Surgical treatment of carcinoid heart disease

A 70-year-old female with severe tricuspid regurgitation and stenosis was admitted to our institution because of watery diarrhea and peripheral edema. The urinary 5-hydroxyindoleacetic acid (5-HIAA) level was 292.9 mg/l (normal, 0.5-5.0 mg/l). Abdominal computed tomography showed enhanced multiple nodules in the liver. The liver biopsy revealed metastatic carcinoid disease, which was thought as an etiology in severe tricuspid regurgitation and stenosis. We administered long acting somatostatin analog, octreotide to control carcinoid symptoms. After improvement of general condition, she successfully underwent bioprosthetic valve replacement with concomitant octreotide administration. Postoperative course was uneventful. She had been followed up with administration of octreotide at outpatient clinic. Cardiac surgery for carcinoid heart disease is complicated by hemodynamic instability secondary to carcinoid crises which can be provoked pharmacologically by administration of vasoactive medications. Octreotide is an effective tool to manage manifestation of carcinoid activity. We could performed surgical treatment of carcinoid heart disease safely in the perioperative presence of octreotide.