830 Surgical Management of a Patient with Triple Carcinoid Heart Valve Disease
L Holland, S Ghouri, N Sahdev, G Liu, P Punjabi- Surgery
Abstract
Background
Carcinoid heart disease is an uncommon manifestation of carcinoid syndrome that can present to a cardiac surgeon as a complex constellation of structural problems. Patients develop progressive valve disease, more commonly of the right-sided heart valves but sometimes involving the left, which will in turn impact cardiac function. Without intervention, carcinoid heart disease portends a dismal prognosis. Given the rarity with which these cases are encountered, in conjunction with their complexity, it is important for the cardiac surgeon to be equipped with the knowledge of how to operate on these patients and the challenges likely to be faced.
Case
A 72-year-old man, who had previously undergone small bowel resection for multifocal neuroendocrine tumours, was referred to our centre with significant symptomatic carcinoid heart valvulopathy affecting the tricuspid, mitral and aortic valves. He successfully underwent triple valve replacement and permanent epicardial pacing system implantation along with coronary artery bypass grafting. He was discharged after an inpatient stay of two weeks and is well at follow-up.
Discussion
Triple valve replacement is infrequently performed in the UK, but all centres ought to be prepared to offer this treatment in a select group of patients. In this report we describe the technicalities of performing such an operation and the relevant surgical anatomy, the rationale and technique of pre-emptive epicardial pacing system implantation, and both the pre- and post-operative management of such patients.