Surgical treatment of carcinoid syndrome metastatic disease: Partial hepatectomy with veno-venous bypass and subsequent tricuspid valve replacement. Case report
Carcinoid syndrome is a relatively rare condition that may affect the liver and the right heart. Some of these cases may require surgical treatment with a multidisci-plinary approach.
We report the case of a patient with progressive dyspnoea, arterial hypotension and facial flushing, diagnosed with liver and cardiac involvement from carcinoid syndrome. The patient was taken to surgery in two different occasions, first for metastatic liver resection, and then to subsequent cardiac surgery for tricuspid valve replacement.
We report here a case review, including the clinical course, the intra-operative management, and the information available in the literature regarding which procedure to perform initially in these types of cases which are not very common in clinical practice.
2. Fox DJ, Khattar RS. Carcinoid heart disease: presentation, diagnosis, and management. Heart. 2004;90:1224-8.
3. Fraenkel M, Kim M, Faggiano A, de Herder WW, Valk GD. Incidence of gastroenteropancreatic neuroendocrine tumours: a systematic review of the literature. Endocr Relat Cancer. 2014;21:R153-63.
4. Modlin IM, Lye KD, Kidd M. A5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97:934-59.
5. Lundin L, Norheim I, Landelius J. Carcinoid heart disease: relationship of circulating vasoactive substances to ultrasound-detectable cardiac abnormalities. Circulation. 1988;77:264-9.
6. Pokuri VK, Fong MK, Iver R. Octreotide and lanreotide in gastroenteropancreatic neuroendocrine tumors. Curr Oncol Rep. 2016;18:7.
7. Patel C, Mathur M, Escarcega RO, Bove A. Carcinoid heart disease: current understanding and future directions. Am Heart J. 2014;167:789-95.
8. Castillo JG, Silvay G, Solís J. Current concepts in diagnosis and perioperative management of carcinoid heart disease. Semin Cardiothorac Vasc Anesth. 2013;17:212-23.
9. Manoly I, McAnelly S-L, Sriskandarajah S, McLaughlin KE. Prognosis of patients with carcinoid heart disease after valvular surgery. Interact Cardiovasc Thorac Surg. 2014;19:302-5.
10. Williamson JML, Anderson J, Spalding DRC. Surgical resection of hepatic and cardiac neuroendocrine metastases from a caecal primary tumour. Ann R Coll Surg Engl. 2014;96:e7-8.
11. Suphathamwit A, Dhir A, Dobkowsky W, Quan D. Successful hepatectom using venovenous bypass in a patient with carcinoid heart disease with severe tricuspid regurgitation. J Cardiothorac Vasc Anesth. 2016;30:446-51.
12. Mayo SC, de Jong MC, Pulitano C, Clary BM, Reddy SK, Clark Gamblin T, et al. Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multiinstitutional analysis. Ann Surg Oncol. 2010;17:3129-36.
13. Rosario I, Andrade M, Arroja I, Plácido A, Mendes M. Carcinoid heart disease. Rev Port Cardiol. 2014;33:59-60.
14. Calero Rueda MJ, Aldamiz-Echevarría G, Arjonilla-López A, Sánchez Almaraz C, García Romero A, Sánchez-Aquino R, et al. Cardiac metastasis in a patient with a bronchial carcinoid. Circulation. 2014;130:e1-3.
15. Askew JW, Connolly HM. Carcinoid valve disease. Curr Treat Options Cardiovasc Med. 2013;15:544-55.
16. Yan AT, Gupta P, Deva D, Choi R, Kirpalani A. An unusual case of metastatic carcinoid tumour in the interventricular septum. J Cardiovasc Med. 2016;17:e126-8.
17. Lillegard JB, Fisher JE, Mckenzie TJ, Que FG, Farnell MB, Kendrick ML, et al. Hepatic resection for the carcinoid syndrome in patients with severe carcinoid heart disease: does valve replacement permit safe hepatic resection? J Am Coll Surg. 2011;213:130-8.
18. Dobson R, Burgess MI, Pritchard DM, Cuthbertson DJ. The clinical presentation and management of carcinoid heart disease. Int J Cardiol. 2014;173:29-32.
19. Yamaoka Y, Ozawa K, Kumada K, Shimahara Y, Tanaka K, Mori K, et al. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass. Arch Surg. 1992;127:276-80.
20. Mancuso K, Kaye AD Boudreaux JP, Fox CJ, Lang P, Kalarickal PL, et al. Carcinoid syndrome and perioperative anesthetic considerations. J Clin Anesth. 2011;23:32941.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.