Case report

Cardiac surgery in a patient with retroperitoneal fibrosis and heart valvulopathy, both due to pergolide medication for Parkinson's disease

Efstratios E Apostolakis¹ , Nikolaos G Baikoussis¹ , Dimitrios Tselikos¹ , Ioanna Koniari¹ , Christos Prokakis¹ , Eleftherios Fokaeas² and Menelaos Karanikolas³

¹  Department of Cardiothoracic Surgery, University of Patras, School of Medicine. Patras, Greece

²  Department of Urology, University of Patras, School of Medicine, Patras, Greece

³  Department of Anaesthesiology and Critical Care Medicine, University of Patras, School of Medicine. Patras, Greece

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Journal of Cardiothoracic Surgery 2009, 4:65doi:10.1186/1749-8090-4-65

Published:	13 November 2009

Abstract

Retroperitoneal fibrosis is best described as a chronic inflammatory process which may be idiopathic, but can rarely be brought about by medications, such as pergolide, used for treating Parkinson's disease. Pergolide can produce a fibrotic process in heart valves, resulting in valve insufficiency in up to 25% of cases. Herein we describe the case of a 68-year-old man who received pergolide for 2 years for Parkinson's disease. The patient developed retroperitoneal fibrosis resulting in renal failure from ureteral obstruction necessitating ureteral stenting, as well as significant aortic and mitral valve insufficiency. He successfully underwent surgery for combined aortic valve, mitral valve and ascending aorta replacement because of severe valve insufficiency and dilated (d = 5.8 cm) ascending aorta. Retroperitoneal fibrosis improved with pergolide cessation and corticosteroid treatment. This is the second case reported in the literature, of a patient who had double valve and ascending aorta replacement surgery because he suffered from this rare but serious adverse effect of dopamine agonists used for managing Parkinson's disease.