366 RIGHT HEART FAILURE IN CARCINOID HEART DISEASE: A MULTIDISCIPLINARY APPROACH

Abstract Introduction Carcinoid heart disease occurs in more than 50% of patients with neuroendocrine gastrointestinal tumors, and it is the initial presentation carcinoid syndrome up to 20% patients. The characterized by pathognomonic plaque-like deposits fibrous tissue endocardium valvular cusps, cardiac chambers, occasionally, intima pulmonary arteries or aorta. tricuspid valve are most often affected disease, several combinations dysfunction (usually pulmonic stenosis + regurgitation). Valvular can lead peripheral edema, ascites right-sided failure, extreme cases may present low output syndrome. Valve surgery relieve symptoms should be considered controlled neoplasia. Case report a 47-years-old man history operated tumor (ileal resection+right hemicolectomy+mesenteric lymphadenectomy) was admitted our department for right failure. His clinical examination remarkable ankle swelling, flushing, liver congestion, ascites; moreover patient reported progressive compromise functional capacity weight loss due anorexia. Laboratory findings were normal range except BNP 184 pg/ml (UNL <100 pg/dl). ECG: sinus rhythm 80 bpm, diffuse repolarization abnomarlities. Transthoracic echocardiography showed: severe chambers remodeling RV+RA dilatation associated systo-diastolic septal bulge (pressure volume overload), torrential regurgitation (secondary fibrotic retraction leaflets coaptation deficiency apical tethering), moderate-to-severe stenosis; on left side: mitral aortic valves normal, there mild reduction ventricle ejection fraction secondary ventricular interdipendence. discussed Heart Team: sided both responsible patient's symptoms, so he scheduled surgical intervention after achieving adeguate haemodinamic stability. Pre-surgery catetherization showed pressures. Coronary normal. Before, during treated octreotide reduce risk Crisis perioperative period. underwent replacement biological prosthesis Mosaic n°33 Avalus n°23 respectively. Histological extensive endocardium. Post-surgical hospital stay uneventful, discharged 14 days good conditions. In order prevent thromboembolic events anticoagulant therapy Warfarin introduced. Conclusion this rare condition failure symptoms. Team discussion multidisciplinary approach involving surgeons oncologist mandatory establish best treatment strategy timing interventions. However, since condition, evidence needed better understand long term outcomes options (including future percutaneous perspectives).