– 2 year FS DSH with grade 6/6 systolic heart murmur since birth
– echoe performed today without sedation (so a little wiggly)
– pet sometimes seems to have lack of energy after running around but otherwise clinically doing well at home
– I am wondering about the possibility of a VSD (have not had much feline congenital heart disease experience!) My findings are: (I think)
– enlarged right heart – aortic regurg
– LV normal but mild LAE – no MR or SAM
– enlarged pulmonary artery with increased flow velocity
– 2 year FS DSH with grade 6/6 systolic heart murmur since birth
– echoe performed today without sedation (so a little wiggly)
– pet sometimes seems to have lack of energy after running around but otherwise clinically doing well at home
– I am wondering about the possibility of a VSD (have not had much feline congenital heart disease experience!) My findings are: (I think)
– enlarged right heart – aortic regurg
– LV normal but mild LAE – no MR or SAM
– enlarged pulmonary artery with increased flow velocity
– a defect seen in in the IVS on 2-D and turbulance through the defect on colour
Attached are a few of the images that may be helpful. Am I on the right track or totally out to lunch?!
[videoembed id=6891] [videoembed id=6892] [videoembed id=6893] [videoembed id=6894]
Comments
Nice vsd jacquie clear in the
Nice vsd jacquie clear in the 5 chamber view and in the last video. I can’t tell where you are on that spectral doppler though but looks like the rvot which is high so maybe some ps too especially with the CF turbulence in the video and dilated pa after the pv. Let’s see what Peter says.
Nice vsd jacquie clear in the
Nice vsd jacquie clear in the 5 chamber view and in the last video. I can’t tell where you are on that spectral doppler though but looks like the rvot which is high so maybe some ps too especially with the CF turbulence in the video and dilated pa after the pv. Let’s see what Peter says.
Hi!
This looks like a
Hi!
This looks like a combination of a VSD + either pulmonic stenosis or – more likely – double chambered right vnetricle. Do you have a color recording across the VSD? What about the PCV of the cat (polycytemia)?
The VSD is large enough to cause PHT with secondary PA enlargement but because of the high velocities you recorded within the RV/RVOT it could be that this (PS or double chambered RV) prevents PHT is this patient.
What to do depends on if if it´s a LR or RL-Shunt. COuld you perform a bubble study?
If you record the CDI flow across the VSD I would increase the nyquist limit (change PRF)
Nice case anyway!
And beautiful images/clips!
Peter
Hi!
This looks like a
Hi!
This looks like a combination of a VSD + either pulmonic stenosis or – more likely – double chambered right vnetricle. Do you have a color recording across the VSD? What about the PCV of the cat (polycytemia)?
The VSD is large enough to cause PHT with secondary PA enlargement but because of the high velocities you recorded within the RV/RVOT it could be that this (PS or double chambered RV) prevents PHT is this patient.
What to do depends on if if it´s a LR or RL-Shunt. COuld you perform a bubble study?
If you record the CDI flow across the VSD I would increase the nyquist limit (change PRF)
Nice case anyway!
And beautiful images/clips!
Peter
Thanks Eric and Peter. These
Thanks Eric and Peter. These cases can be complex! I have attached a picture of the Doppler flow I got through the VSD (aliased) so likely not too helpful!
The new clip shows just how thick the right ventricular wall is. I could not assess for pulmonary hypertension as there was no TR and I didn’t see PI but may have missed it.
It looks like I need more investigation for this patient. A PCV has not been run but will be recommended.
From what we know so far in this case, could we say that the lesion(s) present are hemodynamically significant as the RV wall is thickened and there was mild LAE present? Can we offer any type of prognosis or do I have to dig alot further? Would anesthesia be risky? I did recommend a repeat echoe to monitor for changes. Also discussed referral to a cardiologist for a more thorough interpretation 🙂 (admitted that this case was beyond my level at this stage)
Thanks so much – great learning case for me indeed.
Thanks Eric and Peter. These
Thanks Eric and Peter. These cases can be complex! I have attached a picture of the Doppler flow I got through the VSD (aliased) so likely not too helpful!
The new clip shows just how thick the right ventricular wall is. I could not assess for pulmonary hypertension as there was no TR and I didn’t see PI but may have missed it.
It looks like I need more investigation for this patient. A PCV has not been run but will be recommended.
From what we know so far in this case, could we say that the lesion(s) present are hemodynamically significant as the RV wall is thickened and there was mild LAE present? Can we offer any type of prognosis or do I have to dig alot further? Would anesthesia be risky? I did recommend a repeat echoe to monitor for changes. Also discussed referral to a cardiologist for a more thorough interpretation 🙂 (admitted that this case was beyond my level at this stage)
Thanks so much – great learning case for me indeed.
I guess, would not be able to
I guess, would not be able to use TR to assess for pulmonary hypertension anyway as PS appears to be present – just caught that.
I guess, would not be able to
I guess, would not be able to use TR to assess for pulmonary hypertension anyway as PS appears to be present – just caught that.
Hi!
I reviewed your material
Hi!
I reviewed your material again and I think it´s pulmonix stenosis not double chambered right ventricle. And I think you underestimated the RVOT velocities (these can somtimes be difficult to get in alignment). The CDI across the VSD doesn´t really help 🙂 Your PRF setting is too low. A CW across the VSD helps if exacltly positioned. But what about a bubble study?? This is the gold standard for detecting a R-L or bidirectional shunt. BTw it´s not really a tetralogy of Fallot since the AO is obviously not overriding. If the cat has a R-L shunt, a catheter intervention could be tried but is not as simple as in dogs.
What you could try is Atenolol at 6.25mg/cat.
If it´s a R-L shunt with severe polycytemia you could use hydroxyurea (but I have not tried it in cats yet since there has never been a need for it in my practice)
I will put a presentation about congenitals in cats on the sonopath homepage witin the next 2 months. Just to illustrate.
Best Regards from Austria!
Peter
Hi!
I reviewed your material
Hi!
I reviewed your material again and I think it´s pulmonix stenosis not double chambered right ventricle. And I think you underestimated the RVOT velocities (these can somtimes be difficult to get in alignment). The CDI across the VSD doesn´t really help 🙂 Your PRF setting is too low. A CW across the VSD helps if exacltly positioned. But what about a bubble study?? This is the gold standard for detecting a R-L or bidirectional shunt. BTw it´s not really a tetralogy of Fallot since the AO is obviously not overriding. If the cat has a R-L shunt, a catheter intervention could be tried but is not as simple as in dogs.
What you could try is Atenolol at 6.25mg/cat.
If it´s a R-L shunt with severe polycytemia you could use hydroxyurea (but I have not tried it in cats yet since there has never been a need for it in my practice)
I will put a presentation about congenitals in cats on the sonopath homepage witin the next 2 months. Just to illustrate.
Best Regards from Austria!
Peter
Thanks Peter!
I would like
Thanks Peter!
I would like to do a bubble study as it doesn’t look that hard to do but would prefer to have someone with me who has done one before to make sure I know what to look for. Maybe if the owner agrees to refer, I could tag along.
I will watch out for more of your case examples on the homepage!
Jacquie
Thanks Peter!
I would like
Thanks Peter!
I would like to do a bubble study as it doesn’t look that hard to do but would prefer to have someone with me who has done one before to make sure I know what to look for. Maybe if the owner agrees to refer, I could tag along.
I will watch out for more of your case examples on the homepage!
Jacquie
Hi Jaquie,
I have done the
Hi Jaquie,
I have done the microbubble before without anyone being to my side (and I wasn’t very experience the first time)
I just placed a catheter and injection port on the cephalic and asked someone to injected some ml of sal sol into vein, while I was ready with the probe on the right parasternal long-axis left ventricular outflow view or where you can see the defect or the right parasternal four chamber view. And once ready, They injected the solution previously aggitated and I promise that the bubbles started to appear very obvious on the RA and RV. In a normal heart no other chamber should present the bubbles and they disappeared quickly, if it is a R-L shunting you will see bubbles in the LV! As a routine I used to check also the abdominal aorta repeating the procedure one more time but this time scanning the abdominal aorta, specially when I was suspencting of reverse PDA. (I always checked the heart first, then the abdo AO)
It is amaizing to see and confirm dx, and I can warranty you that is fine to do it yourself.
Just my little contribution. I probably have a video somewhere there with how it looks if you need it let me know Im happy to post it. (Im sure Peter or Eric must have nicer videos than mine hehehehe)
Good luck and GO FOR IT!
P.S. Peter, in the 3rd video at the level of the PA it looks like a double valve is that like a ring on the PA? or is the first one part of the RV? or the defect? Thanks
Hi Jaquie,
I have done the
Hi Jaquie,
I have done the microbubble before without anyone being to my side (and I wasn’t very experience the first time)
I just placed a catheter and injection port on the cephalic and asked someone to injected some ml of sal sol into vein, while I was ready with the probe on the right parasternal long-axis left ventricular outflow view or where you can see the defect or the right parasternal four chamber view. And once ready, They injected the solution previously aggitated and I promise that the bubbles started to appear very obvious on the RA and RV. In a normal heart no other chamber should present the bubbles and they disappeared quickly, if it is a R-L shunting you will see bubbles in the LV! As a routine I used to check also the abdominal aorta repeating the procedure one more time but this time scanning the abdominal aorta, specially when I was suspencting of reverse PDA. (I always checked the heart first, then the abdo AO)
It is amaizing to see and confirm dx, and I can warranty you that is fine to do it yourself.
Just my little contribution. I probably have a video somewhere there with how it looks if you need it let me know Im happy to post it. (Im sure Peter or Eric must have nicer videos than mine hehehehe)
Good luck and GO FOR IT!
P.S. Peter, in the 3rd video at the level of the PA it looks like a double valve is that like a ring on the PA? or is the first one part of the RV? or the defect? Thanks
Hi mvdamian – your right. I
Hi mvdamian – your right. I should just go for it damn it! Thanks for the encouragement!
Jacquie
Hi mvdamian – your right. I
Hi mvdamian – your right. I should just go for it damn it! Thanks for the encouragement!
Jacquie
Hi you both!
I know what you
Hi you both!
I know what you mean. That´s why I first thought that this might be some infundibular stenosis or double chambered right ventrice but I think it´s rather some oblique section of the outflow tract since the turbulence on color starts behind it. One thing I´m not totally sure of is the fact that there´s some diastolic red signal within the PA that starts somewhere distal to the PV. The problem is that the color doesn´t fill the PA so it could be artificial. Still there could be (unlikely) an additional shunt (PDA????), but this is rather hypothetic. I would recommend using the PA122 for the the Doppler (color and CW) of the PV.
Regarding the bubble study. There should be a presentation about how to perform a bubble study somewhere at sonopath. It´s very detailled and filled with images how to do it (Eric, can you tell us where we can find it?). I usually use hestarch and agitate it by use of two syringes (one contains hestarch, the other is empty) and an empty 3 way tap. The advantage over saline is that the signal is stronger and lasts longer (in my experience).
Please post the bubble study once you got it! I´m looking fwd to seeing it!
Best Regards from Austria!
Peter
Hi you both!
I know what you
Hi you both!
I know what you mean. That´s why I first thought that this might be some infundibular stenosis or double chambered right ventrice but I think it´s rather some oblique section of the outflow tract since the turbulence on color starts behind it. One thing I´m not totally sure of is the fact that there´s some diastolic red signal within the PA that starts somewhere distal to the PV. The problem is that the color doesn´t fill the PA so it could be artificial. Still there could be (unlikely) an additional shunt (PDA????), but this is rather hypothetic. I would recommend using the PA122 for the the Doppler (color and CW) of the PV.
Regarding the bubble study. There should be a presentation about how to perform a bubble study somewhere at sonopath. It´s very detailled and filled with images how to do it (Eric, can you tell us where we can find it?). I usually use hestarch and agitate it by use of two syringes (one contains hestarch, the other is empty) and an empty 3 way tap. The advantage over saline is that the signal is stronger and lasts longer (in my experience).
Please post the bubble study once you got it! I´m looking fwd to seeing it!
Best Regards from Austria!
Peter
Everyone here is a “how to”
Everyone here is a “how to” in the resources/interventional procedures category of sonopath for members on how to perform a bubble study. Anything with a needle and “how to” go here. If it isn’t here we can get it in there by request in most cases. Click here.
Everyone here is a “how to”
Everyone here is a “how to” in the resources/interventional procedures category of sonopath for members on how to perform a bubble study. Anything with a needle and “how to” go here. If it isn’t here we can get it in there by request in most cases. Click here.
Great! Thanks Peter and
Great! Thanks Peter and Eric!!! I love the idea of using hestarch.
Also Eric, is there any chance that when someone comments on a post that is not created by you (like this one) but you want to follow up, to receive an email saying that someone else has posted too? I had to come back to check it out to follow it.
In the ones I post I do receive the email, but not on this ones.
Thanks thanks thanks
and GO FOR IT Jaquie!!!
Great! Thanks Peter and
Great! Thanks Peter and Eric!!! I love the idea of using hestarch.
Also Eric, is there any chance that when someone comments on a post that is not created by you (like this one) but you want to follow up, to receive an email saying that someone else has posted too? I had to come back to check it out to follow it.
In the ones I post I do receive the email, but not on this ones.
Thanks thanks thanks
and GO FOR IT Jaquie!!!
Your wish is our desire and
Your wish is our desire and thx for the recommendation! This is how we can evolve with all your help. From Paulo the wordpress wizard SP IT extraordinaire:
“There is now a check box under the comment area – ‘Notify me of follow-up comments by email.”
Your wish is our desire and
Your wish is our desire and thx for the recommendation! This is how we can evolve with all your help. From Paulo the wordpress wizard SP IT extraordinaire:
“There is now a check box under the comment area – ‘Notify me of follow-up comments by email.”