Endocrine Abstracts

Introduction: Established guidelines recommend carefully selected patients with Carcinoid Heart Disease (CHD) may undergo surgical valve replacement as definitive management. Right sided heart valve involvement is classical, occurring as result of plaque deposition on valve leaflets as a consequence of vasoactive peptides secreted by the NET because of carcinoid syndrome. Tricuspid and Pulmonary valve involvement leads to right heart failure (RHF) increasing mortality and morbidity independently. There is a paucity of studies reviewing percutaneous approaches in this group. Here we compare 2 patients with metastatic NET with carcinoid heart disease treated successfully by surgical valve replacement and percutaneous valve intervention and review short-term outcomes.

Case 1: 56 years old female presented with carcinoid syndrome was diagnosed with metastatic small bowel neuroendocrine in 2015, developed rapid deterioration of pulmonary valve function (stenosis and regurgitation) with an element of TV thickening and mild TR with features of right heart failure in 2019. She had biochemical evidence of functioning NET with RHF evidenced by elevated N-terminal pro BNP of 436 ng/l, CgA (283ng/ml) and UHIAA 1321ng/24 hours. SSTR scintigraphy revealed widespread progressive multiple metastasis including bone, breast, liver, retro-orbital lesions. Her past treatment included Lutathera™ and Lanreotide autogel™. Her 2 – Echo, and CT-coronary angiogram confirmed thickened right heart valves with pulmonary affected more than tricuspid. She was not deemed suitable for surgical intervention. There were favourable pulmonary annular dimensions for percutaneous approach. This was undertaken with octreotide cover. Her RHF and quality of life dramatically improved immediately.

Case 2: 65 years old male presented with carcinoid syndrome with metastatic small bowel NET developed features of right heart failure in 2020. Cardiac investigations revealed pulmonary and tricuspid regurgitation, and right coronary artery disease. He was treated with pulmonary valve replacement, tricuspid valve replacement and Coronary artery bypass graft. Recent Echo revealed TVR in situ and mild PVR. He is on Olatuton™. His disease remains stable, and his quality of life has improved.

Conclusion: Options for surgical valve replacement in patients with Carcinoid heart disease with stable NET disease exist, however percutaneous valve options should be further explored and studies in this area are needed.