par Ewalenko, M.;Richard, Cl;Vandenbossche, Jean Luc 
Référence Revue médicale de Bruxelles, 20, 5, page (A419-A426)
Publication Publié, 1999
Référence Revue médicale de Bruxelles, 20, 5, page (A419-A426)
Publication Publié, 1999
Article révisé par les pairs
| Résumé : | We report cardiac valvulopathy occuring after prolonged intake of anorectic drugs containing fenfluramine (Fen) and/or dexfenfluramine (D-Fen) in 14 patients whose evolution was followed by Doppler echocardiography. A relation between these drugs and valvular regurgitation was first suspected after 4 cases reported in 1991-1992 and confirmed after 3 more patients in 1993-94-95, who were taken D-Fen or Fen alone. All were women, aged 42 to 73 years. Patient 1 to 7 had been taking Fen and/or D-Fen for 14 to 52 months. Patients 8 to 14 had been taking a mixture of Fen and/or D-Fen, diethylpropion and chinese-herbs for 3 to 69 months. These last 7 patients developped renal failure requiring hemodialysis or peritoneal dialysis in 5 and subsequent renal transplantation in 4. All presented with cardiac murmur(s) and some with dyspnea or palpitations. An initial echocardiography was performed at the time of diagnosis, and was repeated annually for a follow up period extending to 8 years. We conclude that a relation between Fen and/or D-Fen and the outbreak of valvular heart disease is identified in our patients, confirming previous findings. The nephrotoxicity observed in 7 patients is due to the "chinese-herbs". When Fen and/or D-Fen are stopped and proper therapy initiated, the cardiac symptoms may stabilize or even subside, though slowly. Hemodynamic unstability and/or infection appear to be an aggravating factor. These patient's follow up must be prolonged for several years and is readily achieved with echocardiography. Systematic screening of all patients having taken Fen and/or D-Fen must be performed, as renal and urinary screening for all patients having taken chineseherbs. Endocardial prophylaxis must always be prescribed. |
