Hi all, I hope you can help me with this case. I am a bit confused at the findings. Initially I thought it was PDA but the lack of volume overload remodelling just does not fit. However, I find something on the left short axis view…Please help:

Hi all, I hope you can help me with this case. I am a bit confused at the findings. Initially I thought it was PDA but the lack of volume overload remodelling just does not fit. However, I find something on the left short axis view…Please help:

This is 12 year old silky terrier. Male, not neutered. At 6 months old, a grade 2-6 pansystolic heart murmur is heard. At 1 year old, grade 4-6. No symptoms. Was started on enalapril. No xrays-ECG-echo. After a few years…enalapril stopped. After a few years, re’started. Dog has been on back enalapril for at least 3 years now. Patient is now starting to cough. At some point in 2010 dog had and ECG and Echo of which there is no report other than ¨nothing abnormal¨. Current findings:

Xrays: appears to have general mild enlargement, with increased ventricular contact with sternum aspect of the thorax. No obvious LA enlargement. On lateral view I fail to find a good descending aorta. On VD view I see a bulging main pulmonary artery. A mild vascular pattern. There might be mild peri-hilar pulmonary oedema…although I’m not too convinced.

ECHO:

-No LA enlargement. There appears to be a postvalvular aortic dilation.

-No significant mitral regurgitation nor abnormal mitral valves.

-there is mild tricuspid regurgitation, valves appear fairly normal to me. It is not significant since less than 2.5m/s

-There is significant Main pulmonary artery dilation and insufficiency.

-There is left and right ventricular concentric hypertrophy.

-On the left parasternal short axis/oblique view, I find a flow from aorta to somewhere I’m not sure…Which I thought it looks like PDA…but heart remodelling does not fit PDA…so Im very puzzled at the findings.

Please, I would appreciate anybody who could enlighten me with their knowdlege…