Hi, I would Appretiate your help with this case.
-14 month old, Male neutered, French bulldog. 11.8kg. Echo performed to identify the origin of a grade III systolic murmur (more prominent on left cranial basilar aspect) and an arrythmia (I thought it was more a sinus arrythmia when i asucultated). ECG pending.
– Echocardio findings:
Mild subvalvular (vs valvular?) stenosis: turbulent flow and narrowing of the LVOT.
Hi, I would Appretiate your help with this case.
-14 month old, Male neutered, French bulldog. 11.8kg. Echo performed to identify the origin of a grade III systolic murmur (more prominent on left cranial basilar aspect) and an arrythmia (I thought it was more a sinus arrythmia when i asucultated). ECG pending.
– Echocardio findings:
Mild subvalvular (vs valvular?) stenosis: turbulent flow and narrowing of the LVOT.
Mitral valve: fairly normal (mildly prominent?). There is a minor/trivial mitral regurgitation which I could not pick at CW doppler but i think I can see briefly when playing video of long axis slowly.
No PDA, tricuspid regurgitation, nor other findings.
LA: Ao ratio: 1.98 but I think this is partly due to a smaller aorta and when considering the actual size (24.3mm then it appears only mildly enlarged.
Aorta Peak velocity: 2.2-2.3m/s(possibly underestimated a bit). Press Grad: 20apprx. (MILD stenosis). Mild aortic insufficiency (that i could not see on Bmode doppler but I think there is in the CW profile.
EPSS: mildly elevated (6.8 to 7.1 approx). Due to the regurgitation??
Aortic profile: conserves the shape. Mild stenosis.
LVOT to Aortic root (Valsava point)ratio: 0.82 (12.2:14.8)=MILD stenosis.
On Mmode LA/Ao and short axist right parasternal, the aortic valves are not clearly seen. I fail to identify the mercedes sign.
MModes: LVDd appears mildly increased (31.3mm, 33.3mm and 34mm in long axis, short axis and Bmode long axis respectively). PWDd appears slightly over the range at 8.8.7, 8.8, 9.8mm (respectively in the 3 types of measurements).
I could not find breed specific reference ranges. So im using Boon’s tables.
FS: 28 and 34 (oops) in long axis and short axis. Regardless, on the lower side.
-Questions: are these interpretations correct? I cant see much of pressure overload remodelling (only a mild PW thickening) and how is the increased LV diastolic dilation explained? is there mitral valve disease? I dont htink so, how can this be explained?
Would you start any medication? I would think NOT because of lack of remodelling?
Thank you in advance for your help. 
Comments
Your la/ao is artifically
Your la/ao is artifically enlarged because you need to slide more toward the spine to get the proper wide aorta and the av valve clean. Subjectively your june boon la/ao should be 1.2 or similar. Remember to be sure you subjkective assessment in 5 chamber long axis matches your numbers. The lvot velocity is consistent with mild/moderate sas. Need to check when full grown to see if clinical velocities occur i.e in the > 5 m/sec.
Curbside guide has a solid summary of SAS fyi
https://sonopath.com/products/book
Thanks Eric.
Thanks Eric.