Successful Hepatectomy Using Venovenous Bypass in a Patient With Carcinoid Heart Disease and Severe Tricuspid Regurgitation

GASTROINTESTINAL NEUROENDOCRINE tumor (GINET) is an uncommon, slow-growing tumor arising from neuroendocrine cells. Its incidence, about 2.5 to 5 cases per 100,000, has been increasing up to 10% per year. Its ability to synthesize and secrete active peptides and other neuroamines can lead to carcinoid syndrome, which may manifest as cutaneous flushing, gastrointestinal (GI) hypermobility, and bronchospasm. Carcinoid heart disease is a process of endomyocardial fibroelastosis usually affecting the right heart valves (tricuspid and pulmonic) with involvement of subvalvular apparatus. The degeneration of one or both right heart valves leads to dilation of the right heart chambers and right ventricular (RV) dysfunction, and the resulting increase in right-sided pressures and liver congestion can result in significant hemorrhage during liver resection. The authors present the successful management of right hepatectomy using venovenous bypass in a patient with severe tricuspid regurgitation and moderate pulmonic regurgitation due to carcinoid heart disease. They also present a review of the literature regarding the appropriate sequence of surgeries in this unique situation.