Quadruple Valve Replacement for Carcinoid Heart Disease
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| Format: | Artículo científico |
| Language: | en |
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Sociedade Brasileira de Cirurgia Cardiovascular
2018
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| author | Syed Saleem Mujtaba |
| author_facet | Syed Saleem Mujtaba |
| contents | Quadruple Valve Replacement for Carcinoid Heart Disease Syed Saleem Mujtaba Stephen Clark Medicina surgery Heart Valves Carcinoid Heart Disease Malignant Carcinoid Syndrome Heart Valve Prosthesis Implantation Introduction: Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature.Methods: All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours.Results: Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases.Conclusion: Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement. 2018 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398956442014 https://www.redalyc.org/journal/3989/398956442014/ https://www.redalyc.org/journal/3989/398956442014/html/ https://www.redalyc.org/journal/3989/398956442014/398956442014.epub https://www.redalyc.org/journal/3989/398956442014/movil 10.21470/1678-9741-2017-0224 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.4 Vol.33 |
| format | Artículo científico |
| id | redalyc_398956442014 |
| institution | Redalyc |
| language | en |
| publishDate | 2018 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| spellingShingle | Quadruple Valve Replacement for Carcinoid Heart Disease Syed Saleem Mujtaba Medicina surgery Heart Valves Carcinoid Heart Disease Malignant Carcinoid Syndrome Heart Valve Prosthesis Implantation Quadruple Valve Replacement for Carcinoid Heart Disease Syed Saleem Mujtaba Stephen Clark Medicina surgery Heart Valves Carcinoid Heart Disease Malignant Carcinoid Syndrome Heart Valve Prosthesis Implantation Introduction: Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature.Methods: All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours.Results: Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases.Conclusion: Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement. 2018 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398956442014 https://www.redalyc.org/journal/3989/398956442014/ https://www.redalyc.org/journal/3989/398956442014/html/ https://www.redalyc.org/journal/3989/398956442014/398956442014.epub https://www.redalyc.org/journal/3989/398956442014/movil 10.21470/1678-9741-2017-0224 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.4 Vol.33 |
| title | Quadruple Valve Replacement for Carcinoid Heart Disease |
| topic | Medicina surgery Heart Valves Carcinoid Heart Disease Malignant Carcinoid Syndrome Heart Valve Prosthesis Implantation |
| url | https://www.redalyc.org/articulo.oa?id=398956442014 https://www.redalyc.org/journal/3989/398956442014/ https://www.redalyc.org/journal/3989/398956442014/html/ https://www.redalyc.org/journal/3989/398956442014/398956442014.epub https://www.redalyc.org/journal/3989/398956442014/movil |