Loyalka Pranav, Schechter Michael, Nascimbene Angelo, Raman Ajay Sundara, Ilieascu Cezar A, Gregoric Igor D, Kar Biswajit
Tex Heart Inst J. 2016 Aug 1;43(4):341-4. doi: 10.14503/THIJ-15-5310. eCollection 2016 Aug.
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. The patient had a history of metastatic neuroendocrine tumor of the small bowel with carcinoid syndrome, carcinoid heart disease, and tricuspid valve regurgitation previously treated with surgical valve replacement. Because of the patient's severe chronic obstructive pulmonary disease and hostile chest anatomy seen on a computed tomographic scan dating from previous cardiothoracic surgery, we considered off-label percutaneous valve replacement a viable alternative to open-heart surgery. A 29-mm Edwards Sapien XT valve was successfully deployed over the native pulmonary valve. There were no adverse sequelae after the procedure, and the patient was discharged from the hospital the next day. This case report shows that percutaneous valve replacement can be a valid option in carcinoid heart disease patients who are not amenable to surgical valve replacement.
类癌性心脏病表现为由于三尖瓣和肺动脉瓣功能障碍导致的右侧心力衰竭。尽管当患者出现症状时，手术瓣膜置换是主要的治疗方法，但它与较高的围手术期死亡率相关。我们报告一例继发于类癌性心脏病的严重肺动脉瓣狭窄病例，经皮瓣膜置换治疗成功。一名患有严重肺动脉瓣狭窄的67岁男性被转诊至我们中心进行肺动脉瓣置换。该患者有小肠转移性神经内分泌肿瘤伴类癌综合征、类癌性心脏病和三尖瓣反流病史，此前已接受手术瓣膜置换治疗。由于患者患有严重的慢性阻塞性肺疾病，且在既往心胸外科手术的计算机断层扫描中显示胸部解剖结构复杂，我们认为使用未获批准的经皮瓣膜置换术是心脏直视手术的可行替代方案。一枚29毫米的爱德华兹Sapien XT瓣膜成功植入到原生肺动脉瓣上。术后无不良后遗症，患者于次日出院。本病例报告表明，对于不适合手术瓣膜置换的类癌性心脏病患者，经皮瓣膜置换可能是一种有效的选择。
