Carcinoid heart disease. A cardiologist's viewpoint

Area of Science:

• Cardiology
• Oncology
• Medical Imaging

Background:

• Malignant midgut carcinoid tumors can lead to significant cardiac complications.
• Carcinoid heart disease affects heart valves and chambers, primarily on the right side.
• Serotonin and tachykinins are suspected contributors to carcinoid heart disease etiology.

Purpose of the Study:

• To describe cardiac abnormalities in patients with malignant midgut carcinoid tumors.
• To evaluate the role of cardiac ultrasound in diagnosing carcinoid heart disease.
• To discuss the indications for surgical intervention in severe carcinoid heart disease.

Main Methods:

• Cardiac ultrasound (echocardiography) was used to assess cardiac structure and function.
• Histopathological examination of cardiac lesions was performed.
• Clinical data of patients with malignant carcinoid tumors and cardiac involvement were reviewed.

Main Results:

• Cardiac abnormalities were observed in 60-70% of patients with malignant midgut carcinoid tumors via ultrasound.
• Common findings include tricuspid and pulmonary valve dysfunction, right heart enlargement, and septal abnormalities.
• Microscopically, lesions show fibrous tissue on endocardium with potential myocardial infiltration.

Conclusions:

• Cardiac ultrasound is crucial for identifying characteristic abnormalities in carcinoid heart disease.
• Reconstructive valvular surgery offers benefits for patients with severe disease and right heart failure, when the malignancy is controlled.
• The exact cause of carcinoid heart disease is still unknown, but tumor-secreted substances are implicated.