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This case report was an attempt to present the importance of diagnostic echocardiography and closure of a patent foramen ovale in carcinoid heart disease. Herein, we present a case of a 48-year-old woman with a carcinoid metastasis presenting with tricuspid regurgitation, pulmonic stenosis, patent foramen ovale, and borderline left ventricular ejection fraction on an echocardiogram. Surgical intervention included closing the patent foramen ovale and replacing the tricuspid valve via mini-sternotomy. The tricuspid valve was repaired and the ejection fraction was preserved. The patient had an uncomplicated post-operative course. As indicated in this report, closing the patent foramen ovale along with fixing malfunctioning valves can improve the ejection fraction and the associated symptoms.