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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
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AFRICA
and is associated with improvement in a patient’s functional
state. However, a significantly high 30-day mortality rate,
which is attributed to bleeding complications, intractable heart
failure and other concomitant co-morbidities, has been a major
drawback. According to the Duke carcinoid database, supported
by other databases, older age, particularly over 60 years of age,
is an important independent risk factor for high peri-operative
complications and is also associated with high mortality rates.
55-59
Conclusion
At least half of the patients with carcinoid syndrome present
with structural heart disease, usually evidenced during routine
transthoracic echocardiographic examination. Although
carcinoid heart disease is undoubtedly regarded as a rare form
of structural heart disease, a strong suspicion should be raised
in patients with classical or florid carcinoid syndrome. Although
echocardiography remains the gold standard for diagnostic and
confirmatory purposes, biochemical screening and imaging for
primary carcinoid tumour should form an integral part of the
diagnostic algorithm.
Valve replacement is associated with significant improvement
in heart-failure symptoms and improves patients’ functional
capacity. However, stringent peri-operative management is vital
to avoid carcinoid crisis and impending death. Although there
are no definite stringent criteria for the choice of an artificial
valve, mechanical valve prostheses are considered durable as they
are not affected by vasoactive substances. However bioprosthetic
valves should be preferred to avoid long-term anticoagulation.
Early detection and valve surgery should be considered to avoid
the development of right heart failure, as advanced heart failure
represents a high-risk subgroup. In patients with advanced
heart failure and possible advanced myocardial dysfunction,
transplantation could be an option.
I thank the Servier Programme for Registrars in Cardiology for their enthu-
siasm and dedication and the support they offered me for the abstract I
presented, titled Carcinoid heart disease.
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