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Progressive dyspnoea in a patient with neuroendocrine tumor: do invasive haemodynamics help?
  1. Elias B Hanna,
  2. Wasawat Vutthikraivit
  1. Cardiovascular Medicine, The University of Iowa, Coralville, Iowa, USA
  1. Correspondence to Dr Elias B Hanna, Cardiovascular Medicine, The University of Iowa, Coralville, IA 52241, USA; elias-hanna{at}

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Clinical introduction

A man in his 60s with a history of small bowel neuroendocrine tumour and liver metastases presents with progressive dyspnoea. Transthoracic and transesophageal echocardiograms demonstrate tricuspid and pulmonic valve dysfunction with an enlarged right ventricle. Right heart catheterisation is performed (figure 1).

Figure 1

(A) Simultaneous RA–RV pressure recording. (B) Simultaneous RV–PA pressure recording. PA, pulmonary arterial; RA, right atrial; RV, right ventricular.


What is the diagnosis suggested by the invasive haemodynamics?

  1. Severe tricuspid regurgitation (TR) and mild tricuspid stenosis, mild pulmonic valve disease.

  2. Severe tricuspid stenosis and severe pulmonic stenosis.

  3. Severe tricuspid and pulmonic regurgitation (PR), with mild tricuspid and pulmonic …

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  • Contributors All authors have contributed to the writing of this manuscript and all authors have read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.