A 57-year-old woman was referred for dyspnoea during mild exercise, especially during the past year. Electrocardiogram and chest X-ray demonstrated no significant anomaly. Nt-pro brain natriuretic peptide was moderately elevated to 319 ng/L (range: 0–290 ng/L). Echocardiographic examination showed normal left ventricle function and anatomy, mild regurgitations of the aortic and mitral valves and a severe regurgitation of the tricuspid valve ( Figs. 1 and 2 ), with an estimated systolic pulmonary pressure of 60 mmHg. The mechanism of the valvular regurgitations corresponded to valvular fibrosis and subsequently restriction motion. Right heart catheterization confirmed pulmonary arterial hypertension with normal pulmonary wedge pressure and cardiac output. Thoracic tomodensitometry ruled out pulmonary embolism. There was also no clinical or biological evidence for a carcinoid syndrome. The patient had no previous medical history, but she had taken benfluorex (150 mg tid ) for the past 8 years because of excessive weight (159 cm, 82 kg) and hypertriglyceridaemia.
