Staged Percutaneous Treatment of Severe Carcinoid Heart Disease by Transfemoral Pulmonary Valve Replacement and Novel Vena Cava Valve Implantation

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Introduction: Carcinoid heart disease with severe valve destruction represents the major cause of high morbidity and mortality in patients with carcinoid syndrome.

Aim(s): In this case report, we present a patient suffering advanced carcinoid heart disease at whom a two-stage minimally invasive percutaneous approach for management of severe pulmonary and tricuspid valve regurgitation was applied for the first time.

Materials and methods: A patient with an ileal neuroendocrine tumour (G2, Ki67: 5%) presented with right heart failure (NYHA IV). Echocardiography disclosed advanced carcinoid heart disease affecting both the pulmonary and the tricuspid valves. A balloon-expandable 29-mm Edwards SAPIEN XT was successfully implanted percutaneously into the pulmonary valve. Since no catheter-based techniques were available for the replacement of the native tricuspid valve, we designed a novel approach to reduce the abdominal congestion: for the first time we implanted an Edwards SAPIEN 26-mm valve into the ICV between the right atrium and the ostium of the hepatic veins, which completely prevented regurgitation into the VCI and abdominal veins.

Conference: 12th Annual ENETSConcerence (2015)

Presenting Author: Stangl K

Authors: Pschowski R, Laule M, Baur A, Pape U, Pavel M,

Keywords: Carcinoid heart disease, percutaneous ,