Valvular heart disease in patients with Parkinson disease treated with high-dose Pergolide
Guy Van Campa, Anja Flamezb , Celia Perdaensc
Departments of aCardiology, bNeurology and cPathology, Vrije Universiteit Brussel (AZ-VUB), Brussels, Belgium.
Two patients are described,both suffering from valvular heart disease,probably due to the intake of high doses of pergolide.
Patient 1 is a 61-year-old male with a 9-year history of Parkinson disease. From August 2001 on, high doses of pergolide were given (8 mg daily). In October 2002 the patient was admitted because of pulmonary oedema. Echocardiography showed restrictive motion of both mitral leaflets (predominately of the posterior leaflet)and of all tricuspid leaflets. This resulted in an important excentric mitral regurgitaion grade 3/4 and an important central tricuspid regurgitation (grade 3/4).
Patient 2 is a 73-year-old woman who was treated with high dose of pergolide (7 mg daily the last 6 months) to aleviate symptoms of Parkinson disease. The patient consulted for the evaluation of a new holosystolic apical murmur. The echocardiography showed a mildly hypokinetic left ventricle and a restrictive motion of both aortic and mitral valves with a severe mitral regurgitation and a moderate to severe aortic regurgitation. Tricuspid regurgitation was moderate and a systolic pulmonary artery pressure of 70 mmHg was measured. The patient underwent mitral and aortic valve replacement.
On macroscopic examination the leaflets were white and glistening. The aortic valve showed a focal, plaque-like endocardial thickening (Upper), while the lesions of the mitral valve were more extensive and extended to the chordae tendinae. Histologically, a 'plaque' was present on the ventricular surface of the aortic valve,consisting of stromal cells within a myxoid matrix (Lower). The underlying native valve architecture was not destroyed. Inflammation, thrombotic vegetations and calcifications were absent. Neovascularization was not visible on hematoxylin-eosin and orcein-van Gieson staining.
These changes are consistent with the lesions described in carcinoid, ergot-and fenfluramine related valvulopathies.
Figure legend
Upper: Macroscopic examination of the aortic valve of patient 2.
Lower: Histology of the aortic valve of patient 2 ( * plaque; ** ventricularis; *** spongiosa; **** fibrosa).
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