Echocardiographic imaging of tricuspid and pulmonary valve abnormalities in primary ovarian carcinoid tumor

Constantina Aggeli,Christos Pitsavos,Athanasios Kartalis,Ioannis Felekos,Christina Kazazaki,Christodoulos Stefanadis,Dimitrios Giannopoulos

doi:10.1186/1476-7120-8-37

Constantina Aggeli, Christos Pitsavos + Show 5 more

Open Access

https://doi.org/10.1186/1476-7120-8-37

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Abstract

Carcinoid is a rare malignancy originating from enterochromaffin cells and is clinically characterized by flushing, diarrhea and bronchospasm, due to secretion of vasoactive substances. A dreaded complication is carcinoid heart disease, which mainly affects right cardiac chambers, resulting in thickened, immobile and retracted tricuspid and pulmonary valves. In the current report, a case of a 60-year old female presenting with symptoms of right heart failure is described. Transthoracic two-dimensional and real-time three-dimensional echocardiography findings, as well as biochemical markers, including pro-BNP and NT-pro-BNP, were consistent with carcinoid syndrome. The histological diagnosis of carcinoid was confirmed after surgical resection of an ovarian mass.

Highlights

Primary cardiac tumors are rare (5%) while metastatic tumors of the heart, predominantly from carcinoma of lung and breast, malignant melanoma, and leukemias and lymphomas, constitute the majority of cardiac tumorsCardiac carcinoid is an exceedingly rare cause of valvular disease and is characterized by plaque-like deposits of fibrous tissue on endocardial surface of valve cusps and leaflets usually on the right heart valves (90%).A case, regarding an ovarian carcinoid mass with cardiac manifestations involving both tricuspid and pulmonary valves, is described.Case Presentation A 60-year old Caucasian female, was referred to our cardiology department, due to early fatigue (NYHA II/III) and ankle edema, progressively deteriorating over the last year, complaining of anorexia
Patients with carcinoid heart disease typically present with symptoms of right-sided heart failure, and when symptoms are advanced (NYHA class 3 or 4), outlook is poor [4,5]
According to various studies, there seems to be a strong correlation between serotonin, 5-HIAA levels and the prevalence of carcinoid heart disease [7,8]

Summary

Background

Primary cardiac tumors are rare (5%) while metastatic tumors of the heart, predominantly from carcinoma of lung and breast, malignant melanoma, and leukemias and lymphomas, constitute the majority of cardiac tumors. A case, regarding an ovarian carcinoid mass with cardiac manifestations involving both tricuspid and pulmonary valves, is described. Case Presentation A 60-year old Caucasian female, was referred to our cardiology department, due to early fatigue (NYHA II/III) and ankle edema, progressively deteriorating over the last year, complaining of anorexia She had a medical history of hypertension, which was treated with an angiotensin receptor blocker, with no other risk factors for coronary artery disease. The patient had 90 bpm and a respiratory rate of 12 breaths/min Her temperature was 37°C and her blood pressure was 140/90 mmHg. Cardiac examination revealed a left parasternal holosystolic murmur, a third cardiac sound (S3) and a palpable right ventricular heave, whereas lung auscultation was unremarkable.

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