Case Study

Stage C1 Valvular Disease, Mitral Valve Prolapse and Left Sided Congested Heart Failure in a 12 year old Yorkshire Terrier

A 12-year-old SF Yorkshire terrier was presented for evaluation of a progressive cough over the last 2-3 weeks. Abnormalities on physical examination were respiratory distress and a grade V/VI heart murmur.

A 12-year-old SF Yorkshire terrier was presented for evaluation of a progressive cough over the last 2-3 weeks. Abnormalities on physical examination were respiratory distress and a grade V/VI heart murmur.

Sonographic Differential Diagnosis

Flail mitral valve leaflet. Ruptured chordae tendinae. Moderate left atrial enlargement. Moderate to severe pulmonary hypertension. This is most consistent with C1 to D1 valvular disease. Recommend Lasix 2-4 mg/kg b.i.d., blood pressure measurements, and oxygen therapy over the next 24 hours. Ace inhibitor is recommended at 0.5 mg/kg s.i.d. progressing to b.i.d., Pimobendan at 0.3 mg/kg b.i.d. and aspirin therapy 25 mg s.i.d. with food. Recheck echocardiogram in 2-3 weeks. The patient is at risk for sudden death. Sildenafil may be necessary in the near future. Cage rest is recommended.

Image Interpretation

The left heart demonstrated a linear ventricular septum. Contractility was functionally adequate demonstrated by the FS% measurement. Flail mitral valve leaflet was noted in this patient. Ruptured chordae tendinae are likely due to the corresponding clinical signs. The left atrium was normal size at this point. The left ventricular outflow demonstrated normal flow patterns and velocities through the aortic valve. Slight areas of lung consolidation were noted. This is consistent with potential pulmonary edema or emerging pulmonary thromboembolic disease. LA:AO Rishniw 2.4 Pulmonic insufficiency velocity 372 Mitral insufficiency velocity 670 Tricuspid insufficiency velocity 457 Hepatic vein dilation was noted at 0.72 cm at the base of the vena cava

DX

Stage C1 Valvular Disease Left CHF

Outcome

None

Clinical Differential Diagnosis

Cardiac – mitral/tricuspid valve insufficiency, myocardial weakness, chordae tendina rupture Pulmonary – cardiogenic edema, neoplasia, pneumonia, lung lobe torsion, allergic Trachea – collapse, neoplasia Pleural effusion