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The authors report a case of carcinoid of the small intestine with liver metastases in whom the entire right side of the heart was affected, with severe tricuspid incompetence and pulmonary stenosis. The extent of the fibrosis, which affected all three layers of the heart on the right side has lead the authors to reconsider the various factors which cause the heart failure in carcinoid syndrome. This must now be included in the wider category of APUD. The severity of the tricuspid lesions compared with the derangement of the valvular and subvalvular structures makes an argument in favour of surgical correction.
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