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Features of Carcinoid Heart Disease Identified by 2-and 3-Dimensional Echocardiography and Cardiac MRI

Bhattacharyya, S; Toumpanakis, C; Burke, M; Taylor, AM; Caplin, ME; Davar, J; (2010) Features of Carcinoid Heart Disease Identified by 2-and 3-Dimensional Echocardiography and Cardiac MRI. CIRC-CARDIOVASC IMAG , 3 (1) 103 - 111. 10.1161/CIRCIMAGING.109.886846.

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Abstract

Background-Carcinoid heart disease is a rare form of valvular heart disease. We sought describe the spectrum of carcinoid heart disease identified by echocardiography and cardiac MRI.Method and Results-Two hundred fifty-two patients with carcinoid syndrome underwent a range of investigations including 2D transthoracic echocardiography, 3D transthoracic echocardiography and transesophageal echocardiography, and cardiac MRI. Fifty-two patients had evidence of carcinoid heart disease. Involvement of the tricuspid, pulmonary, mitral, and aortic valves were found in 47 (90%), 36 (69%), 15 (29%), and 14 (27%), respectively. Myocardial metastases were found in 2 (3.8%) patients. Several patterns of disease were identified depending on the extent and severity to which each leaflet and its associated subvavlular apparatus was affected. Thirteen of 15 (87%) patients with left-sided carcinoid involvement had a patent foramen ovale. Three patients with severe degree of shunting had severe valvular regurgitation. Patients with mild/moderate degree of shunting had mild or moderate valvular regurgitation. Three-dimensional transthoracic echocardiography/transesophageal echocardiography provided detailed anatomic information particularly for the tricuspid and pulmonary valves. Cardiac MRI allowed complementary assessment of valvular heart disease and delineation of myocardial metastases. Gallium-68 octreotide positron emission tomography identified neuroendocrine metastases.Conclusions-Carcinoid heart disease is a heterogeneous disease with a wide spectrum of echocardiographic findings. A multimodality approach is needed in patients with this complex pathology. (Circ Cardiovasc Imaging. 2010;3:103-111.)

Type:Article
Title:Features of Carcinoid Heart Disease Identified by 2-and 3-Dimensional Echocardiography and Cardiac MRI
DOI:10.1161/CIRCIMAGING.109.886846
Keywords:valves, heart disease, carcinoid, TWO-DIMENSIONAL ECHOCARDIOGRAPHY, DIAGNOSIS, TUMORS
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science

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