Severe insuffiency of the aortic and tricuspidal valves associated with pergolide use

A 58-year-old woman with Parkinson's disease was treated with high-dose pergolide for 10 years. After the addition of citalopram, a selective serotonin reuptake inhibitor, to treat an anxiety disorder, she developed cardiac decompensation that was most likely related to typical pergolide-related fibroproliferative abnormalities of the tricuspidal, aortic and mitral valves, without cardiomyopathy or coronary heart disease. The aortic and tricuspidal valves were replaced with prosthetics and pergolide was switched to ropinirol. At a control visit after one year, patient's heart function was stable. Pergolide is an ergot-derived dopamine agonist used in the treatment of Parkinson's disease and restless-legs syndrome. In 2002, it was first associated with heart-valve defects. Patients treated with pergolide should be monitored for clinical signs of heart-valve failure. If there is no evidence of heart-valve defects, then regular monitoring of cardiac function is indicated. In case of indications of heart-valve failure pergolide should be discontinued. In some cases the heart-valve abnormalitites are reversible.