One-Stop Transcatheter Pulmonary and Tricuspid Valve Replacement for Carcinoid Heart Disease Treatment.

BACKGROUND

Carcinoid heart disease is a complex consequence of functional neuroendocrine tumors, characterized by progressive thickening and degeneration of the right-sided valvular apparatus, leading to valvular and heart failure. Management is challenging, requiring multidisciplinary considerations regarding tumor disease management, heart failure pharmacotherapy, and heart valve replacement in individuals with acceptable performance status.

CASE SUMMARY: We present a case of a middle-aged man with a history of metastatic neuroendocrine tumor receiving biweekly octreotide therapy. He presented with constitutional syndrome and right-sided heart failure signs. Cardiac imaging revealed significant tricuspid and pulmonary regurgitation. The patient was a poor surgical candidate; consequently, after multimodal cardiac imaging assessment, alternative 1-stop transcatheter pulmonary and tricuspid replacement was planned and performed.

DISCUSSION: Patients with symptomatic carcinoid heart disease require comprehensive multidisciplinary evaluation. For high-risk patients with multivalvular disease, transcatheter valve replacements provide a feasible and less invasive alternative to standard surgical replacement.

TAKE-HOME MESSAGES: One-stop transcatheter valvular interventions are a feasible therapeutic alternative to surgical replacement in patients with symptomatic carcinoid heart disease and suitable anatomy. Multimodal cardiac imaging is crucial for preprocedural assessment and the performance of transcatheter right-sided heart valve interventions.