for the TV and PV. CMR allowed complimentary assessment of VHD and delineation of myocardial metastases. Gallium-68 octreotate positron emission tomography (PET) identified neuroendocrine metastases. CONCLUSIONS: -Carcinoid heart disease is a heterogeneous disease with a wide spectrum of echocardiographic findings. A multi-modality approach is needed in patients with this complex pathology.
19920029
