Rapid Native and Bioprosthetic Tricuspid Valve Degeneration in Carcinoid Heart Disease

Carcinoid heart disease (CaHD) is a severe complication of metastatic neuroendocrine tumors characterized by serotonin-mediated fibrotic degeneration of right-sided cardiac valves.

We present 3 patients with metastatic neuroendocrine tumors complicated by severe carcinoid valvulopathy involving native and prosthetic tricuspid valves. Two patients underwent bioprosthetic tricuspid valve replacement for severe tricuspid regurgitation, including 1 patient who developed rapid recurrent prosthetic valve degeneration requiring transcatheter tricuspid valve-in-valve replacement. A third patient presented with advanced bivalvular carcinoid involvement requiring complex surgical reconstruction complicated by postoperative cardiogenic shock and death.

These cases illustrate the progressive nature of serotonin-mediated valvular degeneration, challenges in prosthetic valve selection, and the importance of multidisciplinary management and close echocardiographic surveillance in CaHD.

Persistent serotonin exposure may result in rapid degeneration of native and bioprosthetic valves despite surgical intervention. Early recognition and multidisciplinary management are essential to optimize outcomes in CaHD.