1. Drug-induced aortic valve stenosis: An under recognized entity
- Author
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Bernard Assoun, Marie-Christine Copin, B. Blanchard-Lemoine, Carlo Banfi, Jean-Pierre Gueffet, Xavier Halna du Fretay, Sylvie Lantuejoul, Emmanuel Bogino, Sylvestre Maréchaux, Jean-Fortuné Ikoli, Caroline Augier, Raymond Roudaut, Louis Guillou, Yannick Jobic, M.-C. Malergue, Pierre Nazeyrollas, Pierre Morera, Pierre-Vladimir Ennezat, Patrick Bruneval, Dominique Grisoli, Odile Patra, Nicolas Piriou, Olivier Fabre, Christophe Tribouilloy, Olivier Chavanon, Hélène Petit-Eisenmann, J.P. Remadi, Lorraine Greffe, Daniel Czitrom, Eric Brochet, Jean Noel Trochu, Camille Dambrin, André Vincentelli, Département de cardiologie et hypertension, CHU Grenoble, Immunopathologie humaine, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mutualiste de Montsouris (IMM), Institut du thorax, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier Universitaire de Reims (CHU Reims), Département Cardiologie, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Nouvel Hôpital Civil de Strasbourg, CHU Strasbourg, Université de Strasbourg (UNISTRA), Service Chirurgie Cardio-Vasculaire [CHU Toulouse] (CCV), Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Langages, Littératures, Sociétés, Études Transfrontalières et Internationales (LLSETI), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Oncology - Pathology - Anatomy, Institute of Pathology-University of Bern, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Département d'anatomie et cythologie pathologique, CHU Grenoble-Hôpital Michallon, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupement Hospitalier de l'Institut Catholique de Lille, Faculté Libre de Médecine de Lille (FLM), Institut Catholique de Lille (ICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL)-Institut Catholique de Lille (ICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL)-UC Lille, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), and Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Fenfluramine/adverse effects/analogs & derivatives ,Aortic Valve Stenosis/chemically induced/diagnostic imaging/pathology ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Bicuspid aortic valve ,Aortic valve replacement ,Internal medicine ,Fenfluramine ,medicine ,Humans ,030212 general & internal medicine ,Aortic valve regurgitation ,Methysergide/adverse effects ,Aged ,Retrospective Studies ,Aged, 80 and over ,ddc:617 ,business.industry ,Methysergide ,valvular heart disease ,Mitral valve replacement ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,Surgery ,Stenosis ,Aged 80 and over ,Aortic valve stenosis ,Cardiology ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; 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 > 15 mm Hg) 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 62 years) patients having both AS and typical features of mitral DI-VHD were identified. Mean transaortic pressure gradient was 32+/-13 mm Hg. 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
- Published
- 2016