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Elderly presentation of tetralogy of Fallot precipitated by an occultbronchial carcinoid tumour

Elderly presentation of tetralogy of Fallot precipitated by an occultbronchial carcinoid tumour Letters to the editor Q Springer-Verlag 1993 Em J Cardio-thorac Surg (1993) 7: 54 E. Murray, K. Minami, R. Koerfer Klinik fur Thorax- und Herzchirurgie, Universitat Bochum, Herzzentrum Nordrhein-Westfalen, Georgstrasse 11, W-4790 Bad Oeynhausen, FRG We read with interest the article by Mitchell et al. (2) on tetralogy sive coronary artery disease (CAD). If this is the case the total correction of Fallot’s tetralogy would be expected to give only of Fallot in a 6%year-old woman. The authors suggest that the temporary relief. Unsuspected CAD has been reported as a cause of acute deterioration in their patient’s condition could be due to the mortality after correction of congenital heart disease in adults (1). bronchial carcinoid tumour which was an incidental finding during corrective surgery. They, however, omit to mention whether they have measured the 5 HIAA levels before removing the tumour 14 days later. The authors also did not mention if they noted any References carcinoid features at surgery. They mentioned that their patient had had mild angina for several years and had suffered a myocardial 1. Mair DD, Seward JB, Driscoll DJ, Danielson GK (1985) Surgi- infarct. However, the authors omit to tell us if coronary angiogra- cal repair of Ebstein’s anomaly: selection of patients and early phy was performed. In retrospect, the patient could have progres- and late operative results. Circulation 72 [Suppl] September 2. Mitchell IM, Waller DA, Walker DR (1992) Elderly presentation of tetralogy of Fallot precipitated by an occult bronchial car- cinoid tumour. Eur J Cardio-thorac Surg 6: 335-336 Correspondence to: E. Murray Reply I. M. Mitchell ‘, D. A. Waller ‘, D. R. Walker’ 1 Department of Cardiac Surgery, Leeds General Infirmary, Great George St., Leeds LSl 3EX, UK * Department of Cardiac Surgery, Freeman Hospital, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK We thank Dr Murray for his comments on our case report of a that the tumour was actively secreting vasoactive peptides however, 6%year-old woman with tetralogy of Fallot and a bronchial car- is incontestable evidence of the nature of the tumour. cinoid tumour. We did not measure 5 HIAA concentrations before Fibrosis is the predominant feature of a carcinoid tumour effect- removing the tumour since they would have been of little value as ing the heart. This varies in severity and effects mainly the right side, a diagnostic tool in this instance, particularly as histology was leading to both pulmonary and tricuspid stenosis in particular. We already available. Cardiopulmonary bypass is associated with did observe pulmonary valve stenosis with thickended valve cusps, marked changes in the biochemical and endocrine balance and since but cannot comment on the significance since this is also a feature we are unaware of any studies on the subject, it would be difficult of tetralogy - some degree of excessive fibrosis perhaps being ex- to know how to interpret the significance of an isolated abnormal pected in such long-standing disease. 5 HIAA measurement so soon after cardiac surgery. Demonstration Finally, although some of our patient’s symptoms might have been due to coronary artery disease, angiography performed prior to surgery did not reveal significant pathology. Provided that she remains free of tumour recurrence, we therefore expect her to have Correspondence to: I. M. Mitchell, FRCS lasting benefit from her cardiac surgery. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Elderly presentation of tetralogy of Fallot precipitated by an occultbronchial carcinoid tumour

European Journal of Cardio-Thoracic Surgery , Volume 7 (1) – Jan 1, 1993
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Publisher
Oxford University Press
Copyright
© Springer-Verlag 1993
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1016/1010-7940(93)90152-2
Publisher site
See Article on Publisher Site

Abstract

Letters to the editor Q Springer-Verlag 1993 Em J Cardio-thorac Surg (1993) 7: 54 E. Murray, K. Minami, R. Koerfer Klinik fur Thorax- und Herzchirurgie, Universitat Bochum, Herzzentrum Nordrhein-Westfalen, Georgstrasse 11, W-4790 Bad Oeynhausen, FRG We read with interest the article by Mitchell et al. (2) on tetralogy sive coronary artery disease (CAD). If this is the case the total correction of Fallot’s tetralogy would be expected to give only of Fallot in a 6%year-old woman. The authors suggest that the temporary relief. Unsuspected CAD has been reported as a cause of acute deterioration in their patient’s condition could be due to the mortality after correction of congenital heart disease in adults (1). bronchial carcinoid tumour which was an incidental finding during corrective surgery. They, however, omit to mention whether they have measured the 5 HIAA levels before removing the tumour 14 days later. The authors also did not mention if they noted any References carcinoid features at surgery. They mentioned that their patient had had mild angina for several years and had suffered a myocardial 1. Mair DD, Seward JB, Driscoll DJ, Danielson GK (1985) Surgi- infarct. However, the authors omit to tell us if coronary angiogra- cal repair of Ebstein’s anomaly: selection of patients and early phy was performed. In retrospect, the patient could have progres- and late operative results. Circulation 72 [Suppl] September 2. Mitchell IM, Waller DA, Walker DR (1992) Elderly presentation of tetralogy of Fallot precipitated by an occult bronchial car- cinoid tumour. Eur J Cardio-thorac Surg 6: 335-336 Correspondence to: E. Murray Reply I. M. Mitchell ‘, D. A. Waller ‘, D. R. Walker’ 1 Department of Cardiac Surgery, Leeds General Infirmary, Great George St., Leeds LSl 3EX, UK * Department of Cardiac Surgery, Freeman Hospital, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK We thank Dr Murray for his comments on our case report of a that the tumour was actively secreting vasoactive peptides however, 6%year-old woman with tetralogy of Fallot and a bronchial car- is incontestable evidence of the nature of the tumour. cinoid tumour. We did not measure 5 HIAA concentrations before Fibrosis is the predominant feature of a carcinoid tumour effect- removing the tumour since they would have been of little value as ing the heart. This varies in severity and effects mainly the right side, a diagnostic tool in this instance, particularly as histology was leading to both pulmonary and tricuspid stenosis in particular. We already available. Cardiopulmonary bypass is associated with did observe pulmonary valve stenosis with thickended valve cusps, marked changes in the biochemical and endocrine balance and since but cannot comment on the significance since this is also a feature we are unaware of any studies on the subject, it would be difficult of tetralogy - some degree of excessive fibrosis perhaps being ex- to know how to interpret the significance of an isolated abnormal pected in such long-standing disease. 5 HIAA measurement so soon after cardiac surgery. Demonstration Finally, although some of our patient’s symptoms might have been due to coronary artery disease, angiography performed prior to surgery did not reveal significant pathology. Provided that she remains free of tumour recurrence, we therefore expect her to have Correspondence to: I. M. Mitchell, FRCS lasting benefit from her cardiac surgery.

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Jan 1, 1993

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