Operation for anorexigen-associated valvular heart disease.
OBJECTIVE
Recently, valvular regurgitation has been observed in patients who have taken fenfluramine or dexfenfluramine with or without phentermine. This study describes the clinical, echocardiographic, and pathologic findings of anorexigen-associated valvular heart disease and the surgical interventions required to treat it.


METHODS
We reviewed clinical information on 14 patients with severe anorexigen-associated valvular disease who underwent cardiac operations.


RESULTS
Thirteen women (mean age 44.2 +/- 5.3 years) received fenfluramine, 58.5 +/- 22.3 mg/day, and phentermine, 32.1 +/- 11.4 mg/day, for an average of 12.1 +/- 7.3 months before presentation. One woman received dexfenfluramine, 30 mg/day for 13 months, and phentermine, 60 mg/day, concomitantly for 6 months. Presenting symptoms included dyspnea (12 cases), palpitations (3), and atypical chest pain (3). Six patients had heart failure, and 4 had a new murmur. Echocardiography demonstrated severe mitral valve regurgitation in all patients. Seven also had aortic regurgitation, and 4 had significant tricuspid regurgitation. Four patients had successful mitral valve repair, 1 with concomitant aortic valve repair. Ten additional patients eventually required mitral valve replacement, 5 with concomitant aortic valve replacement. Excised valves demonstrated a glistening white appearance with plaque-like encasement of leaflets and chordae. Focal surface proliferation and fibrosis with a "stuck-on" appearance was consistently found.


CONCLUSIONS
Anorexigen use may lead to severe multivalvular regurgitation with characteristic echocardiographic and pathologic findings. Recognition of drug-induced valvulopathy is important because of widespread use of these medications and the uncertain natural history of the disease. Early surgical experience suggests that valve repair is possible in these young patients.
Caccitolo
J A
JA
Division of Cardiovascular Surgery and Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Connolly
H M
HM
Rubenson
D S
DS
Orszulak
T A
TA
Schaff
H V
HV
D000328:Adult; D001067:Appetite Depressants / Q000009:adverse effects*; D020372:Dexfenfluramine / Q000009:adverse effects*; D005260:Female; D005277:Fenfluramine / Q000009:adverse effects*; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010645:Phentermine / Q000009:adverse effects*; D018490:Serotonin Agents / Q000009:adverse effects*; D017366:Serotonin Receptor Agonists / Q000009:adverse effects*; D014463:Ultrasonography
D001067:Appetite Depressants; D018490:Serotonin Agents; D017366:Serotonin Receptor Agonists; D005277:Fenfluramine; D010645:Phentermine; D020372:Dexfenfluramine