A cohort of patients with Parkinson's disease treated with either ergot-derived or non–ergot-derived dopamine agonists underwent echocardiographic evaluation. As compared with a group of normal control subjects, patients taking pergolide or cabergoline had a higher frequency of clinically important valve regurgitation and more evidence of stiffening and displacement of the mitral leaflet, as measured by the tenting area of the mitral valve. Patients with Parkinson's disease taking pergolide or cabergoline had a higher frequency of clinically important valve regurgitation and more evidence of stiffening and displacement of the mitral leaflet than controls. Several studies and case reports strongly support a causal relationship between the occurrence of drug-induced “restrictive” valvular heart disease and treatment with pergolide, an ergot-derived dopamine receptor agonist mainly used to treat Parkinson's disease. 1 – 6 More specifically, pergolide may induce fibrotic changes in valve leaflets and in the mitral subvalvular apparatus, causing thickening, retraction, and stiffening of valves and resulting in incomplete leaflet coaptation and valve regurgitation. Valvular heart damage has also been reported with the ergot-derived dopamine agonists bromocriptine and cabergoline. 5 – 7 This is important, since cabergoline is widely prescribed in many countries for Parkinson's disease and, at low . . .