Valvular heart disease caused by carcinoid syndrome: emphasis on the use of intraoperative transesophageal echocardiography.

e ARCINOID TUMORS ARE rare neuroendocrine tumors derived from enterochromaffin cells with an annual incience of 1.2 to 2.1 per 100,000 in the general population.1 arcinoid syndrome is a term for a constellation of symptoms aused by a variety of mediators. Symptoms of episodic flushng, secretory diarrhea, bronchospasm, hypotension, and rightided heart disease are caused by mediators such as serotonin, istamine, prostaglandin, kallikrein, neuropeptide, and bradyinin. Specifically, carcinoid heart disease occurs in more than 0% of patients with carcinoid syndrome.2-4 In addition, severe ypotension and bronchospasm may occur during a carcinoid risis. A patient scheduled for a tricuspid valve replacement (TVR) ecause of carcinoid heart disease is described. According to he transthoracic echocardiographic (TTE) findings, she was cheduled only for a TVR; however, during intraoperative ransesophageal echocardiography (TEE), additional involveent of the pulmonary valve was revealed.

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