Right heart failure many years after heart transplantation – a case of a rare etiology
█ Case report
Parázs Nóra1, Lakatos Bálint Károly1, Kovács Attila1, Assabiny Alexandra1,
Király Ákos1, Tarjányi Zoltán1, Szakál-Tóth Zsófia1, Teszák Tímea1, Tokodi Márton1, Ujvári Adrienn1, Kugler Szilvia1, Szücs Nikolette2, Merkely Béla1, Sax Balázs11Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
2Semmelweis Egyetem, Belgyógyászati és Onkológiai Klinika, Budapest
We present a case of patient with a rare etiological factor for right heart failure 4 years after heart transplantation. Annual follow-up revealed a liver metastasis of a well-differentiated neuroendocrine tumor in our 66 year-old male patient one year after uneventful heart transplantation. This time, no specific therapy was initiated as the primary source of the metastasis could not be identified. The regular echocardiographic examinations showed excellent graft function with normal chamber diameters and intact valves.
Four years after heart transplantation the patient presented with shortness of breath and echocardiography revealed severely dilated right ventricle with reduced function, a coaptation defect of the tricuspid valve with corresponding severe regurgitation. Due to the established presence of a neuroendocrine metastasis, we have diagnosed carcinoid valvulopathy and attempted again to localize the primary source with Octreoscan, unsuccessfully. We initiated long-lasting somatostatin analog, along with combined diuretic therapy. Our patient is still doing well with a compensated functional status.