-12 year old dog, presented for wheezing and mild cough. Not febrile or very sick.
-Radiographs show cardiomegaly. Other vet was worried about DCM or pericardial effusion.
-No murmur present.
-mild AI (congenital?) with mild cardiac remodeling. As far as I can tell, the valve looks ok. No other leaking valves.
Values are:LA 2.43, Ao 1.63, IVSd 1.18; LVIDd 2.59; LVFWd 1.37; IVSs 1.63; LVIDs 1.68 ; LVFWs 1.82; MPA .%FS 35; LA:Ao 1.49.
I unfortunately didn’t save a right long axis view but I have a tipped view.
-12 year old dog, presented for wheezing and mild cough. Not febrile or very sick.
-Radiographs show cardiomegaly. Other vet was worried about DCM or pericardial effusion.
-No murmur present.
-mild AI (congenital?) with mild cardiac remodeling. As far as I can tell, the valve looks ok. No other leaking valves.
Values are:LA 2.43, Ao 1.63, IVSd 1.18; LVIDd 2.59; LVFWd 1.37; IVSs 1.63; LVIDs 1.68 ; LVFWs 1.82; MPA .%FS 35; LA:Ao 1.49.
I unfortunately didn’t save a right long axis view but I have a tipped view.
-I am still learning echo and am trying to put together everything I saw in one coherent picture. Can you help me explain the big picture in this case? Is this long – standing aortic stenosis that is unrelated to the current signs? Thanks.
Comments
Subjectively I think the
Subjectively I think the heart is pretty normal maybe upper end of normal but the LA size is eyeballing about 2.5 cm in la max and the atrial septum isnt deviated. Theres a touch of AI but not likely an issue. The lvot veloicity has an angle of about 45 degree angle instead of < 15 degrees which is necessary for spectral doppler. So need to twist the probe slightly which will lengthen out and straighten the aorta. This puts you lined up with flow better with the aorta diving loing and straight down the screen. From what I see the heart isnt a clinical player here. You have artifact in the spectral TV view so I dont think I would believe that flow but even if TR not likely an issue.
All these issues can be cleaned up with the SDEP echo protocol to plug our teaching video here on positioning and doppler and flow efficency.
https://sonopath.com/products/downloadable
Otherwise our seminar in Denver in October with Mandi Klemen will get this all cleaned up too:) Attendees get the sdep echo video download included with the course.
http://www.sonopath.com/events/2017-sonopath-sdep-ce-eventslecture-events
Hi!
There are 4 main reasons
Hi!
There are 4 main reasons for aortic insufficiency that should always be considered/ruled out:
Aortic stenosis (very likely the case here although the degree is unclear)
Ventricular septal defect (peri-membranous)
aortic valve endocarditis (very unlikely here)
myxomatous degenerative valve disease (I don’t think this is the case here)
There are some breeds like I wolfs which tend to have mild aortic regurgitation without other abnormalities.
I agree with Eric in that this isn’t a clinical player.
Staging of AI is a bit difficult and needs more views…
regards
Peter
Somtimes I am able to get
Somtimes I am able to get better aortic doppler measurements subxyphoid.
Need a low frequency probe. Seems like it lines up better for doppler.
Yes I always use subxyphoid
Yes I always use subxyphoid and flatten the probe on the linea alba with probe head just under the xyphoid. Drops the ao right down the middle. Small dogs a 6 mhz will do it but need 3-4 mhz for anything larger. These are the images you should get.. one is mine the other is peter’s. We do it the same way and its position 4 in sdep echo:
https://sonopath.com/products/downloadable