Surgical Correction of Carcinoid Heart Disease Improves Liver Function and 5-Hydroxyindoleacetic Acid Levels

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Introduction: Neuroendocrine tumours of the gastrointestinal tract cause carcinoid syndrome and carcinoid heart disease. These tumours secrete serotonin, which can bind to heart valves and cause fibrosis and valve incompetence. Most cases involve the tricuspid valve +/- pulmonary valve. Medical management comprises diuretics for fluid overload and somatostatin analogues to reduce circulating serotonin. Definitive treatment is heart-valve replacement surgery which improves exercise tolerance but has high perioperative mortality. We have previously reported that valve-replacement surgery can reduce 5-hydroxyindoleacetic acid (5-HIAA) levels, reflecting a decline in hormone activity.

Aim(s): The purpose of this study is to confirm these findings and investigate the reason for this effect. The liver is known to degrade serotonin and other tumour products; therefore, it is possible that reduction in 5-HIAA is related to improvements in liver function. We investigated the role of the kidneys also.

Materials and methods: Included in this study were all patients from the Queen Elizabeth Hospital Birmingham who had undergone heart-valve replacement surgery from 2010-2019 (n=40). After exclusion criteria were applied, 17 patients were left. We collected tumour markers, liver function data and renal function data pre- and post-surgery using electronic patient records. Data analysis was performed using SPSS.

Conference: 17th Annual ENETSConcerence (2020)

Presenting Author: Shah H

Authors: Shah H, Sagar V, Venkataraman H, Steeds R, Rooney S,

Keywords: carcinoid, carcinoid syndrome, neuroendocrine tumour, carcinoid heart disease, 5hiaa,