Valvular heart disease in patients taking pergolide.
OBJECTIVE
To determine whether an association exists between pergolide and valvular heart disease.


METHODS
Three patients with severe, unexplained tricuspid regurgitation were examined at our institution from September 2000 to April 2002. Echocardiography and histology of surgically explanted valves revealed abnormalities suggestive of carcinoid involvement, methysergide or ergotamine treatment, or use of fenfluramine and dexfenfluramine. Carcinoid valvular heart disease was excluded. None of the patients had prior treatment with these drugs. All 3 patients were taking pergolide.


RESULTS
Of the 3 patients, 2 had predominantly right-sided congestive heart failure. In all 3 patients, echocardiography showed unusual valve morphology, with severe tricuspid valve regurgitation. Significant left-sided valve regurgitation was noted in 2 patients. Histologic analysis revealed surface fibroproliferative lesions with preserved underlying valve architecture.


CONCLUSIONS
The echocardiographic and histopathologic features of these cases are strikingly similar to those associated with carcinoid-, ergot-, and fenfluramine-induced valve disease. An association between pergolide and valvular heart disease may therefore exist.
Pritchett
Allison M
AM
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Morrison
John F
JF
Edwards
William D
WD
Schaff
Hartzell V
HV
Connolly
Heidi M
HM
Espinosa
Raul E
RE
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D010479:Pergolide / Q000009:adverse effects*; D014262:Tricuspid Valve Insufficiency / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography
D000978:Antiparkinson Agents; D010479:Pergolide