Excerpt

A 62-year-old female with a known history of pulmonary disease (congenital bronchiectasis of the left lung) presented with right-sided heart failure. Echocardiography demonstrated straightened, restricted tricuspid leaflets fixed in an almost opened position (Fig. 1a), resulting in severe tricuspid regurgitation (Fig. 1b, Movie Clip 1). Although the normal concave curvature of the tricuspid leaflets was decreased, the tricuspid leaflets and tendons appeared non-thickened on visual assessment. The pulmonic valve was intact. The right heart chambers were moderately dilated and right ventricular contractility was preserved. Pulmonary artery systolic pressure could not be reliably estimated due to lack of coaptation of tricuspid leaflets. These findings were more in favor of organic tricuspid valve disease than cor pulmonale, and hence the suspicion for carcinoid heart disease was raised. Abdominal CT scan revealed a mass (presumably a neuroendocrine tumor) in the right ovary, ascites and abdominal lymphadenopathy. No focal liver lesions were detected. Serum serotonin level was significantly increased to >1000 ng/mL (normal range 80–400 ng/mL). The patient received therapy for right-sided heart failure which resulted in symptomatic improvement, and subsequently was referred to surgery for tricuspid valve replacement.

…