Currently submitted to: JMIR Cardio
Date Submitted: Nov 5, 2025
Open Peer Review Period: Nov 10, 2025 - Jan 5, 2026
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
When the Right Heart Leads to the Pelvis: Advanced Tricuspid Regurgitation Revealing an Ovarian Mass
ABSTRACT
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 malcoaptation 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.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.