S Bromocriptine
Mitral regurgitation, aortic valve regurgitation, and tricuspid regurgitation: case reportA 76-year-old man developed mitral regurgitation, aortic valve regurgitation, and tricuspid regurgitation during treatment with bromocriptine.The man, who had Parkinson's disease treated with bromocriptine 30 mg/day for more than 7 years (total cumulative dose = 77 g) [route not stated], presented with severe dyspnoea, leading to urgent hospitalization for congestive heart failure. His trans-thoracic doppler echocardiography showed a dilated left ventricle with normal ejection fraction without wall motion abnormalities. Both the mitral and the aortic valves were thickened with a drumstick appearance and restrictive motion of the two mitral leaflets causing severe mitral regurgitation. Significant aortic valve regurgitation due to restrictive motion of the right and the noncoronary aortic cusps was noted. Significant tricuspid regurgitation with thickened tricuspid leaflets and a dilated tricuspid annulus was seen and the left atrium was dilated. Coronary angiography revealed three-vessel disease.The man's bromocriptine treatment was interrupted and he was managed medically and still alive. [outcomes not stated]Author comment: "Although there was no histological proof however, given the time course, cumulative dose, chemical similarity of bromocriptine to other ergo derivatives and typical valve lesions seen on [Trans-thoracic Doppler echocardiography], we felt that there was a strong and probable association between prolonged bromocriptine treatment and the occurrence of severe multiple valves disease."Cautres T, et al. Multiple valvular regurgitation associated with bromocriptine therapy.