J Cardiovasc Ultrasound.  2011 Jun;19(2):99-101. 10.4250/jcu.2011.19.2.99.

Carcinoid Heart Disease: A Rare Cause of Right Ventricular Dysfunction Evaluation by Transthoracic 2D, Doppler and 3-D Echocardiography

Affiliations
  • 1Department of Internal Medicine, Faculty of Medicine, Geriatry-Second University of Naples (S.U.N.), Naples, Italy. federico.cacciapuoti@unina2.it
  • 2Montevergine Cardiology Clinic (Avellino), Mercogliano, Italy.

Abstract

Carcinoid heart disease is a rare cause of heart failure with or without right valvular heart impairments. In this study, we showed a case of carcinoid tumour with hepatic metastases inducing carcinoid heart disease. Neuroendocrine heart involvement happens for severe tricuspid valve insufficiency and plaques on right ventricular (RV) walls produced by a release of serotonin (5-HT). A patient affected by primitive ileal tumour with 5-HT-secernent hepatic metastases inducing tricuspid insufficiency is showed. Transthoracic 2-D echocardiography showed tricuspid valve regurgitation and both right atrium, RV-walls plaques and RV dilation. Continue-wave Doppler showed a characteristic "dagger shaped" spectrum of tricuspid systolic flow. RV function was evaluated with 3-D transthoracic echocardiography. In particular, RV volumes, RV ejection fraction and stroke volume were defined by this technique. 2, 3-D echocardiography and Doppler method are useful techniques to show heart valves' derangements and RV function to non-invasively detect RV impairments in carcinoid heart disease.

Keyword

Carcinoid heart disease; Tricuspid valve incompetence; RV function; 2-D and 3-D echocardiography

MeSH Terms

Carcinoid Heart Disease
Carcinoid Tumor
Echocardiography
Echocardiography, Three-Dimensional
Heart
Heart Atria
Heart Failure
Humans
Neoplasm Metastasis
Serotonin
Stroke Volume
Tricuspid Valve Insufficiency
Ventricular Dysfunction, Right
Serotonin

Figure

  • Fig. 1 A: Two-dimensional echocardiography recorded in the patient with carcinoid heart disease. Dilatation of right cavities and thickened, fixed and retracted tricuspid leaflets. Endocardial plaques on right ventricular walls are also evident. B: Severe tricuspid regurgitation seen in the same patient at color flow imaging.

  • Fig. 2 "Dagger shaped" of systolic tricuspid flow, characterized by an early peak pressure and its rapid decline.

  • Fig. 3 A: Three-dimensional transthoracic echocardiography showing the adhesion of tricuspid leaflets to right ventricular walls, that prevents the valve closure during systole. B: Three-dimensional shape of diastolic and systolic volumes (EDV and ESV), ejection fraction% (EF%) and stroke volume (SV) of right ventricle.


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