Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms

BMJ Case Rep. 2017 Oct 23:2017:bcr2017220888. doi: 10.1136/bcr-2017-220888.

Abstract

Severe carcinoid syndrome and carcinoid heart disease in neuroendocrine tumours can have a significant impact on a patient's quality of life and are a major cause of morbidity and mortality. We present a novel approach to managing a patient with medically uncontrollable carcinoid syndrome. Inferior and superior vena cava placement of transcatheter heart valves has been used to treat patients with right heart failure due to severe tricuspid and pulmonary regurgitation. However, this procedure has not been attempted to specifically reduce hormone secretion, primarily from the liver, in order to control carcinoid syndrome symptoms. We attempted this procedure in a patient with severe carcinoid disease and tricuspid regurgitation as a bridge to later definitive therapy. The procedure was technically successful, but did not improve carcinoid symptoms. The possible reasons for the failure are discussed here.

Keywords: interventional cardiology; valvar diseases.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Carcinoid Heart Disease / complications
  • Carcinoid Heart Disease / diagnostic imaging*
  • Carcinoid Heart Disease / psychology
  • Carcinoid Heart Disease / surgery
  • Echocardiography / methods
  • Fatal Outcome
  • Female
  • Heart Valve Prosthesis / standards
  • Heart Valve Prosthesis Implantation / methods
  • Humans
  • Liver / pathology
  • Neuroendocrine Tumors / complications*
  • Neuroendocrine Tumors / drug therapy
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / surgery
  • Octreotide / administration & dosage
  • Octreotide / therapeutic use
  • Peptides, Cyclic / administration & dosage
  • Peptides, Cyclic / therapeutic use
  • Quality of Life
  • Somatostatin / administration & dosage
  • Somatostatin / analogs & derivatives
  • Somatostatin / therapeutic use
  • Tricuspid Valve Insufficiency / complications*
  • Tricuspid Valve Insufficiency / surgery
  • Vena Cava, Inferior / surgery*

Substances

  • Antineoplastic Agents
  • Antineoplastic Agents, Hormonal
  • Peptides, Cyclic
  • lanreotide
  • Somatostatin
  • Octreotide