Carcinoid heart disease occurs in up to 20% of patients with symptoms of carcinoid syndrome (diarrhoea, flushing, abdominal pain, bronchospasm (asthma).
Excess serotonin, a hormone released by the NET tumours into the bloodstream affects the heart by causing thick ‘plaques’ within the heart muscle and damage to valves (tricuspid and pulmonary) on the right side of the which become ‘tightly narrowed’ or ‘leaky’. Patients with carcinoid heart disease present with symptoms such as breathlessness, fatigue, enlarged liver and swollen ankles and without treatment can develop right heart failure.
Somatostatin analogues (octreotide, lanreotide etc) can slow the progression of carcinoid heart disease, however, some patients may need cardiac surgery to replace the narrowed or leaking valves to improve their symptoms and quality of life. Cardiac surgery for valve replacement necessitates that the patient have open heart surgery and be put on ‘cardiopulmonary’ bypass machine while the cardiac surgeon replaces the valve. Some patients are too unwell or unwilling to undergo such significant surgery.
In a world first, two prominent Sydney interventional Cardiologists – Dr David Tanous and Dr Philip Roberts have percutaneously implanted an artificial valve into a NET patient, treating her narrowed pulmonary valve. In this procedure, a catheter was inserted into the femoral vein (in the groin) and with the assistance of x-ray imaging, an artificial valve was placed across the narrowed valve. Sheryl, who had been suffering from carcinoid heart disease for some time, now ‘feels well enough to return to work”.
On the day I saw her she proclaimed that she felt wonderful and had more energy and was surprised that her recovery time was so quick. The Unicorn Foundation is excited about the use of this treatment and its future potential in NET patients with symptomatic and significant carcinoid heart disease. Dr John Leyden