Recurrent prosthetic valve tricuspid valve regurgitation due to carcinoid; open or interventional approach?

MP051 

Abstract Submission 

Barbara Robinson (1), W. Randolph Chitwood (2), Samantha Kwon (3), Deepa Kabirdas (4)

(1) Br health for you LLC, Lake Barrington, IL, (2) East Carolina University/ECU Health System, Greenville, NC, (3) University of Florada,Ocala Campus, Ocala, FL, (4) Cardiology Raleigh, Raleigh, NC

Barbara Robinson    -  Contact Me
Br health for you LLC

*W. Randolph Chitwood    -  Contact Me
East Carolina University/ECU Health System

Samantha Kwon    -  Contact Me
University of Florada,Ocala Campus

Deepa Kabirdas    -  Contact Me
Cardiology Raleigh

Barbara Robinson    -  Contact Me
Br health for you llc

INTRODUCTION
We report a case of severe bioprosthetic carcinoid tricuspid valve regurgitation(TR), rapid degeneration of a pericardial tricuspid valve prosthesis performed robotically and rereplacement via sternotomy with a mechanical valve. Bioprosthetic tricuspid valve destruction may occur with persistent carcinoid disease. With combined cardiac and hepatic disease, addressing the cardiac component is favored first. Severe TR is an indication for tricuspid valve replacement(TVR).

With combined cardiac and hepatic disease, addressing the cardiac component is favored. The choice of prosthetic TVR remains controversial with some groups favoring mechanical, others biological. Mechanical valve may obviate risk of bioprosthetic valve deterioration if persistent hepatic carcinoid disease is present. Tissue valve options include bioprosthesis or percutaneous choices.
We report a case of rapid degeneration by carcinoid of a pericardial tricuspid valve prosthesis performed robotically and rereplacement with a mechanical valve via sternotomy.

METHODS
A 45-year-old man with primary terminal ileal carcinoid tumor, hepatic metastases, elevated chromogranin levels, previously treated with chemotherapy presented with dyspnea, a pansystolic murmur, jugular venous distention, hepatomegaly, ascites, and peripheral edema. Original preoperative TEE seen by the cardiothoracic surgery attending of the initial native stenotic and regurgitant tricuspid valve secondary to carcinoid disease showed massive TR with leaflet sclerosis and tethered, retracted chords (Figure 1). The patient did not desire a mechanical prosthesis initially with concern for possible hepatic reintervention.
RESULTS
He initially underwent a right thoracic robot-assisted #29 Magna Ease bovine pericardial TVR. Nine months later he developed severe tricuspid bioprosthesis insufficiency.
At median sternotomy reoperation, fibrotic tissues surrounded the tricuspid annulus.
The thickened, immobile and retracted pericardial bioprosthesis was difficult to extirpate and was replaced via median sternotomy with a 27-mm St. Jude mechanical prosthesis.He is well postoperatively.
CONCLUSION
We illustrate a case of bovine pericardial bioprosthesis destruction with carcinoid.
Options for subsequent bioprosthesis degeneration from persistent carcinoid have not been thoroughly
Historically, the morbidity and mortality of TVR have been higher in carcinoid.
Percutaneous options should be considered.

Mitral & Tricuspid Valve Reoperations