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[Progressive dyspnoea in two patients with carcinoid syndrome]
S Nölting1, M Nicolaus, J Behr
1Medizinische Klinik II, Campus Großhadern, Klinikum der Ludwig-Maximilians-Universität München, Interdisziplinäres Zentrum für Neuroendokrine Tumoren des GastroEnteroPankratischen Systems (GEPNET-KUM), Marchioninistraße 15, 81377, München.
Abstract:
In patients with carcinoid syndrome, there has always to be considered cardiac impairment. We report about two patients with hepatic and bone metastases of a neuroendocrine tumor of the midgut, who suffered from progressive dyspnea. This was caused in both cases by a right-to-left atrial shunt, in case 1 based on a patent foramen ovale (PFO), in case 2 based on a secundum atrial septal defect. Symptoms were significantly reduced by percutaneous closure of PFO and ASD, respectively. Right-to-left atrial shunt was facilitated by right-sided carcinoid induced endocardial fibrosis with the consequence of severe tricuspid regurgitation, leading to an increase of right atrial pressure.
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