BACKGROUND: Carcinoid involvement of left-sided heart valves has been reported 
in patients with a patent foramen ovale, carcinoid tumor of the lung, and active 
carcinoid syndrome with high levels of serotonin. The present study details the 
clinical features and surgical management of patients with carcinoid heart 
disease affecting both left- and right-sided valves.
METHODS AND RESULTS: Eleven patients (7 men, 4 women) with symptomatic carcinoid 
heart disease underwent surgery for left- and right-sided valve disease between 
1989 and 1999. Mean age was 57+/-9 years, and median preoperative NYHA class was 
3. All patients had metastatic carcinoid tumors and were on somatostatin analog. 
Of 11 patients, 5 (45%) had a patent foramen ovale; 1 of these also had a 
primary lung carcinoid tumor. Surgery included tricuspid valve replacement in 
all patients, pulmonary valve replacement in 3 and valvectomy in 7, mitral valve 
replacement in 6 and repair in 1, aortic valve replacement in 4 and repair in 2, 
CABG in 2, and patent foramen ovale closure in 5. One myocardial metastatic 
carcinoid tumor was removed. There were 2 perioperative deaths. At a mean 
follow-up of 41 months, 4 additional patients were dead. All but 1 surgical 
survivor initially improved >/=1 functional class. No patient required 
reoperation.
CONCLUSIONS: Carcinoid heart disease may affect left- and right-sided valves and 
occurred without intracardiac shunting in 55% of this surgical series. Despite 
metastatic disease that limits longevity, operative survivors had improvement in 
functional capacity. Cardiac surgery should be considered for select patients 
with carcinoid heart disease affecting left- and right-sided valves.