Chest
Volume 121, Issue 2, February 2002, Pages 649-652
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Selected Reports
Autopsy Findings of Heart and Lungs in a Patient With Primary Pulmonary Hypertension Associated With Use of Fenfluramine and Phentermine

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A 36-year-old woman (height, 157 cm; weight, 117 kg; body mass index, 47.5) received fenfluramine and phentermine (fen-phen) for 7 months, and pulmonary hypertension subsequently developed. Her pulmonary arterial pressure was 56 mm Hg, and echocardiography showed right ventricular dilatation and hypokinesia. Cardiopulmonary arrest developed during right-heart catheterization, and she died 3 days later. At autopsy, right ventricular dilatation with fibroproliferative tricuspid valve was identified. The pulmonary arteries, including the main arteries and elastic arteries to the arterioles, revealed fibroproliferative plaque; the latter was more severe and more prominent in the upper lobes than in the lower lobes. Combined cardiac valvular disease and pulmonary hypertension appear to occur frequently in patients receiving fen-phen, and more autopsy cases of patients with a history of fen-phen usage are warranted to document the frequency of combined cardiac valvular disease and pulmonary hypertension in the United States.

Section snippets

Case Report

A 36-year-old woman (height, 157 cm; weight, 117 kg; body mass index, 47.5) was transferred from the outpatient cardiac laboratory to the ICU of University of Kansas Medical Center after cardiorespiratory arrest that occurred during right-heart catheterization. She had delivered a son by cesarean section in 1993 and received a diagnosis of gestational diabetes at that time. She had a history of fen-phen usage (daily dosage: fenfluramine, 30 mg; phentermine, 15 mg) for 7 months from February to

Discussion

PPH is a lethal disease with an estimated median survival of 2.5 years.7 PPH occurs more frequently in female than in male patients, and PPH associated with fen-phen usage appears to occur almost exclusively in obese, middle-age women (mean ± SD age, 44 ± 8 years; body mass index > 30), as seen in this case.14

All 24 patients reported from the Mayo Clinic with cardiac valvular disease were female, 8 of whom also had PPH.4 Thus, fen-phen usage causes both cardiac valvular lesions and PPH

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