Surgical correction of carcinoid heart disease improves liver function and 5-hydroxyindoleacetic acid levels.
Author
Shah, Husnain AbbasSagar, Vandana
Hughes, Simon
Khanna, Amardeep
Yim, Ivan
Lodge, Freya
Singh, Harjot
Oelofse, Tessa
Ó'Súilleabháin, Críostóir
Venkataraman, Hema
Shetty, Shishir
Steeds, Richard
Rooney, Stephen
Shah, Tahir
Publication date
2022-04-08
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Introduction: Carcinoid heart disease (CHD) is a consequence of neuroendocrine tumors releasing 5-hydroxytryptamine (5-HT) into the systemic circulation, affecting right heart valves, causing fibrosis, and eventually right heart failure. The aim of this study was to determine the effect of valve-replacement on kidney function, liver function, and 5-hydroxyindoleacetic acid (5-HIAA) levels. Methods: A Retrospective study of 17 patients with CHD who had undergone heart-valve replacement surgery between 2010 and 2019, from the Queen Elizabeth Hospital Birmingham. 5-HIAA levels, liver, and kidney function were measured in addition to hepatic inferior vena cava (IVC) diameter and its relationship to carcinoid symptoms. Results: Eleven patients were male and six were female. At time of surgery, average age was 66.6 ± 8.1 years and average BMI was 25.8 ± 5.5 Kg/cm2. Three out of 17 patients had one valve replaced, 13/17 had two replaced (tricuspid and pulmonary), and 1/17 had three replaced (tricuspid, pulmonary and aortic). There was a 31% average decline in 5-HIAA [799.8 (343.6-1078.0) to 555.3 (275.8-817.9), p = 0.011], a 35% decline in bilirubin [20 (16-29) to 13 (10-19), p = < 0.001], and a 15% reduction in the short and long axes of the IVC after valve-replacement surgery [20.0 (18.0-25.0) and 36.5 (29.0-39.8) to 17.0 (14.5-19.3) and 31.0 (26.5-34.3) respectively, p = < 0.001 and 0.002 respectively]. Conclusion: Valve replacement surgery improves 5-HIAA levels alongside improved liver function and hepatic IVC diameter. These findings are consistent with resolution of congestive hepatopathy, and therefore enhanced clearance of 5-HIAA. This suggests that valve-replacement surgery can indirectly have beneficial outcomes on hepatic function and is also associated with a drop in the circulating levels of tumor derived serotonin.Citation
Shah HA, Sagar V, Hughes S, Khanna A, Yim I, Lodge F, Singh H, Oelofse T, Ó'Súilleabháin C, Venkataraman H, Shetty S, Steeds R, Rooney S, Shah T. Surgical Correction of Carcinoid Heart Disease Improves Liver Function and 5-Hydroxyindoleacetic Acid Levels. Front Surg. 2022 Apr 8;9:791058. doi: 10.3389/fsurg.2022.791058Type
ArticleAdditional Links
http://www.frontiersin.org/SurgeryPMID
35465425Journal
Frontiers in SurgeryPublisher
Frontiers Media S.Aae974a485f413a2113503eed53cd6c53
10.3389/fsurg.2022.791058