nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”nmp-85Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSАКТУАЛЬНЫЕ ВОПРОСЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ КАРЦИНОИДНОЙ БОЛЕЗНИ СЕРДЦА (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)CURRENT ISSUES OF CARCINOID HEART DISEASE DIAGNOSIS AND MANAGEMENT (CLINICAL OBSERVATIONS)ХубутияМ. Ш.KhubutiyaM. S.ГазарянГ. А.GazaryanG. A.АлиджановаХ. Г.AlidzhanovaH. G.

д.м.н., старший научный сотрудник отделения неотложной клинической кардиологии с методами неинвазивной функциональной диагностики

doctorhafiza@mail.ruГазарянЛ. Г.GazaryanL. G.МуслимовР. Ш.MuslimovR. S.НИИ скорой помощи им. Н.В. Склифосовского ДЗ г. Москвы, МоскваРоссияSklifosovsky research Institute for Emergency Medicine of Moscow Healthcare Department, MoscowRussian Federation201426032016032733Copyright © Хубутия М.Ш., Газарян Г.А., Алиджанова Х.Г., Газарян Л.Г., Муслимов Р.Ш., 20162016Хубутия М.Ш., Газарян Г.А., Алиджанова Х.Г., Газарян Л.Г., Муслимов Р.Ш.Khubutiya M.S., Gazaryan G.A., Alidzhanova H.G., Gazaryan L.G., Muslimov R.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/85

РЕЗЮМЕ. Представлены данные, свидетельствующие о прогрессировании карциноидной болезни сердца, послужившие поводом для повторной госпитализации больной после эндокардинтимэктомии и множественного протезирования клапанов. Данные подтверждают, что в случаях сочетанного поражения клапанов правых отделов сердца следует исходить из высокой вероятности их карциноидного поражения. В этой связи, наряду с эхокардиографией особую ценность приобретает мультиспиральная компьютерная томография, позволяющая подтвердить диагноз, выявить метастазы в различных органах и определить локализацию первичного очага. Операция на открытом сердце может быть эффективной только в сочетании с хирургическим лечением первичной опухоли и использованием аналогов соматостатина.

ABSTRACT. We report a case of progressive carcinoid heart disease (cHD) having caused readmission of a patient after excision of endocardium with arterial intima and multiple valve replacement. The data prove that in cases of combined valve heart disease of the right side it is necessary to assume the high probability of the carcinoid disease. Therefore, in spite of the high value of echocardiography, multispiral computed tomography (MScT), confirming the diagnosis, detecting metastases in different organs and determining the localization of the primary tumor, becomes particularly important. open heart surgery can be effective only when accompanied by operative therapy for the primary tumor with the use of somatostatin analogues. 

карциноидная болезнь сердцаэндокардинтимэктомиямножественное протезирование клапанов сердцаэхокардиографиямультиспиральная компьютерная томография сердцаcarcinoid heart diseaseexcision of endocardium and arterial intimamultiple artificial heart valvesechocardiographymultispiral computed tomography of the heartReferencesMacGee W. Metastatic and invasive tumours involving the heart in a geriatric population: a necropsy study // Virchows Arch. A Pathol. Anat. Histopathol. – 1991. – Vol. 419, N. 3. – P. 183–189.MacGee W. Metastatic and invasive tumours involving the heart in a geriatric population: a necropsy study // Virchows Arch. A Pathol. Anat. Histopathol. – 1991. – Vol. 419, N. 3. – P. 183–189.Бокерия Л.А., Малашенков А.И., Кавсадзе В.Э., Серов Р.А. Кардиоонкология. – М.: Изд-во НЦССХ им. А.Н.Бакулева РАМН, 2003. – 254 с. Bokeriya L.A., Malashenkov A.I., Kavsadze V.E., Serov R.A. Kardioonkologiya [Cardio-oncology]. Moscow: NTsSSKh im. A.N. Bakuleva RAMN Publ., 2003. 254 p. (In Russian).Бокерия Л.А., Малашенков А.И., Кавсадзе В.Э., Серов Р.А. Кардиоонкология. – М.: Изд-во НЦССХ им. А.Н.Бакулева РАМН, 2003. – 254 с. Bokeriya L.A., Malashenkov A.I., Kavsadze V.E., Serov R.A. Kardioonkologiya [Cardio-oncology]. Moscow: NTsSSKh im. A.N. Bakuleva RAMN Publ., 2003. 254 p. (In Russian).Reynen K., Köckeritz U., Strasser R.H. Metastases to the heart // Ann. Oncol. – 2004. – Vol. 15, N. 3. – P. 375–381.Reynen K., Köckeritz U., Strasser R.H. Metastases to the heart // Ann. Oncol. – 2004. – Vol. 15, N. 3. – P. 375–381.Grebenc M.L., Rosado de Christenson M.L., Burke A.P., et al. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation // Radiographics. – 2000. – Vol. 20, N. 4. – P. 1073–1103.Grebenc M.L., Rosado de Christenson M.L., Burke A.P., et al. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation // Radiographics. – 2000. – Vol. 20, N. 4. – P. 1073–1103.Sarjeant J.M., Butany J., Cusimano R.J. Cancer of the heart: epidemiology and management of primary tumors and metastases // Am. J. Cardiovasc. Drugs. – 2003. – Vol. 3, N. 6. – P. 407–421.Sarjeant J.M., Butany J., Cusimano R.J. Cancer of the heart: epidemiology and management of primary tumors and metastases // Am. J. Cardiovasc. Drugs. – 2003. – Vol. 3, N. 6. – P. 407–421.Butany J., Leong S.W., Carmichael K., Komeda M. A 30-year analysis of cardiac neoplasms at autopsy // Can. J. Cardiol. – 2005. – Vol. 21, N. 8. – P. 675–680.Butany J., Leong S.W., Carmichael K., Komeda M. A 30-year analysis of cardiac neoplasms at autopsy // Can. J. Cardiol. – 2005. – Vol. 21, N. 8. – P. 675–680.Lam K.Y., Dickens P., Chan A.C. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies // Arch. Pathol. Lab. Med. – 1993. – Vol. 117, N. 10. – P. 1027–1031.Lam K.Y., Dickens P., Chan A.C. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies // Arch. Pathol. Lab. Med. – 1993. – Vol. 117, N. 10. – P. 1027–1031.Yusuf S.W., Bathina J.D., Qureshi S., et al. Cardiac tumors in a tertiary care cancer hospital: clinical features, echocardiographic findings, treatment and outcomes // Heart Int. – 2012. – Vol. 7 , N. 1 . – e4.Yusuf S.W., Bathina J.D., Qureshi S., et al. Cardiac tumors in a tertiary care cancer hospital: clinical features, echocardiographic findings, treatment and outcomes // Heart Int. – 2012. – Vol. 7 , N. 1 . – e4.Шхвацабая Л.В. Диагностика вторичного опухолевого поражения сердца // Клин. мед. – 1983. – № 11. – C. 61–65. Shkhvatsabaya L.V. Diagnostika vtorichnogo opukholevogo porazheni￾ya serdtsa [Diagnosis of secondary tumor lesions of the heart. Kliniches￾kaya meditsina. 1983; 11: 61–65. (In Russian).Шхвацабая Л.В. Диагностика вторичного опухолевого поражения сердца // Клин. мед. – 1983. – № 11. – C. 61–65. Shkhvatsabaya L.V. Diagnostika vtorichnogo opukholevogo porazheni￾ya serdtsa [Diagnosis of secondary tumor lesions of the heart. Kliniches￾kaya meditsina. 1983; 11: 61–65. (In Russian).Amano J., Nakayama J., Yoshimura Y., Ikeda U. Clinical classification of cardiovascular tumors and tumor-like lisions, and its incidences // Gen. Thorac. Cardiovasc. Surg. – 2013. – Vol. 61, N. 8. – P. 435–447.Amano J., Nakayama J., Yoshimura Y., Ikeda U. Clinical classification of cardiovascular tumors and tumor-like lisions, and its incidences // Gen. Thorac. Cardiovasc. Surg. – 2013. – Vol. 61, N. 8. – P. 435–447.Кнышов Г.В., Витовский Р.М., Захарова В.П. Опухоли сердца. Проблемы диагностики и хирургического лечения. – Киев: Книга плюс, 2005. – 254 с. Knyshov G.V., Vitovskiy R.M., Zakharova V.P. Opukholi serdtsa. Problemy diagnostiki i khirurgicheskogo lecheniya [Problems of diagnosis and surgical treatment]. Kiev: Kniga plyus publ., 2005; 254 p. (In Russian).Кнышов Г.В., Витовский Р.М., Захарова В.П. Опухоли сердца. Проблемы диагностики и хирургического лечения. – Киев: Книга плюс, 2005. – 254 с. Knyshov G.V., Vitovskiy R.M., Zakharova V.P. Opukholi serdtsa. Problemy diagnostiki i khirurgicheskogo lecheniya [Problems of diagnosis and surgical treatment]. Kiev: Kniga plyus publ., 2005; 254 p. (In Russian).Pandya U.H., Pellikka P.A., Enriquez-Sarano M., et al. Metastatic carcinoid tumor to the heart: echocardiographic-pathologic study of 11 patients // J. Am. Coll. Cardiol. – 2002. – Vol. 40, N. 7. – P. 1328–1332.Pandya U.H., Pellikka P.A., Enriquez-Sarano M., et al. Metastatic carcinoid tumor to the heart: echocardiographic-pathologic study of 11 patients // J. Am. Coll. Cardiol. – 2002. – Vol. 40, N. 7. – P. 1328–1332.Pellikka P.A., Tajik A.J., Khandheria B.K., et al. Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients. Circulation // 1993. – Vol. 87, N. 4. – P. 1188–1196.Pellikka P.A., Tajik A.J., Khandheria B.K., et al. Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients. Circulation // 1993. – Vol. 87, N. 4. – P. 1188–1196.Головин Д.И. Атлас опухолей человека (гистологическое строение). – Л.: Медицина, 1975. – 320 с. Golovin D.I. Atlas opukholey cheloveka (gistologicheskoe stroenie) [Atlas of human tumors (histology)]. Leningrad: Meditsina publ.,1975. 320 p. (In Russian).Головин Д.И. Атлас опухолей человека (гистологическое строение). – Л.: Медицина, 1975. – 320 с. Golovin D.I. Atlas opukholey cheloveka (gistologicheskoe stroenie) [Atlas of human tumors (histology)]. Leningrad: Meditsina publ.,1975. 320 p. (In Russian).Öberg K.E. Gastrointestinal neuroendocrine tumors // Ann Oncol. – 2010. – Vol. 21, Suppl 7. – vii 72–80.Öberg K.E. Gastrointestinal neuroendocrine tumors // Ann Oncol. – 2010. – Vol. 21, Suppl 7. – vii 72–80.Janson E.T., Holmberg L., Stridsberg M., et al. Carcinoid tumors: Analysis of prognostic factors and survival in 301 patients from a referral center // Ann. Oncol. – 1997. – Vol. 8, N. 7. – P. 685–690.Janson E.T., Holmberg L., Stridsberg M., et al. Carcinoid tumors: Analysis of prognostic factors and survival in 301 patients from a referral center // Ann. Oncol. – 1997. – Vol. 8, N. 7. – P. 685–690.Максимова Т.М., Белов В.Б. Заболеваемость злокачественными новообразованиями и смертность от них в России и некоторых зарубежных странах // Проблемы социальной гигиены, здравоохранения и истории медицины. – 2012. – № 1. – С. 9–12. Maksimova T.M., Belov V.B. Zabolevaemost’ zlokachestvennymi novoo￾brazovaniyami i smertnost’ ot nikh v Rossii i nekotorykh zarubezhnykh stranakh [The incidence of malignant neoplasms and mortality in Russia and some foreign countries]. Problemy sotsial’noy gigieny, zdra￾vookhraneniya i istorii meditsiny. 2012; 1: 9–12. (In Russian).Максимова Т.М., Белов В.Б. Заболеваемость злокачественными новообразованиями и смертность от них в России и некоторых зарубежных странах // Проблемы социальной гигиены, здравоохранения и истории медицины. – 2012. – № 1. – С. 9–12. Maksimova T.M., Belov V.B. Zabolevaemost’ zlokachestvennymi novoo￾brazovaniyami i smertnost’ ot nikh v Rossii i nekotorykh zarubezhnykh stranakh [The incidence of malignant neoplasms and mortality in Russia and some foreign countries]. Problemy sotsial’noy gigieny, zdra￾vookhraneniya i istorii meditsiny. 2012; 1: 9–12. (In Russian).Fox D., Khattar R. Carcinoid heart disease: presentation, diagnosis, and management // Heart. – 2004. – Vol. 90, N. 10. – P. 1224–1228.Fox D., Khattar R. Carcinoid heart disease: presentation, diagnosis, and management // Heart. – 2004. – Vol. 90, N. 10. – P. 1224–1228.Ross E.M., Roberts W.C. The carcinoid syndrome: comparison of 21 necropsy subjects with carcinoid heart disease to 15 necropsy subjects without carcinoid heart disease // Am. J. Med. – 1985. – Vol. 79, N. 3. – P. 339.Ross E.M., Roberts W.C. The carcinoid syndrome: comparison of 21 necropsy subjects with carcinoid heart disease to 15 necropsy subjects without carcinoid heart disease // Am. J. Med. – 1985. – Vol. 79, N. 3. – P. 339.Bhattacharyya S., Davar J., Dreyfus G., Caplin M. Carcinoid heart disease // Circulation. – 2007. – Vol. 116, N. 24. – P. 2860–2865.Bhattacharyya S., Davar J., Dreyfus G., Caplin M. Carcinoid heart disease // Circulation. – 2007. – Vol. 116, N. 24. – P. 2860–2865.Bernheim A., Connolly H., Hobday T., et al. Carcinoid heart disease // Prog. Cardiovas. Dis. – 2007. – Vol. 49, N. 6. – P. 439–451.Bernheim A., Connolly H., Hobday T., et al. Carcinoid heart disease // Prog. Cardiovas. Dis. – 2007. – Vol. 49, N. 6. – P. 439–451.Moller J.E., Connolly H.M., Rubin J., et al. Factors associated with progression of carcinoid heart disease // N. Engl. J. Med. – 2003. – Vol. 348, N. 11. – P. 1005–1015.Moller J.E., Connolly H.M., Rubin J., et al. Factors associated with progression of carcinoid heart disease // N. Engl. J. Med. – 2003. – Vol. 348, N. 11. – P. 1005–1015.Zuetenhost J., Bonfrer J., Korse C., et al. Carcinoid heart disease. The role of urinary 5-hydroxyindoleacetic acid excretion and plasma levels of atrial natriuretic peptide, transforming growth factor-betta and fibroblast growth factor // Cancer. – 2003. – Vol. 97, N. 7. – P. 1609–1615.Zuetenhost J., Bonfrer J., Korse C., et al. Carcinoid heart disease. The role of urinary 5-hydroxyindoleacetic acid excretion and plasma levels of atrial natriuretic peptide, transforming growth factor-betta and fibroblast growth factor // Cancer. – 2003. – Vol. 97, N. 7. – P. 1609–1615.Lundin L., Norheim I., Landelius J., et al. Carcinoid heart disease: relationship of circulating vasoactive substances to ultrasound-detectable cardiac abnormalities // Circulation. – 1988. – Vol. 77, N. 2. – P. 264– 269.Lundin L., Norheim I., Landelius J., et al. Carcinoid heart disease: relationship of circulating vasoactive substances to ultrasound-detectable cardiac abnormalities // Circulation. – 1988. – Vol. 77, N. 2. – P. 264– 269.Moller J., Pellikka P., Bernheim A., et al. Prognosis of carcinoid heart disease analysis of 200 cases over two decades // Circulation. – 2005. – Vol. 112, N. 2. – P. 3320–3327.Moller J., Pellikka P., Bernheim A., et al. Prognosis of carcinoid heart disease analysis of 200 cases over two decades // Circulation. – 2005. – Vol. 112, N. 2. – P. 3320–3327.Ragland M.M., Tak T. The Role of Echocardiography in Diagnosing Space-Occupying Lesions of the Heart // Clin. Med. Res. – 2006. – Vol. 4, N. 1. – P. 22–32.Ragland M.M., Tak T. The Role of Echocardiography in Diagnosing Space-Occupying Lesions of the Heart // Clin. Med. Res. – 2006. – Vol. 4, N. 1. – P. 22–32.Bastarrika G., Cao M.G., Cano D., et al. Magnetic resonance imaging diagnosis of carcinoid heart disease // J. Comput. Assist. Tomogr. – 2005. – Vol. 29, N. 6. – P. 756–759.Bastarrika G., Cao M.G., Cano D., et al. Magnetic resonance imaging diagnosis of carcinoid heart disease // J. Comput. Assist. Tomogr. – 2005. – Vol. 29, N. 6. – P. 756–759.Prakash P., Kalra M.K., Stone J.R., et al. Imaging findings of pericardial metastasis on chest computed tomography // J. Comput. Assist. Tomogr. – 2010. – Vol. 34, N. 4. – P. 554–558.Prakash P., Kalra M.K., Stone J.R., et al. Imaging findings of pericardial metastasis on chest computed tomography // J. Comput. Assist. Tomogr. – 2010. – Vol. 34, N. 4. – P. 554–558.Connolly H.M., Schaff H.V., Mullany C.J., et al. Surgical management of left-sided carcinoid heart disease // Circulation. – 2001. – Vol. 104, N. 12. – Suppl. 1. – P. 136–140.Connolly H.M., Schaff H.V., Mullany C.J., et al. Surgical management of left-sided carcinoid heart disease // Circulation. – 2001. – Vol. 104, N. 12. – Suppl. 1. – P. 136–140.Connolly H.M., Schaff H.V., Mullany C.J., et al. Carcinoid heart disease: impact of pulmonary valve replacement in right ventricular function and remodeling // Circulation. – 2002. – Vol. 106, N. 12. – Suppl. 1. – P. 151–156.Connolly H.M., Schaff H.V., Mullany C.J., et al. Carcinoid heart disease: impact of pulmonary valve replacement in right ventricular function and remodeling // Circulation. – 2002. – Vol. 106, N. 12. – Suppl. 1. – P. 151–156.Mokhles P., Herwerden P., Herder W., et al. Carcinoid heart disease: outcomes after surgical valve replacement // Eur. J. Cardio-Thoracic Surgery. – 2012. – Vol. 41, N. 6. – P. 1278–1283.Mokhles P., Herwerden P., Herder W., et al. Carcinoid heart disease: outcomes after surgical valve replacement // Eur. J. Cardio-Thoracic Surgery. – 2012. – Vol. 41, N. 6. – P. 1278–1283.Narine K., Dohmen P., Daenen W. Tricuspid and pulmonary valve involvement in carcinoid disease // Tex. Heart Inst. J. – 2000. – Vol. 27, N. 4. – P. 405–407.Narine K., Dohmen P., Daenen W. Tricuspid and pulmonary valve involvement in carcinoid disease // Tex. Heart Inst. J. – 2000. – Vol. 27, N. 4. – P. 405–407.Bhattacharyya S. eComment. Cardiovascular surgery in carcinoid heart disease // Interact. Cardiovasc. Thorac. Surg. – 2012. – Vol. 15, N. 3. – P. 471.Bhattacharyya S. eComment. Cardiovascular surgery in carcinoid heart disease // Interact. Cardiovasc. Thorac. Surg. – 2012. – Vol. 15, N. 3. – P. 471.Thorburn C.W., Morgan J.J., Shanahan M.X., Chang V.P. Long-term results of tricuspid valve replacement and the problem of prosthetic valve thrombosis // Am. J. Cardiol. – 1983. – Vol. 51, N. 7. – P. 1128– 1132.Thorburn C.W., Morgan J.J., Shanahan M.X., Chang V.P. Long-term results of tricuspid valve replacement and the problem of prosthetic valve thrombosis // Am. J. Cardiol. – 1983. – Vol. 51, N. 7. – P. 1128– 1132.Komoda S., Komoda T., Pavel M.E., et al. Cardiac surgery for carcinoid heart disease in 12 cases // Gen. Thor. Cardiovas. Surg. – 2011. – Vol. 59, N. 12. – P. 780–785.Komoda S., Komoda T., Pavel M.E., et al. Cardiac surgery for carcinoid heart disease in 12 cases // Gen. Thor. Cardiovas. Surg. – 2011. – Vol. 59, N. 12. – P. 780–785.Castillo J.G., Filsoufi F., Rahmanian P.B., et al. Early and Late Results of Valvular Surgery for Carcinoid Heart Diseas // J. Amer. Coll Card. – 2008. – Vol. 51, N. 15. – P. 1507–1509.Castillo J.G., Filsoufi F., Rahmanian P.B., et al. Early and Late Results of Valvular Surgery for Carcinoid Heart Diseas // J. Amer. Coll Card. – 2008. – Vol. 51, N. 15. – P. 1507–1509.Mabvuure N., Cumberwortha A., Hindochab S. In patients with carcinoid syndrome undergoing valve replacement: will a biological valve have acceptable durability? // Interact. Cardiovasc. Thorac. Surg. – 2012. – Vol. 15, N. 3. – P. 467–472.Mabvuure N., Cumberwortha A., Hindochab S. In patients with carcinoid syndrome undergoing valve replacement: will a biological valve have acceptable durability? // Interact. Cardiovasc. Thorac. Surg. – 2012. – Vol. 15, N. 3. – P. 467–472.Hajj-Chahine J., Jayle C., Houmaida H., Corbi P. eComment. Valve replacement in carcinoid heart disease // Interact. Cardiovasc. Thorac. Surg. – 2012. – Vol. 15, N. 3. – P. 471–472.Hajj-Chahine J., Jayle C., Houmaida H., Corbi P. eComment. Valve replacement in carcinoid heart disease // Interact. Cardiovasc. Thorac. Surg. – 2012. – Vol. 15, N. 3. – P. 471–472.Mokhles P., van Herwerden L.A., de Jong P.L., et al. Carcinoid heart disease: outcomes after surgical valve replacement // Eur. J. Cardiothorac. Surg. – 2012. – Vol. 41, N. 6. – P. 1278–1283.Mokhles P., van Herwerden L.A., de Jong P.L., et al. Carcinoid heart disease: outcomes after surgical valve replacement // Eur. J. Cardiothorac. Surg. – 2012. – Vol. 41, N. 6. – P. 1278–1283.Vaughan D.J., Brunner M.D. Anesthesia for patients with carcinoid syndrome // Int. Anesthesiol. Clin. – 1997. – Vol. 35, N. 4. – P. 129–142.Vaughan D.J., Brunner M.D. Anesthesia for patients with carcinoid syndrome // Int. Anesthesiol. Clin. – 1997. – Vol. 35, N. 4. – P. 129–142.Connolly H.M., Pellikka P.A. Carcinoid heart disease // Curr. Cardiol. Rep. – 2006. – Vol. 8, N. 2. – P. 96–101.Connolly H.M., Pellikka P.A. Carcinoid heart disease // Curr. Cardiol. Rep. – 2006. – Vol. 8, N. 2. – P. 96–101.Corleto V.D., Angeletti S., Schillaci O., Marignani M. Long-term octreotide treatment of metastatic carcinoid tumor // Ann. Oncol. – 2000. – Vol. 11, N. 4. – P. 491–493.Corleto V.D., Angeletti S., Schillaci O., Marignani M. Long-term octreotide treatment of metastatic carcinoid tumor // Ann. Oncol. – 2000. – Vol. 11, N. 4. – P. 491–493.

The authors declare that there are no conflicts of interest present.