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A 70-year-old woman with a metastatic neuroendocrine tumour presented with heart failure. A 2D transthoracic echocardiogram (TTE) showed thickened, retracted and fixed tricuspid valve (TV) leaflets with free-flowing tricuspid regurgitation (figure 1A, online supplementary videos 1 and 2), and thickened and retracted pulmonary valve (PV) cusps with severe pulmonic regurgitation (figure 1B, online supplementary video 3 and 4s). A 3D TTE en face view of the mitral valve (MV) and TV from the ventricles showed a wide-open fixed TV, while the MV opens and closes normally, giving rise to an image that simulates the heart winking at you (figure 1C, online supplementary video 5). A 3D TTE in long-axis view (upper) and en face view (lower) of the PV showed a mildly stenotic pulmonary valve, with a diastolic regurgitant orifice and reopening in telediastole (figure 1D, online supplementary video 6). These findings were confirmed with continuous Doppler and colour M-mode imaging (figure 1E). High telediastolic right ventricular pressure secondary to both regurgitations, shown by the severe dilatation of the inferior vena cava and abrupt mid-diastolic ending of pulmonary regurgitation (figure 1E), can explain the diastolic ejective pulmonary flow that reopens the PV. The rare carcinoid tumours release serotonin that can produce fibrotic endocardial plaque in the right cavities with thickening, retraction and severe regurgitation of right heart valves.1 More than 50% of cases develop carcinoid heart disease and this is the major cause of death. A TTE allows detailed and quantitative morphofunctional analysis,2 and a 3D TTE provides a more graphic presentation than conventional 2D TTE.
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Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Files in this Data Supplement:
- Data supplement 1 - Online video 1
- Data supplement 2 - Online video 2
- Data supplement 3 - Online video 3
- Data supplement 4 - Online video 4
- Data supplement 5 - Online video 5
- Data supplement 6 - Online video 6
Footnotes
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Contributors All authors have equally contributed to the submission of this manuscript.
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Competing interests none.
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Patient consent Obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.