Valvular heart disease in patients exposed to pergolide: insights from the clinical presentation.

PURPOSE: The aim of this study was to determine whether the presence of symptoms would aid in the detection of valvular heart disease (VHD) in those exposed to pergolide. METHODS: Utilizing a prospective, cross-sectional study design, patients with an exposure to pergolide were asked regarding the presence or absence of chest pain, shortness of breath or lower extremity edema through a questionnaire. Echocardiograms were obtained on the same day as the questionnaire and were blinded to all staff involved in the study. The sensitivity, specificity, positive and negative predictive value of the reported symptoms towards the outcome moderate or severe valvular regurgitation were obtained. Using the area under the receiver-operating characteristic curve, we also ascertained whether a relationship existed between symptoms, pergolide dose and presence of VHD. To understand the associations between symptoms and echocardiographic covariates, a logistic regression analysis was performed adjusted for age and gender. RESULTS: The sensitivity, specificity, positive and negative predictive value of symptom presentation and total dose was sufficiently low that it did not aid in the determination whether significant valvular regurgitation was present. Multivariable analysis noted a significant association with indexed left atrial volume (p = 0.011), estimated pulmonary artery pressure (p = 0.047) and shortness of breath. CONCLUSIONS: The presence or absence of symptoms does not help guide whether valvular regurgitation is present or absent in individuals exposed to pergolide. Therefore, echocardiography is needed to confirm or refute pergolide-associated VHD.

Sinus of valsalva pseudoaneurysm and mechanical aortic valve endocarditis.

We present the case of a 54-year-old male with a St. Jude aortic valve replacement who presented with fever and a new diastolic murmur. An echocardiogram identified a pseudoaneurysm that appeared to originate from the left sinus of Valsalva. In anticipation of open valve surgery, a 64-slice computed tomographic (CT) angiogram was performed to characterize the size and location of the pseudoaneurysm. In addition, the CT scan was able to rule out significant coronary artery disease and obviate the need to perform a potentially high-risk catheterdirected angiogram in the setting of an infected pseudoaneurysm.