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CLINICAL STUDY

Metastatic carcinoid tumor to the heart: echocardiographic-pathologic study of 11 patients

Utpal H. Pandya, MD^*, Patricia A. Pellikka, MD^*, Maurice Enriquez-Sarano, MD^*, William D. Edwards, MD, Hartzell V. Schaff, MD and Heidi M. Connolly, MD^*,*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received March 8, 2002; revised manuscript received May 15, 2002, accepted May 23, 2002.

^* Reprint requests and correspondence: Dr. Heidi M. Connolly, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Connolly.heidi{at}mayo.edu

OBJECTIVES: We sought to investigate the clinical and echocardiographic (echo) characteristics of metastatic carcinoid tumor in the heart.

BACKGROUND: Right-sided valvular dysfunction is the hallmark of carcinoid heart disease. Cardiac metastases are uncommon in carcinoid syndrome. Features of patients with metastatic carcinoid tumor involving the heart (MCH) have not been well described.

METHODS: From 1985 through 1999, 11 patients (8 male, 3 female), mean age ± standard deviation, 58 ± 6 years, were seen who had pathologically confirmed MCH. All patients had echoes, which were reviewed retrospectively.

RESULTS: All patients with MCH had carcinoid syndrome. The primary carcinoid tumor was in the small bowel in 83% of patients, and all patients had hepatic metastases. On pathologic review, the 11 patients had 15 MCH tumors. All metastases were intramyocardial. The MCH involved the right ventricle in 40%, left ventricle in 53%, and ventricular septum in 7%. The average size of macroscopic tumors was 1.8 ± 1.2 cm. Nine MCH tumors were detected by echo in 6 of the 11 patients (55%). Mean echo-detected tumor size was 2.4 cm (range, 1.2 to 4). All tumors noted by echo were well circumscribed, non-infiltrating, and homogeneous. In the 5 other patients, review of autopsy records revealed 6 macroscopic tumors, mean size 0.35 cm (range, 0.2 to 0.4), none detected by echo even retrospectively. Carcinoid valve disease was present in 8 of the 11 MCH patients. The tricuspid valve was affected in all 8 patients (73%), pulmonary valve in 7 (64%), and left sided valves in 4 (36%) All patients with MCH identified by echo had cardiac surgery, 3 primarily for carcinoid valve disease and 2 for non-carcinoid cardiac disease; in 1 patient, MCH was the primary indication for cardiac surgery.

CONCLUSIONS: MCH is uncommon but can be easily identified by echo if tumor size is 1.0 cm. In patients without valvular dysfunction, MCH may be the only manifestation of carcinoid heart disease. A search for MCH should be an integral part of the echo exam in patients with carcinoid syndrome.

Abbreviations and Acronyms   5-HIAA   5-hydroxyindoleacetic acid   MCH   metastatic carcinoid tumor involving the heart

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