Balancing carcinoid crisis and right ventricular dysfunction during tricuspid and pulmonic valve replacement for carcinoid heart disease: A case report. Int J Surg Case Rep 2023 Jan;102:107855
Date
01/08/2023Pubmed ID
36610355Pubmed Central ID
PMC9829749DOI
10.1016/j.ijscr.2022.107855Scopus ID
2-s2.0-85145728191 (requires institutional sign-in at Scopus site)Abstract
INTRODUCTION AND IMPORTANCE: Carcinoid tumors are rare malignancies of neuroendocrine origin that can manifest with a constellation of systemic symptoms including right-sided cardiac involvement. Many patients with carcinoid heart disease require valve replacement, but intraoperative management of carcinoid syndrome varies within the literature.
CASE PRESENTATION: A 72-year-old man with carcinoid syndrome underwent tricuspid and pulmonic valve replacement with multiple episodes of carcinoid crisis intraoperatively as well as right ventricular dysfunction after cardiopulmonary bypass.
CLINICAL DISCUSSION: Octreotide is the mainstay in prevention and treatment of intraoperative carcinoid crisis, but reported dosages and timing varies significantly. The use of exogenous catecholamines is also controversial as they are thought to paradoxically worsen carcinoid symptoms. Our patient was managed successfully with both an octreotide infusion and intermittent boluses, as well as exogenous catecholamines for right ventricular support during and after cardiopulmonary bypass.
CONCLUSION: The management of carcinoid syndrome in patients undergoing valve surgery for carcinoid heart disease is dependent on timely prevention and treatment of carcinoid crisis and effective mitigation of right ventricular dysfunction.
Author List
Pagryzinski AR, Schena S, Novalija J, Almassi GH, Pagel PS, Hang DAuthors
G Hossein Almassi MD Professor in the Surgery department at Medical College of WisconsinJutta Novalija MD, PhD Professor in the Anesthesiology department at Medical College of Wisconsin
Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
