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Successful tricuspid valve replacement and pulmonary valvulotomy for carcinoid heart disease.

A case of successful tricuspid valve replacement with a mechanical prosthesis and pulmonary valvulotomy for carcinoid heart disease is reported. The patient was a 61 years old women. The primary tumor was in the terminal ileum. Liver metastasis and carcinoid syndrome were present since 8 years. After cardiac surgery, the patient survived 38 months and late death was related to disseminated metastasis. Even in case of metastasis, carcinoid tumor is slow growing. Without cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac failure rather than to tumoral growth. Thus, even in presence of metastasis, cardiac surgery may be mandatory to improve both quality of life and survival.

Carcinoid Heart Disease↗

[Supervision of patients with artificial heart valves (author's transl)].

Valvulotomy mortality is 2--5% depending on the age and the condition of the myocardium. Ball valves, disk valves and biological prostheses are most commonly used. The most important complications of valve prostheses include bacterial endocarditis, loosening of the artificial valve, hemolytic anemias and thromboembolism. Presently, the Hancock prosthesis gives the best results. Thrombus formation, the most frequent complication of ball and disk valves--sometimes in spite of anticoagulation--does not occur with the biological prosthesis. Strict anticoagulant therapy and supervision is therefore not necessary. Should the Hancock prosthesis continue to prove satisfactory, it is to be hoped that resistance to early operation will be overcome and that the most important cause of failure, valvulotomy in an irreversible damaged heart, will thus be eliminated.

Anemia, Hemolytic↗