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Hiding in Plain Sight: Pulmonic Valve Involvement in Carcinoid Heart Disease
M Kasim Malik1, Alexander Whitaker2, Ghadi Moubarak3
1Baylor Scott and White, The Heart Hospital, Plano, Texas.
Insights
Carcinoid heart disease can affect the pulmonic valve, causing stenosis. Early detection through echocardiography and CT imaging is crucial for timely surgical intervention in affected patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Carcinoid heart disease (CHD) commonly affects the right-sided heart valves.
- Tricuspid valve involvement is well-documented in CHD.
- Pulmonic valve involvement in CHD is less frequently recognized but clinically significant.
Purpose of the Study:
- To report a case of newly diagnosed pulmonic stenosis in a patient with known carcinoid heart disease.
- To highlight the importance of vigilant monitoring for pulmonic valve compromise in CHD.
- To emphasize the role of advanced imaging in surgical planning for complex CHD cases.
Main Methods:
- Case report of a 50-year-old male with hypertension and CHD.
- Initial evaluation for tricuspid valve replacement.
- Serial echocardiography to assess valve function.
- Computed tomography (CT) imaging for detailed anatomical and flow assessment.
Main Results:
- Echocardiography revealed new-onset flow acceleration across the pulmonic valve, indicative of pulmonic stenosis.
- CT imaging confirmed the presence and severity of pulmonic stenosis.
- Surgical plan was revised to include both tricuspid and pulmonic valve replacement.
Conclusions:
- Pulmonic valve stenosis can develop or progress in patients with carcinoid heart disease.
- A high index of clinical suspicion is necessary for diagnosing pulmonic involvement in CHD.
- Multimodality imaging, including echocardiography and CT, is essential for comprehensive assessment and surgical planning in CHD.
Abstract:
A 50 year old male with medical history of hypertension and carcinid heart disease was initially seen in valve clinic for planned tricuspid valve replacement. A repeat echocardiogram demonstrated flow acceleration accross the pulmonic valve concerning for pulmonic stenosis, which was not seen on prior echocardiograms. Follow up CT imaging confirmed pulmonic stenosis and the surgical plan was changed to include both tricuspid and pulmonic valve replacements. A high clinical index of suspicion is requried for evaluation pulmonic involvement in carcinoid heart disease.
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