Carcinoid heart disease of gonadal primary presenting with hypoxia: a case report.
Case report
Echocardiography
Neuroendocrine tumour
Patent foramen ovale
Shunt
Valvular disease
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
18
07
2020
revised:
26
08
2020
accepted:
02
12
2020
entrez:
14
6
2021
pubmed:
15
6
2021
medline:
15
6
2021
Statut:
epublish
Résumé
Carcinoid heart disease is a potential sequela of metastatic neuroendocrine tumour that has characteristic valve appearances. Patients can present with symptoms of carcinoid syndrome or be relatively asymptomatic until symptoms of progressive heart failure manifest. We present a case of a 54-year-old male who was admitted to the hospital for investigation of hypoxia. Transthoracic echocardiogram was suggestive of carcinoid heart disease which subsequently led to a diagnosis of metastatic neuroendocrine (carcinoid) tumour of the testicular primary. Work-up revealed a patent foramen ovale with evidence of the right to left interatrial shunt from severe tricuspid regurgitation as the cause of his hypoxia. Prior to surgical excision of the primary tumour, percutaneous patent foramen ovale closure was performed resulting in improved arterial oxygen saturation and symptomatic improvement. Carcinoid heart disease typically affects the right-sided cardiac valves and the tricuspid valve appearances were critical in leading to a diagnosis of a metastatic neuroendocrine tumour in our patient. This case demonstrates that percutaneous patent foramen ovale closure can be an effective intervention for hypoxia in those not managed surgically. A high index of suspicion should be maintained for gonadal primary carcinoid tumour when there is carcinoid heart disease in the absence of liver metastases.
Sections du résumé
BACKGROUND
BACKGROUND
Carcinoid heart disease is a potential sequela of metastatic neuroendocrine tumour that has characteristic valve appearances. Patients can present with symptoms of carcinoid syndrome or be relatively asymptomatic until symptoms of progressive heart failure manifest.
CASE SUMMARY
METHODS
We present a case of a 54-year-old male who was admitted to the hospital for investigation of hypoxia. Transthoracic echocardiogram was suggestive of carcinoid heart disease which subsequently led to a diagnosis of metastatic neuroendocrine (carcinoid) tumour of the testicular primary. Work-up revealed a patent foramen ovale with evidence of the right to left interatrial shunt from severe tricuspid regurgitation as the cause of his hypoxia. Prior to surgical excision of the primary tumour, percutaneous patent foramen ovale closure was performed resulting in improved arterial oxygen saturation and symptomatic improvement.
DISCUSSION
CONCLUSIONS
Carcinoid heart disease typically affects the right-sided cardiac valves and the tricuspid valve appearances were critical in leading to a diagnosis of a metastatic neuroendocrine tumour in our patient. This case demonstrates that percutaneous patent foramen ovale closure can be an effective intervention for hypoxia in those not managed surgically. A high index of suspicion should be maintained for gonadal primary carcinoid tumour when there is carcinoid heart disease in the absence of liver metastases.
Identifiants
pubmed: 34124556
doi: 10.1093/ehjcr/ytaa536
pii: ytaa536
pmc: PMC8189296
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ytaa536Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Heart. 2017 Oct;103(19):1488-1495
pubmed: 28596302
Cancer. 1997 Feb 15;79(4):813-29
pubmed: 9024720
Heart. 2004 Oct;90(10):1224-8
pubmed: 15367531
Am J Cardiol. 2004 May 15;93(10):1314-5
pubmed: 15135715
Circulation. 1993 Apr;87(4):1188-96
pubmed: 7681733
Circ Cardiovasc Imaging. 2010 Jan;3(1):103-11
pubmed: 19920029
Aust N Z J Med. 1989 Dec;19(6):716-7
pubmed: 2631666
J Am Coll Cardiol. 2017 Mar 14;69(10):1288-1304
pubmed: 28279296
BJU Int. 2008 May;101(9):1101-5
pubmed: 18190641
Curr Cardiol Rep. 2006 Mar;8(2):96-101
pubmed: 16524535