Publish in this journal
Journal Information
Vol. 63. Issue 1.
Pages 96 (January 2010)
Download PDF
More article options
Vol. 63. Issue 1.
Pages 96 (January 2010)
DOI: 10.1016/S1885-5857(10)70013-X
Full text access
Absence of the Tricuspid Valve Due to Severe Carcinoid Heart Disease
Ausencia valvular tricuspídea por enfermedad cardiaca carcinoide severa
Javier G. Castilloa, David H. Adamsa, Gregory W. Fischerb
a Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, United States
b Department of Anesthesiology, Mount Sinai Medical Center, New York, United States
Article information
Full Text
Download PDF
Figures (2)
Full Text

A 55-year-old man, diagnosed with carcinoid syndrome 12 years previously, experienced generalized hepatic metastasis and subsequent carcinoid heart disease, with a grade VI/VI systolic ejection murmur at the tricuspid valve. In addition, the patient had dyspnea on moderate exertion and evident peripheral symptoms of right heart failure. Following a preoperative evaluation, the patient was referred for surgery to correct the valve involvement and avoid greater deterioration of ventricular function. On intraoperative transesophageal echocardiography (TEE), he showed dilation of the right chambers and a severely affected tricuspid valve (Figure 1A). The tricuspid had a diseased appearance with marked echolucency, and thickening, retraction, and immobility of the leaflets, which were fixed in the diastolic position, resulting in a complete "absence" of the valve structure. Real-time 3-dimensional TEE (3D TEE) confirmed the "absence" of tricuspid leaflets due to fibrosis and fusion with the ventricular tissue. The capability of 3D TEE to orient the sections in any plane enabled a complete, fast, and precise evaluation of the valvular orifice: from the right atrium (Figure 1B: MV, mitral valve; TV, tricuspid valve), from the right ventricle (Figure 1C), and lastly, a lateral view after off-line subtraction of the anterolateral wall of the right ventricle (Figure 1D). The surgical analysis confirmed the 3D echocardiographic findings and additionally disclosed severe involvement of the subvalvular apparatus and endocardial deposit of pearly fibrous plaques, a characteristic of carcinoid heart disease (figure 2A and 2B: AL, anterior leaflet; PL: posterior leaflet; SL: septal leaflet). The patient underwent multivalvular surgery, with mitral repair, tricuspid valve and pulmonary valve replacement, and reconstruction of the right ventricular outflow tract.

Figure 1.

Figure 2.

Funding: project funded by the Department of Cardiothoracic Surgery.

Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?