BALLOON DILATION OF TRICUSPID AND PULMONARY VALVES IN CARCINOID HEART-DISEASE

Heart involvement is usually the cause of death in patients with carci noid syndrome, who may survive a long time even after the disease has entered an advanced stage. For this reason, carcinoid heart disease pa tients have undergone surgical replacement of affected valves. Two of our patients were not good candidates for surgery, due to the extent o f hepatic metastasis. Alternatively, we performed percutaneous balloon valvuloplasty on both the tricuspid and pulmonary valves in both pati ents. To our knowledge, there has been only 1 previous report of succe ssful tricuspid valvuloplasty in a case of carcinoid heart disease, an d this did not involve concomitant pulmonary valvuloplasty Before the procedure, both of our patients had low cardiac output with restrictio n in the right ventricle, pulmonary and tricuspid stenosis, and modera te tricuspid regurgitation. In the 1st patient, valvuloplasty reduced tricuspid and pulmonary gradients without change in cardiac output. Th is patient experienced initial clinical improvement but died 8 months after the procedure, of portal hypertension and extensive hepatic meta stasis. The 2nd patient showed notably diminished gradients and a very significant increase in cardiac output. She advanced from New York He art Association functional class IV to class I, and is now maintained with diuretic therapy In our judgment, balloon valvuloplasty is a soun d alternative to surgery for patients with carcinoid heart disease, es pecially when stenosis is the dominant symptom. Valvuloplasty is contr aindicated in cases of severe tricuspid regurgitation.