[Treatment options in carcinoid heart disease]

Neuroendocrine tumours (NET) constitute a heterogenous population of malignancies most often originating from the gastrointestinal tract. NETs cause substantial morbidity, both from local growth and from their ability to produce hormones that affect systemic physiology. About 20% of patients with metastatic NET disease and carcinoid syndrome develop carcinoid heart disease, a condition dominated by primarily right-sided heart failure caused by structural deterioration of the tricuspid and pulmonary valves. Ultimately, valve replacement may be indicated and has been shown to reduce heart failure symptoms and increase long-term survival. Bioprostheses are the valves of choice but have been shown to degenerate early in some patients due to chronic tumour-associated hormonal activity. New transcatheter treatment options are emerging, both as valve-in-valve procedures but potentially also as primary interventions, both in the tricuspid and pulmonary valve position.