Rapid Progression of Carcinoid Heart Disease During the Preoperative Workup for Multivisceral Transplant

A 46-year-old woman with metastatic neuroendocrine tumor underwent echocardiography as part of an evaluation prior to multivisceral transplant. It revealed normal left ventricular systolic function, mild pulmonic insufficiency, and a thickened immobile anterior tricuspid leaflet with severe tricuspid regurgitation (TR) (Figure 1). She developed New York Heart Association Class II symptoms, and follow-up echocardiogram 8 months later revealed a reduced systolic function (ejection fraction 39%), continued severe TR, mild pulmonary hypertension, and color flow turbulence across the pulmonic valve with a peak velocity of 2.43 m/s, peak gradient of 24 mmHg, and worsening, moderate pulmonic regurgitation.

Figure 1

Figure 1
Thickened, immobile anterior tricuspid leaflet (A white arrow) (B white arrow) with severe TR (B).

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