Format

Send to

Choose Destination

See 1 citation:

Int J Cardiol. 2016 Oct 1;220:429-34. doi: 10.1016/j.ijcard.2016.06.112. Epub 2016 Jun 23.

Drug-induced aortic valve stenosis: An under recognized entity.

Author information

1
Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Universitaire de Grenoble, France. Electronic address: ennezat@yahoo.com.
2
Department of Pathology, Hôpital Européen Georges Pompidou, Paris-Descartes University, France.
3
Department of Cardiology and Cardiovascular Surgery, Institut Mutualiste Montsouris, Paris, France.
4
Department of Cardiology and Vascular Diseases, Institut du Thorax, Centre Hospitalo Universitaire de Nantes, France.
5
Nouvelles Cliniques Nantaises, Nantes, France.
6
Baron Cardiology Office, Orléans, France.
7
Department of Cardiology, Centre Hospitalier Universitaire de Reims, France.
8
Department of Cardiology, Clinique Pasteur, Toulouse, France.
9
Department of Cardiology, Centre Hospitalier Universitaire de Brest, France.
10
Department of Cardiology, Centre Hospitalier Universitaire Bichat, Paris, France.
11
Echocardiography laboratory, Clinique Saint-Augustin, Bordeaux, France.
12
Department of Cardiology, Centre Hospitalier Universitaire de Bordeaux, France.
13
Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Universitaire de Grenoble, France.
14
Department of Cardiology, Centre Hospitalier Victor Provo de Roubaix, France.
15
Department of Cardiology, Centre Hospitalier Universitaire de Strasbourg, France.
16
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Toulouse, France.
17
Department of Cardiovascular Surgery, Clinique Saint Martin, Caen, France.
18
Department of Cardiovasculaire Surgery, Centre Hospitalier Universitaire La Timone, Marseille, France.
19
Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland.
20
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire d'Amiens, France.
21
GCS-Artois Cardiovascular surgery, Hôpital privé de Bois Bernard, Centre Hospitalier de Lens, France.
22
Department of Cardiovascular Surgery, Centre Hospitalier Régional Universitaire de Lille, France.
23
Department of Biopathology-MESOPATH, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France.
24
Department of Pathology, Centre Hospitalier Universitaire d'Amiens, France.
25
Department of Pathology, Université de Lille, CHU de Lille, Faculté de Médecine, F-59000 Lille, France.
26
Department of Cardiology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté libre de médecine / Université Catholique de Lille, France and INSERM U 1088, Amiens, France.
27
Department of Cardiology, Centre Hospitalier Universitaire d'Amiens and INSERM U 1088, Amiens, France.

Abstract

BACKGROUND:

We have been intrigued by the observation that aortic stenosis (AS) may be associated with characteristic features of mitral drug-induced valvular heart disease (DI-VHD) in patients exposed to valvulopathic drugs, thus suggesting that beyond restrictive heart valve regurgitation, valvulopathic drugs may be involved in the pathogenesis of AS.

METHODS:

Herein are reported echocardiographic features, and pathological findings encountered in a series of patients suffering from both AS (mean gradient >15mmHg) and mitral DI-VHD after valvulopathic drugs exposure. History of rheumatic fever, chest radiation therapy, systemic disease or bicuspid aortic valve disease were exclusion criteria.

RESULTS:

Twenty-five (19 females, mean age 62years) patients having both AS and typical features of mitral DI-VHD were identified. Mean transaortic pressure gradient was 32+/-13mmHg. Aortic regurgitation was ≥ mild in 24 (96%) but trivial in one. Known history of aortic valve regurgitation following drug initiation prior the development of AS was previously diagnosed in 17 patients (68%). Six patients underwent aortic valve replacement and 3 both aortic and mitral valve replacement. In the 9 patients with pathology analysis, aortic valvular endocardium was markedly thickened by dense non-inflammatory fibrosis, a characteristic feature of DI-VHD.

CONCLUSION:

The association between AS and typical mitral DI-VHD after valvulopathic drug exposure may not be fortuitous. Aortic regurgitation was usually associated to AS and preceded AS in most cases but may be lacking. Pathology demonstrated the potential role of valvulopathic drugs in the development of AS.

KEYWORDS:

Aortic stenosis; Benfluorex; Drug induced-valvular heart disease; Fenfluramin derivatives

PMID:
27390966
DOI:
10.1016/j.ijcard.2016.06.112
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center