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Fenfluramine can cause valvulopathy & pulmonal hypertonia either through 5HT2B agonism or SERT substrates. This is not fully clear yet.[1][2]

  1. A. Keegan, I. Morecroft, D. Smillie, M. N. Hicks, M. R. MacLean. Circ. Res. 2001, 89, 1231
  2. R. B. Rothmann, M. H. Baumann. Pharmacol. Tber. 2002, 95, 73.