A 70-year-old female with severe
tricuspid regurgitation and
stenosis was admitted to our institution because of watery
diarrhea and peripheral
edema. The urinary 5-hydroxyindoleacetic
acid (5-HIAA) level was 292.9 mg/l (normal, 0.5-5.0 mg/l). Abdominal computed tomography showed enhanced multiple nodules in the liver. The liver biopsy revealed metastatic
carcinoid disease, which was thought as an etiology in severe
tricuspid regurgitation and
stenosis. We administered long acting
somatostatin analog,
octreotide to control
carcinoid symptoms. After improvement of general condition, she successfully underwent bioprosthetic valve replacement with concomitant
octreotide administration. Postoperative course was uneventful. She had been followed up with administration of
octreotide at outpatient clinic. Cardiac surgery for
carcinoid heart disease is complicated by hemodynamic instability secondary to
carcinoid crises which can be provoked pharmacologically by administration of vasoactive medications.
Octreotide is an effective tool to manage manifestation of
carcinoid activity. We could performed surgical treatment of
carcinoid heart disease safely in the perioperative presence of
octreotide.