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Metabolic Syndrome — EECC MCQ

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HardHypertension & Preventive CardiologyMetabolic SyndromeEECC

A patient with metastatic small-bowel neuroendocrine tumour has biochemically controlled carcinoid syndrome and an expected survival beyond two years. Echocardiography shows fixed retracted tricuspid leaflets with torrential regurgitation, severe pulmonary-valve stenosis and progressive right-ventricular dilatation. Symptoms persist despite diuretics. What is the preferred cardiac strategy?

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Correct answer: C — Combined surgical replacement of the tricuspid and pulmonary valves

The best answer is “Combined surgical replacement of the tricuspid and pulmonary valves”. Advanced carcinoid heart disease commonly affects both tricuspid and pulmonary valves; in a patient with controlled tumour biology and useful prognosis, surgery should address both important lesions before irreversible right-ventricular failure. “Isolated tricuspid clipping while leaving severe pulmonary stenosis untreated” is less appropriate because treating only the tricuspid valve leaves a major fixed right-ventricular outflow obstruction “Pulmonary vasodilator monotherapy for presumed pulmonary arterial hypertension” is less appropriate because the haemodynamic problem is organic right-sided valve disease rather than primary pulmonary arteriopathy “Long-term diuretic escalation until irreversible right-ventricular failure develops” is less appropriate because diuresis relieves congestion but deliberately waiting for irreversible ventricular failure loses the operative window “Balloon mitral commissurotomy for the right-sided carcinoid lesions” is less appropriate because mitral commissurotomy neither treats the tricuspid regurgitation nor the pulmonary stenosis

Reference: 2025 ESC/EACTS Guidelines for valvular heart disease. https://academic.oup.com/eurheartj/article/46/44/4635/8234488