Carcinoid heart disease is a potential sequela of a neuroendocrine tumor. Patients who develop the condition may have symptoms of carcinoid syndrome or they may have a relatively asymptomatic period until they begin to show signs of progressive heart failure. Treatments are aimed at addressing the underlying cause and achieving optimal health. A variety of medications are used to treat the syndrome. A diuretic may help relieve the symptoms. Various medications can be given to prevent the onset of a carcinoid crisis.
There are some risks involved with surgery, such as significant valvular dysfunction and symptomatic right ventricular failure. Some contraindications to surgery include end-stage metastatic disease, poor control of carcinoid symptoms, and hepatic dearterialization. Surgical treatment for carcinoid heart disease should only be considered in a patient with severe symptoms. It is not necessary for patients with mild pulmonary insufficiency if their symptoms are well-controlled.
Although there are many treatments for carcinoid heart disease, only a few studies have evaluated the prognosis of patients with the disease. Westberg et al.8 reported similar survival among 52 patients with suspected carcinoid heart disease. In their study, the severity of tricuspid valve regurgitation was a significant risk factor for survival. The prognosis of patients with metastatic carcinoid disease was poor, with median survival of 2.6 years.
The median survival from the diagnosis of carcinoid heart disease is 4.8 years, which is lower than for patients with asymptomatic cardiomyopathy. The mortality rate from carcinoid heart disease is 16% (95 percent confidence interval [CI]: 8% to 24%). The severity of tricuspid valve regurgitation is the most important predictor of outcome. The severity of symptoms depends on the degree of cancer and the type of tricuspid valve.
In addition to reducing the mortality rate, other factors should be considered when considering carcinoid heart disease. Surgical techniques for this condition include hepatic dearterialization, or a hepatic artery ligation. However, this option is not recommended in patients with end-stage metastatic disease. It also requires a multidisciplinary approach. While it is possible to improve the outcome of patients with this heart condition, the operative outcomes can be unpredictable.
Surgical options for carcinoid heart disease include detournement of the hepatic artery or a heart valve. Several different methods have been used for this procedure, including somatostatin analogues, hepatic artery dearterialization, and surgical excision of the tumor. Nevertheless, it is important to understand the risks and benefits of surgery for patients with carcinoid heart disease.
Despite the high mortality rate associated with this disease, a recent study showed that the number of patients undergoing the procedure dropped by about 50%. This study was conducted on a large population of patients with carcinoid heart disease, and it was published in the N Engl J Med 348:11, 2006. The researchers found that both the level of 5-hydroxyindoleacetic acid and the amount of transforming growth factor beta and octreotide in plasma was an important risk factor for carcinoid heart disease.
The most common treatment for carcinoid heart disease is surgical excision of the affected artery. In addition to the surgical excision, a balloon expandable transcatheter heart valve is used in some cases. In these patients, a balloon expandable stent is implanted in the pulmonary artery. In some cases, a stent is not an option. A bioprosthetic valve is used instead.
In patients with carcinoid heart disease, the median survival was 2.6 years following the diagnosis of the condition. In this case, the disease is asymptomatic until the patients have signs and symptoms of progressive heart failure. They may develop symptoms of the asymptomatic form of carcinoid syndrome, but they may not have any other underlying symptoms. This means that the treatment of carcinoid heart disease is a very complex and lengthy process.
In some cases, the tumour is too large to be removed through surgery. In this case, the patient must be diagnosed surgically. In this case, the patient may be able to undergo surgery to remove the tumour. If the tumor has spread to the lungs, it can cause a heart attack. In these cases, the treatment of the cancer is not successful. The tumor must be surgically removed. The doctor will have to remove the entire lungs.