1Department of Laboratory Medicine, Kameda Medical Center, 2Department of Cardiology, Kameda Medical Center, 3Department of Cardiology, The Sakakibara Heart Institute of Okayama, 4Department of Clinical Pathology, Kameda Medical Center, 5Department of Cardiovascular Surgery, Kameda Medical Center
This case is a 70-year-old woman. Two years ago, she underwent surgery for a primary ovarian tumor, which was diagnosed as an ovarian carcinoid tumor based on the pathological findings. Asymptomatic severe tricuspid regurgitation was observed at that time. No medication was prescribed. One month prior to admission, she started to take diuretics for leg edema, and she was admitted to our hospital because of anasarca. Echocardiogram on admission demonstrated severely thickened and shortened tricuspid and pulmonary valves with severe regurgitation. The mobility was restricted. The right atrium and the right ventricle were dilated. She underwent tricuspid valve replacement on the 30th hospital day because of intractable heart failure. After the surgery, the symptoms and activity level improved to the level of using a wheelchair. However, she passed away because of septic shock on the 39th hospital day. Autopsy showed highly thickened, shortened and hardened tricuspid valve leaves and subvalvular tissue. Mobility of the leaflets was highly reduced. The pulmonary valve had similar findings. Pathological examination revealed deposition of myofibroblasts, smooth muscle cells, and mucus substrate in leaflets of both valves, and this denaturalization was diagnosed as carcinoid heart disease. We have experienced an unfortunate case that progressed rapidly after the obvious symptoms appeared. Primary tricuspid regurgitation is irreversible, and it might deteriorate rapidly. We need to pay attention to any signs of the symptoms, and we need to consider surgery at an appropriate time.