Morphologic Features of Carcinoid Heart Disease as Assessed by Three-Dimensional Transesophageal Echocardiography

Background: Carcinoid heart disease (CHD) is a rare cause of valvular heart disease and carries a poor prognosis. CHD has a unique morphology and echocardiographic features that predominantly involve right-sided valvular structures. The diagnosis of CHD is usually made by two-dimensional transthoracic echocardiography (TIE). With the superior spatial resolution of real time three-dimensional transesophageal echocardiography (3DTEE), structural changes that occur in patients with CHD-associated valvular heart disease can be examined in greater detail. We undertook this study to examine the incremental value of 3DTEE in the diagnosis of CHD. Methods: A total of four patients with CHD underwent TIE, transesophageal echocardiography (TEE), and 3DTEE as part of their routine clinical evaluation. Results: TIE and TEE for all four patients revealed thickened, fibrosed, retracted, and malcoapted tricuspid leaflets with wide-open tricuspid valve regurgitation. 3DTEE en face imaging of the tricuspid valve demonstrated the characteristic morphologic features of CHD more clearly in all four patients. Conclusions: 3DTEE provides substantial incremental value over TIE in the assessment of characteristic CHD pathology and thus enhances the echocardiographic diagnosis of CHD. (Echocardiography 2010;27:1098-1105)