[Treatment options in carcinoid heart disease]

Area of Science:

• Cardiology
• Oncology

Background:

• Neuroendocrine tumors (NETs) are a diverse group of cancers, often originating in the gastrointestinal tract.
• NETs can cause significant illness through local growth and hormone production, impacting systemic physiology.
• Carcinoid syndrome, associated with metastatic NETs, affects approximately 20% of patients, leading to carcinoid heart disease.

Purpose of the Study:

• To discuss the implications of carcinoid heart disease in patients with neuroendocrine tumors.
• To review current treatment strategies, including valve replacement for carcinoid heart disease.
• To explore emerging transcatheter treatment options for carcinoid heart disease affecting the tricuspid and pulmonary valves.

Main Methods:

• Literature review of neuroendocrine tumors, carcinoid syndrome, and carcinoid heart disease.
• Analysis of treatment outcomes for valve replacement in carcinoid heart disease.
• Overview of current and novel transcatheter interventions for valvular heart disease in NET patients.

Main Results:

• Carcinoid heart disease typically manifests as right-sided heart failure due to tricuspid and pulmonary valve deterioration.
• Surgical valve replacement can alleviate heart failure symptoms and improve survival in affected patients.
• Bioprosthetic valves may degenerate prematurely due to chronic hormonal activity from NETs.

Conclusions:

• Carcinoid heart disease is a significant complication of metastatic NETs and carcinoid syndrome.
• Valve replacement is a key intervention, though bioprosthetic valve durability can be a concern.
• Transcatheter valve therapies represent a promising advancement for managing carcinoid heart disease, offering potential for both valve-in-valve and primary interventions.