The novel use of Perceval valve for pulmonary valve replacement in carcinoid syndrome: a case report

Sutureless prosthetic aortic valves have continued to play an expansive role in addressing aortic valve disease in patients undergoing heart surgery. These valves have been shown to be safe and associated with excellent clinical and hemodynamic outcomes. While these prostheses are indicated for aortic valve replacement, there are case studies that have reported their use in the pulmonic position in high surgical risk patients. For the first time, herein, we report the implantation of a Perceval sutureless valve in the pulmonic position of a patient with severe carcinoid syndrome. The case adds to the growing body of literature supporting the use of sutureless valves to facilitate complex cardiac operations. The case also demonstrates that patients with severe carcinoid syndrome affecting cardiac structures should be considered for sutureless valves if indicated.

We report the case of a Perceval sutureless valve implanted into the pulmonary position in a patient with severe carcinoid cardiac disease. The patient was a 64-year-old male who was admitted with heart failure after presenting with anasarca and unintentional weight loss. Investigations confirmed a diagnosis of carcinoid syndrome involving the heart and intra-cardiac structures. The patient underwent a median sternotomy, tricuspid valve repair, and pulmonary valve replacement using a Perceval sutureless valve. At 18-month follow-up, the patient does not endorse any cardiovascular symptoms and echocardiography findings are consistent with a well-seated and normally functioning prosthetic valve. Given the small right ventricular tract, the operation involved using a bovine pericardium to accommodate the deployment of the Perceval valve.

A sutureless valve played an important role in facilitating this complex operation on a patient with a high surgical risk profile.