Carcinoid heart disease

Four chamber views in systole (panel A) and diastole (panel B) show thickened and shortened tricuspid valve leaflets (TVL) and enlargement of the right atrium (RA) and ventricle (RV). Characteristically, the diseased tricuspid leaflets stay in a nearly fixed and open position regardless of phase of the the cardiac cycle. Thus, they are both stenotic, because they fail to open, and insufficient, because they fail to close. The degree of insufficiency almost always greatly exceeds the degree of stenosis.