Aortic and mitral fenfluramine-phentermine valvulopathy in 64 patients treated with anorectic agents.
BACKGROUND
Few published studies of the pathology of fenfluramine-phentermine (fen-phen) valvulopathy, described by Connolly and colleagues in 1997, have appeared.


OBJECTIVE
To define temporal changes in the morphology of the stuck-on plaques and to determine whether the plaques progress or regress after cessation of fen-phen.


METHODS
The available clinical information and pathology material from 35 aortic valves (AVs) and 43 mitral valves (MVs) from 64 patients were reviewed.


RESULTS
The valves fell into 3 groups: 17 AVs and 28 MVs had fen-phen lesions only, 2 AVs and 7 MVs had fen-phen changes associated with other valve diseases, and 16 AVs and 8 MVs had no fen-phen changes. Fenfluramine-phentermine-attributable dysfunction was regurgitation in all instances. Typical plaques showed proliferation of myofibroblastic cells with myxoid stroma. Small vascular channels and slight lymphocytic accumulations were often present. Deeper parts of some plaques had dense fibroelastic tissue underlying typical plaque.


CONCLUSIONS
Considerable individual variation in the time course of anorectic agent use and the severity of fen-phen valvulopathy was observed. Possible plaque regression could not be assessed from this study. The observations suggest that in some patients fen-phen-induced plaques may continue to have surface proliferation despite drug withdrawal.
Volmar
K E
KE
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. kvolmar@pds.path.jhu.edu
Hutchins
G M
GM
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D001067:Appetite Depressants / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D005277:Fenfluramine / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D010645:Phentermine / Q000009:adverse effects*; D013997:Time Factors
D001067:Appetite Depressants; D005277:Fenfluramine; D010645:Phentermine