Trans-thoracic echocardiography findings include thickening and retraction of immobile tricuspid valve leaflets with associated tricuspid regurgitation and immobility of the pulmonary valve cusps. Trans-esophageal echocardiography findings provide incremental assessment of the degree of cardiac valve involvement and the atrial septal anatomy in patients with carcinoid heart disease.

• It is the gold standard for diagnosis and follow-up of carcinoid heart disease.^[1][2]

• Should be performed in all patients with carcinoid syndrome and high suspicion of carcinoid heart disease such as clinical features or raised NT-proBNP and/or 5-HIAA levels.
• Findings includes followings:

1. Thickening and retraction of immobile tricuspid valve leaflets with associated tricuspid regurgitation, which is severe at the time of identification in 90 percent of patients.
2. Immobility of the pulmonary valve cusps.

• TEE is primarily used intraoperatively to image the patient with carcinoid heart disease during valve replacement surgery.^[3]
• TEE may provide incremental assessment of the degree of cardiac valve involvement and the atrial septal anatomy in patients with carcinoid heart disease.

• It can be used to evaluate the pulmonary valve, identify cardiac metastases, and assess right ventricular size and function.^[4]

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