DOI: https://doi.org/10.36347/sasjm.2026.v12i01.002

Pages: 6-11

Background: Severe tricuspid regurgitation (TR) is usually functional, secondary to left-sided heart disease, pulmonary hypertension, or atrial fibrillation. Organic TR due to carcinoid heart disease is rare, and ovarian carcinoid tumors represent an uncommon primary source. Case summary: An 84-year-old woman with no prior cardiovascular history was admitted for decompensated right heart failure. She had a 2-year history of severe TR, now presenting with NYHA class III dyspnea, paroxysmal nocturnal dyspnea, and bilateral lower limb edema. ECG revealed atrial fibrillation with right axis deviation and incomplete right bundle branch block. Echocardiography showed a dilated right ventricle with preserved function, markedly enlarged right atrium, and severe TR due to leaflet maladaptation and annular dilation (66 mm). CT imaging identified a right latero-uterine cystic mass (53 × 56 mm) suspicious for ovarian neoplasm, along with ascites and pericardial effusion. Laboratory testing revealed elevated tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). Given her advanced TR and high TRI-SCORE (≥6), surgery was deemed high risk with limited expected benefit. She was managed medically with high-dose furosemide (500 mg daily), spironolactone (75 mg daily), and hydrochlorothiazide (25 mg daily), alongside oncologic evaluation for suspected carcinoid tumor. Discussion: Ovarian carcinoid tumors can cause isolated right-sided valvular disease by releasing serotonin directly into the systemic circulation, bypassing hepatic metabolism. In advanced TR with high TRI-SCORE, registry data show poor survival regardless of surgical intervention, supporting a medical management strategy. Conclusion: Isolated severe TR without left-sided or pulmonary involvement should prompt investigation for systemic or neoplastic causes. Ovarian carcinoid tumor, though rare, should be considered, particularly when surgical correction of TR is not feasible. “