8 mth old cat desexed 2 days ago, no heart murmur and bloods unremarkable. However, prolonged recovery post op, became dyspneic and started showing ‘neurologcal signs’ after surgery.
incidental finding of a severely enlarged RV amd RA during abdominal scan. TV was hardly moving and the CVC was severely distended.
8 mth old cat desexed 2 days ago, no heart murmur and bloods unremarkable. However, prolonged recovery post op, became dyspneic and started showing ‘neurologcal signs’ after surgery.
incidental finding of a severely enlarged RV amd RA during abdominal scan. TV was hardly moving and the CVC was severely distended.
Qns:
1. Is this a congenital case of tricuspid valvular dysplasia?
2. How do I interpret the pulse wave colour flow doppler on the TV?
3. Is my LV Mmode measurment due to the ‘weird’ contraction of the LV?
4. What is the prognosis for this kitty?
Thank you!!
Comments
Could this be ARVC?
Could this be ARVC?
Could this be ARVC?
Could this be ARVC?
Im thinking a primary TV
Im thinking a primary TV dysplasia but tough to tell. Need a PV veloicity to rule out PS. But the RV FW is very thin likely from chronic dysfunction and thinning. So not like a compensitory hypertrophy from PS for example. No VSD to see either. Very little contractility so opportunity for turbulence is minimal to have an auscoultable murmur. The CVC-RA-TV-RV is essentially one chamber here and in obvious right chf but chronically so which supports primary disease…. Regarding the no murmur issue…. its just like a vsd or pda are loud at first then eisenmengers physiology kicks in as the LV/RV pressures equalize and the murmur drops in grade or dissappears… no turbulence… no murmur…. “hole in the heart osmosis” so to speak:) In this case the “hole” is the TV… Its like slow moving mississippi river on the right side here. Right systolic dysfunction.
I’ve summoned our rock star cardiosurgeon Peter Modler to chime in here for a more technical explanation. FYI Peter’s case is Feb 2015 case of the month and when you see it you will know why he is a rock star 🙂 he has outdone himself and recorded history in europe.
Im thinking a primary TV
Im thinking a primary TV dysplasia but tough to tell. Need a PV veloicity to rule out PS. But the RV FW is very thin likely from chronic dysfunction and thinning. So not like a compensitory hypertrophy from PS for example. No VSD to see either. Very little contractility so opportunity for turbulence is minimal to have an auscoultable murmur. The CVC-RA-TV-RV is essentially one chamber here and in obvious right chf but chronically so which supports primary disease…. Regarding the no murmur issue…. its just like a vsd or pda are loud at first then eisenmengers physiology kicks in as the LV/RV pressures equalize and the murmur drops in grade or dissappears… no turbulence… no murmur…. “hole in the heart osmosis” so to speak:) In this case the “hole” is the TV… Its like slow moving mississippi river on the right side here. Right systolic dysfunction.
I’ve summoned our rock star cardiosurgeon Peter Modler to chime in here for a more technical explanation. FYI Peter’s case is Feb 2015 case of the month and when you see it you will know why he is a rock star 🙂 he has outdone himself and recorded history in europe.
Yeow- I am surprised this cat
Yeow- I am surprised this cat made it through surgery.
Prognosis- I would not buy him or her any green bananas
Yeow- I am surprised this cat
Yeow- I am surprised this cat made it through surgery.
Prognosis- I would not buy him or her any green bananas
ARVC: June Boons book.
“This
ARVC: June Boons book.
“This disease is reported in cats with echocardiographic manifestations that include pronounced right atrial and ventricular dilation, paradoxical septal motion, abnormal trabeculation of the right ventricular wall, and aneurysmal dilation of the right ventricular wall with akinetic and dyskinetic muscle. The L side of the heart is essentially normal. Abnormalities of the left side when present include atrial dilation and abnormal fractional shortening in the presence of pardoxical septal motion. The left atrial dilation ranges from mild to severe in these cats”
ARVC: June Boons book.
“This
ARVC: June Boons book.
“This disease is reported in cats with echocardiographic manifestations that include pronounced right atrial and ventricular dilation, paradoxical septal motion, abnormal trabeculation of the right ventricular wall, and aneurysmal dilation of the right ventricular wall with akinetic and dyskinetic muscle. The L side of the heart is essentially normal. Abnormalities of the left side when present include atrial dilation and abnormal fractional shortening in the presence of pardoxical septal motion. The left atrial dilation ranges from mild to severe in these cats”
Hi Randy, thank you for this
Hi Randy, thank you for this case!
Eric , thank you for the compliment 🙂
For me this is severe TD. On your color video you see why there is no murmur: THere is no pressure difference between the RV and RA, that’s why there is no turbulence and no jet. No turbulence, no jet -> no murmur. Pressures in the RV and RA have equalized!
This is not ARVC because this disease is only found in adult cats. And TD is exclusionary.
The left heart seems to be completely underloaded because there is not preload. All blood is somehow trapped in the systemic circuit. But there is still some mitral dysplasia present.
What I cannot rule out is additional congenital diseases and vascular disease (e.g. abnormal pulmonary venous connection etc).
The prognosis is bad for this cat. I wonder why this cat has not developed afib yet…
Go for diuretics, ACEI and Pimobendan.
Good images!!
best regards!
Peter
Hi Randy, thank you for this
Hi Randy, thank you for this case!
Eric , thank you for the compliment 🙂
For me this is severe TD. On your color video you see why there is no murmur: THere is no pressure difference between the RV and RA, that’s why there is no turbulence and no jet. No turbulence, no jet -> no murmur. Pressures in the RV and RA have equalized!
This is not ARVC because this disease is only found in adult cats. And TD is exclusionary.
The left heart seems to be completely underloaded because there is not preload. All blood is somehow trapped in the systemic circuit. But there is still some mitral dysplasia present.
What I cannot rule out is additional congenital diseases and vascular disease (e.g. abnormal pulmonary venous connection etc).
The prognosis is bad for this cat. I wonder why this cat has not developed afib yet…
Go for diuretics, ACEI and Pimobendan.
Good images!!
best regards!
Peter
Thank you Pete, Randy and El
Thank you Pete, Randy and El for your comments! Unfortunately I couldn’t get a PA flow in this cat, could not get the angle right for measurement!
Nonethless I think the consensus is bad prognosis for this cat:(
Thank you Pete, Randy and El
Thank you Pete, Randy and El for your comments! Unfortunately I couldn’t get a PA flow in this cat, could not get the angle right for measurement!
Nonethless I think the consensus is bad prognosis for this cat:(