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Carcinoid heart disease

K Daskalakis, A Karakatsanis, P Stålberg, O Norlén, P Hellman
BACKGROUND: In patients with small intestinal neuroendocrine tumours (SI-NETs), serotonin and other cytokines released from tumour cells may induce fibrosis, leading to carcinoid heart disease and abdominal fibrotic reactions. The aim of this study was to assess the prevalence, clinical complications and management of this reaction in the abdomen. METHODS: This was a retrospective cohort study of patients with SI-NETs diagnosed between 1985 and 2015. Clinical data, outcomes, radiological findings, and surgical and radiological interventions were reviewed...
November 10, 2016: British Journal of Surgery
Maria Bonou, Chris J Kapelios, Gregory Kaltsas, Konstantinos Perreas, Konstantinos Toutouzas, John Barbetseas
Carcinoid heart disease (CHD) complicates approximately 25% of patients with a carcinoid tumor and carcinoid syndrome and leads to heart valve degeneration with mixed-stenotic and regurgitation pathology and consequent heart failure (HF) leading to significant morbidity and mortality. Cardiac surgery in symptomatic, severe CHD leads to significantly better functional capacity and prolonged survival when compared to medical treatment alone. Recent studies have shown improvement in postoperative outcomes of patients undergoing surgery for CHD over the last decades...
November 11, 2016: Cardiology
Angela Lamarca, Jorge Barriuso, Mairéad G McNamara, Richard A Hubner, Juan W Valle
Many patients with neuroendocrine tumour-related carcinoid syndrome treated with somatostatin analogues (SSA) won't achieve adequate symptom relief with the SSA alone; new treatment options are required. Telotristat ethyl is a tryptophan hydroxylase inhibitor, developed for the treatment of carcinoid syndrome. Areas covered: This review summarises the evidence supporting the role of telotristat ethyl in the management of carcinoid syndrome. Rationale, pharmacodynamics, pharmacokinetics, metabolism, clinical experience, efficacy and toxicity profiles are covered...
November 16, 2016: Expert Opinion on Pharmacotherapy
Faidon-Marios Laskaratos, Martin Walker, Keval Naik, Emmanouil Maragkoudakis, Nikolaos Oikonomopoulos, Lee Grant, Tim Meyer, Martyn Caplin, Christos Toumpanakis
BACKGROUND: The antiproliferative activity of octreotide LAR in neuroendocrine tumours (NETs) has been demonstrated by small retrospective studies and confirmed by a prospective phase III trial (PROMID). However, there are limited data about the duration and predictors of response. The aim of our retrospective study was to determine the time to radiological progression (TTRP) of disease and the factors that were associated with better response. METHODS: A total of 254 treatment naïve patients with advanced NETs and positive somatostatin receptor scintigraphy were included...
November 22, 2016: British Journal of Cancer
Marianna Nardozza, Donato Mele, Roberto Ferrari
We report the case of a 67-year-old woman with a carcinoid tumor of midgut origin who developed carcinoid heart disease and died because of bowel perforation. Echocardiography allowed the diagnosis, recognizing the typical abnormalities of tricuspid and pulmonary valve leaflets. The sonographic examination also evidenced peculiar alterations of the right heart hemodynamics: end-diastolic reversal of flow at the level of the pulmonary valve, reduced respiratory excursion without enlargement of the inferior vena cava, and biphasic hepatic venous flow without respiratory variation...
October 18, 2016: Journal of Clinical Ultrasound: JCU
Bulur Serkan, Ming C Hsiung, Navin C Nanda, Shalaka Hardas, Ahmed Mohamed, Ahmed ElKaryoni, Swetha Srialluri, Kirolos Barssoum, Mahmoud Elsayed, Jeng Wei, Wei-Hsian Yin
We present a case of an adult with metastatic carcinoid heart disease, in whom live/real time three-dimensional transthoracic echocardiography provided incremental value over two-dimensional transthoracic echocardiography in assessing involvement of the aortic valve.
November 2016: Echocardiography
B Talvande, A Dorange, M Lecouflet, M Le Nezet, B Kianifard, H Maillard, M Duquenne
INTRODUCTION: Ovarian neuroendocrine tumors are extremely rare. In the ovary, the term of neuroendocrine tumor is usually related to carcinoid tumors although it may be sometimes applied to neuroendocrine carcinomas of non-small cells or small cells cancers usually occurring in the lungs. These carcinoid tumors may develop de novo or from other tumors including teratomas. CASE REPORT: We report a patient who presented with an ovarian carcinoid tumor developed, near or from a dermoid cyst, which was original by its mode of discovery in the dermatology department...
September 9, 2016: La Revue de Médecine Interne
José Mauricio Mota, Luana Guimarães Sousa, Rachel P Riechelmann
Patients with well-differentiated neuroendocrine tumours may develop carcinoid syndrome (CS), which is characterised by flushing, abdominal cramps, diarrhoea, and bronchospasms. In this scenario, long-term secretion of vasoactive substances-serotonin, tachynins, and others, may induce fibrogenic responses in local or distant tissues, leading to complications such as carcinoid heart disease (CHD), mesenteric and/or retroperitoneal fibrosis. Rare cases of lung/pleural fibrosis and scleroderma have also been described...
2016: Ecancermedicalscience
Pranav Loyalka, Michael Schechter, Angelo Nascimbene, Ajay Sundara Raman, Cezar A Ilieascu, Igor D Gregoric, Biswajit Kar
Carcinoid heart disease presents as right-sided heart failure attributable to the dysfunction of the tricuspid and pulmonary valves. Although surgical valve replacement is the mainstay of treatment when patients become symptomatic, it is associated with substantial perioperative mortality rates. We present a case of severe pulmonary valve stenosis secondary to carcinoid heart disease, treated successfully with percutaneous valve replacement. A 67-year-old man with severe pulmonary valve stenosis was referred to our center for pulmonary valve replacement...
August 2016: Texas Heart Institute Journal
Ivancarmine Gambardella, Mario Gaudino, Claudio Ronco, Christopher Lau, Natalia Ivascu, Leonard N Girardi
Acute kidney injury (AKI) in cardiac surgery has traditionally been linked to reduced arterial perfusion. There is ongoing evidence that central venous pressure (CVP) has a pivotal role in precipitating acute renal dysfunction in cardiac medical and surgical settings. We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'. In the cardiac surgery population as a whole, when the CVP value reaches the threshold of 14 mmHg in postoperative period, the risk of AKI increases 2-fold with an odds ratio (OR) of 1...
November 2016: Interactive Cardiovascular and Thoracic Surgery
Islam H Metwally, Amr F Elalfy, Shadi Awny, Islam A Elzahaby, Reham M Abdelghani
OBJECTIVES: This study aims at reporting 2 cases of primary ovarian carcinoid tumor, and providing an adequate registry of such cases and how they were managed. METHODS: 2 female patients with primary ovarian carcinoid were diagnosed and treated in our center. Discussion of their presentation, pathology and treatment is entitled. Also a thorough search of all published registries and case reports of ovarian carcinoid was done with analysis of reported data. RESULTS: 164 cases of primary ovarian carcinoid tumor were detected since 2005 with the predominance of the insular variant...
December 2016: Journal of the Egyptian National Cancer Institute
Andrew K Capulli, Luke A MacQueen, Blakely B O'Connor, Stephanie Dauth, Kevin Kit Parker
Medications based on ergoline-derived dopamine and serotonin agonists are associated with off-target toxicities that include valvular heart disease (VHD). Reports of drug-induced VHD resulted in the withdrawal of appetite suppressants containing fenfluramine and phentermine from the US market in 1997 and pergolide, a Parkinson's disease medication, in 2007. Recent evidence suggests that serotonin receptor activity affected by these medications modulates cardiac valve interstitial cell activation and subsequent valvular remodeling, which can lead to cardiac valve fibrosis and dysfunction similar to that seen in carcinoid heart disease...
July 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Kolouch T, Linkova H, Lang O, Ciprova V, Brunerova L
UNLABELLED: Ovarian carcinoids are very rare, and only their insular form is associated with carcinoid syndrome. We herein describe a case report of an elderly woman who presented with typical carcinoid syndrome, which is routinely characterized by right-sided heart failure, diarrhoea, flushes, and other common manifestations. Further examination and biochemical testing of the patient confirmed suspected carcinoid tumor. However, the tumor was surprisingly localized in the left ovary...
January 2016: Acta Cardiologica Sinica
Miriam Silaschi, James Barr, Sanjay Chaubey, Niki Nicou, Raj Srirajaskanthan, Jonathan Byrne, John Ramage, Philip MacCarthy, Olaf Wendler
BACKGROUND: Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported perioperative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience. METHODS: All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus...
April 21, 2016: Neuroendocrinology
Austin B Rupp, Abdulmohsin Ahmadjee, Jack H Morshedzadeh, Ravi Ranjan
Introduction. Carcinoid tumors are rare neuroendocrine malignancies that secrete multiple bioactive substances. These bioactive substances are responsible for the carcinoid syndrome characterized by diarrhea, flushing, syncope, and right-sided valvular heart disease. Previous case reports have described carcinoid syndrome associated with coronary vasospasm and the well-characterized carcinoid heart disease. Case. Our patient is a 73-year-old female with complex past medical history most notable for metastatic carcinoid tumors diagnosed in 2013-05...
2016: Case Reports in Cardiology
Sushil A Luis, Patricia A Pellikka
Hedinger syndrome refers to carcinoid valvular heart disease. The disease is believed to be triggered by vasoactive substances that result in valvular fibrosis. It classically occurs in patients with metastatic carcinoid and preferentially involves the right sided cardiac valves. Affected valves become thickened and retracted, exhibiting regurgitation and sometimes, stenosis. Echocardiography is recommended in patients with carcinoid syndrome and a follow up study is advisable in those who develop a murmur or other symptoms or signs of valvular heart disease...
January 2016: Best Practice & Research. Clinical Endocrinology & Metabolism
V Jahagirdar, Ali Kamal, R Steeds, John Ayuk
A 63-year-old woman was admitted with a year's history of exertional breathlessness, anxiety attacks, syncopal episodes, diarrhoea, fatigue, reduced appetite, 2 stones weight loss, and flushing affecting her face and trunk. Investigations revealed raised urine 5-hydroxy indole acetic acid (5-HIAA) and chromogranin A. CT scan demonstrated extensive soft tissue encasing the major vessels intra-abdominally, and a retroperitoneal mass. (111)In-octreotide single-photon emission CT (SPECT CT) showed increased focal activity in the mediastinum, retroperitoneum and mesenteric lymph nodes...
February 3, 2016: BMJ Case Reports
Alexander Daniel Jacques Baur, Florian Kunz, Carsten Schwenke, René Pschowski, Torsten Kai Röpke, Marianne Pavel, Timm Denecke
PURPOSE: The aim of this study was to evaluate signs of right-sided heart dysfunction on staging computed tomography (CT) as indirect indicators of carcinoid heart disease. PATIENTS AND METHODS: Patients with functionally active neuroendocrine neoplasm and different grades of tricuspid valve regurgitation (TR) were identified. Two readers independently reviewed contrast-enhanced staging CT performed within 90 days before or after echocardiography. Logistic regression and receiver operating analyses were used to asses the predictive value of right ventricle-left ventricle ratio (RV-LV ratio), ventricular septal bowing, retrograde contrast filling of the hepatic veins during contrast injection, and time to aortal enhancement greater than 100 Hounsfield units during bolus tracking for TR...
March 2016: Journal of Computer Assisted Tomography
Mohammed Farooqui, Sulaiman Rathore, Timothy Ball
Carcinoid heart disease is classically described as right-sided valvular pathology. Solid cardiac metastases from carcinoid tumors are seldom reported. A multimodality imaging approach is needed to diagnose and localize this disease. Biopsy remains the gold standard to confirm the diagnosis of carcinoid. Octreotide uptake is characteristic of carcinoid tumor but not myxoma; thus, an indium-111 octreotide scan is very specific for the diagnosis of carcinoid tumor and helps in assessing the extent of carcinoid disease...
January 2016: Proceedings of the Baylor University Medical Center
Richard R P Warner, Javier G Castillo
No abstract text is available yet for this article.
November 17, 2015: Journal of the American College of Cardiology
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