Inoperable Primary Ovarian Carcinoid Led to the Progression of Carcinoid Heart Disease From Right-Sided to Both-Sided Involvement

A 73-year-old woman presented with diarrhea, leg edema, and exertional dyspnea. Six years before admission, she had been hospitalized for heart failure with moderate-to-severe tricuspid regurgitation because of incomplete leaflet coaptation (Figure 1A; Movie I in the Data Supplement). She was treated with furosemide and has remained on this therapy since then. In the same period of time, an ovarian tumor was detected after total hysterectomy and unilateral salpingo-oophorectomy for uterine myoma. Although the surgeons tried to resect the tumor, it was inoperable and could not be diagnosed definitively at that time because of postoperative adhesion. Figure 1. The time-course of changes in the echocardiograms of the right-sided heart valves. A and C , Tricuspid and pulmonary valves recorded 6 years earlier (arrows). B and D , Tricuspid and pulmonary valves recorded on admission (arrows). Left , The B-mode image; and right , the color Doppler image. Ao indicates aorta; PA, pulmonary artery; RA, right atrium; and RV, right ventricle. On admission, physical examination revealed jugular venous distention, hepatomegaly, and ascites. Compared with the echocardiogram at the previous hospitalization (Figure 1A), the tricuspid valve leaflets were further retracted with severe regurgitation (Figure 1B; Movie II in the Data Supplement). The pulmonary valve was also retracted with moderate regurgitation (Figure 1C and 1D; Movies III and IV in the Data Supplement). It was noteworthy that the aortic and mitral valves became thickened and moderately regurgitant (Figure 2A through 2D; Movies …