The clinical manifestations of the carcinoid syndrome have been known for 35 years. Median survival in patients with carcinoid syndrome, although dependent on several factors, including the extent of liver metastases, is in the range of four years. In this setting, a frequent cause of death is right-sided cardiac dysfunction. When this occurs, the only definitive palliation is surgical in patients with this slow-growing tumor. Successful palliation was provided by tricuspid valve replacement and pulmonary valvoplasty in a patient with carcinoid heart disease and extensive liver metastases. This emphasizes the importance of surgery in selected patients with this slow-growing tumor.