About the Cover
ON THE COVER Carcinoid tumors are uncommon. At diagnosis, 20%—30% of patients present with carcinoid syndrome defined by cutaneous flushing, gastrointestinal hypermotility, bronchospasm, and heart involvement. Carcinoid heart disease is associated with tumor release of protean vasoactive substances, particularly serotonin, causing severe fibrotic endocardial plaquing. This fibrous reaction mostly involves the right-sided valves, extending toward the subvalvular apparatus. Three-dimensional (A) and 2-dimensional (B) echocardiographic images from a patient with carcinoid heart disease demonstrate advanced tricuspid disease with severe septal and anterior leaflet thickening and retraction in a fixed, semi-open position. Intraoperative analysis (C) of the tricuspid valve shows leaflet thickening and retraction with severe subvalvular involvement. Histological study (D) of surgical specimen of the tricuspid valve reveals high cellularity (myofibroblasts) and a proliferating collagenous matrix (original magnification ×200). Images provided by Javier G. Castillo, MD,* Farzan Filsoufi, MD,* Parwis B. Rahmanian, MD,* Anelechi Anyanwu, MD,* Jerome S. Zacks, MD,† Richard R. P. Warner, MD,‡ David H. Adams, MD, FACC,* from the *Department of Cardiothoracic Surgery, †Cardiovascular Institute, and ‡Division of Gastroenterology, The Mount Sinai School of Medicine, New York, New York
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Copyright © 2008 by the American College of Cardiology Foundation.
