Carcinoid syndrome associated severe tricuspid regurgitation

Abstract

Background: Carcinoid heart disease is a serious complication of metastatic neuroendocrine tumors caused by prolonged exposure to circulating serotonin and other vasoactive substances. It predominantly affects right-sided cardiac valves and commonly presents severe tricuspid regurgitation. We report a 65-year-old female with Grade II ileal neuroendocrine tumor with liver metastasis evaluated for preoperative cardiac fitness. Echocardiography revealed severe tricuspid regurgitation, severe pulmonary arterial hypertension (PASP 67 mmHg), dilated right-sided chambers, and mild left ventricular dysfunction (EF 45%). Coronary angiography demonstrated normal epicardial coronary arteries. Histopathology confirmed a well-differentiated Grade II neuroendocrine tumor with chromogranin and synaptophysin positivity and Ki-67 index of 5–6%. The findings were consistent with carcinoid heart disease. Early recognition is essential for optimal perioperative and subsequent post-operative management of TR.