Valvular heart disease in a patient with Parkinson's disease treated with a low daily dose and a low cumulative dose of pergolide.

摘要

Pergolide is an ergot-derived dopamine receptor agonist that is used to treat Parkinson's disease (PDJ and restless leg syndrome (RLS). Pergolide-associated valvular heart disease (PAVHD) has been often reported on recently. The dosage and duration of therapy associated with PAVHD have not been established yet. According to previous reports, the patients taking high doses (more than 5 nig daily) and/or high cumulative doses of pergolide had a higher frequency of VHD than did the patients taking lower doses. In contrast, the patients taking a relatively low dose were seldom reported to have VHD.We report on a case of VHD in a PD patient who was treated with a relatively low daily dose and a low cumulative dose of pergolide. We describe the clinical characteristics as well as the echocardiographic and pathological findings of die mitral valve in this patient.A 61-year-old man with PD was treated with slowly titrated pergolide up to 2.25 mg of daily dose and approximately 2,730 mg of cumulative dose untilhe experienced dyspnea. He was referred to our thoracic surgery department for the evaluation of his heart failure. He had no history of hypertension, rheumatic fever, myocardial infarction, or symptoms of carcinoid syndrome except history of angina pectoris suspected by 24-hour Holter monitoring 20 years ago. However, he did not undergo an echocardiography at that time and had never been medicated for angina. He denied the previous use of ergota-mine, methysergide, or diet drugs such as fenfluramine or dexfenfjuramine, chest irradiation, and central venous catheter placement. There was no clinical or laboratory evidence for infectious or inflammatory heart disease.