REGRESSION OF METASTATIC CARCINOID-TUMOR AFTER VALVULAR SURGERY FOR CARCINOID HEART-DISEASE

BACKGROUND, The carcinoid syndrome is a common sequela in patients wit h carcinoid tumor metastatic to the liver. Cardiac involvement occurs in 19-56% of patients with symptomatic carcinoid syndrome and, in some patients, leads to valvular surgery to relieve symptoms due to progre ssive right-sided heart failure. Reports of these patients have emphas ized amelioration of cardiac symptoms, but postoperative tumor status rarely has been discussed. METHODS, This report describes four patient s who underwent valvular heart surgery for severe carcinoid heart dise ase and had regression of there metastatic carcinoid tumor postoperati vely. RESULTS, All four patients had definite clinical improvement in cardiac function and relief of symptoms related to congestive heart fa ilure postoperatively. Unexpectedly, they also had regression of their metastatic disease, as reflected in decreased levels of urinary 5-hyd roxyindoleacetic acid, and objective evidence of a reduction in the si ze of hepatic metastases. CONCLUSIONS, To tile authors' knowledge, the se four patients represent the first reported cases of metastatic dise ase regression after valvular surgery for carcinoid heart disease. Fur ther descriptions of tumor status in patients having undergone a heart operation for this disease would be valuable in determining the clini cal significance of this finding. (C) 1997 American Cancer Society.