Hello
This is Mika a 2 year old Boston Terrier with a continuous murmur. Regular DVM submitted xrays and EKG to Idexx who reported Rt side enlargement on xrays and normal EKG.They were suspicious of Pulmonic stenosis. They have an appointment scheduled with a cardiologist in 2 weeks but the dog is not doing well so we took a look today.
Hello
This is Mika a 2 year old Boston Terrier with a continuous murmur. Regular DVM submitted xrays and EKG to Idexx who reported Rt side enlargement on xrays and normal EKG.They were suspicious of Pulmonic stenosis. They have an appointment scheduled with a cardiologist in 2 weeks but the dog is not doing well so we took a look today.
On US the Rt heart is markedly enlarged and there appears to be an atrial septal defect seen in multiple views. I can actually see it better in short-axis but I am posting the long axis as I believe it is the traditional view. So I was hoping for confirmation on that!
As well there is a hyperechoic oval mass in the outflow tract of the Rt ventricle. There is no smoke but I am wondering if this is a blood clot or a mass??
I did not see a ventricula septal defect and CW doppler shows a regurgitant jet in Rt short axis from the TR valve towards the transcucer around 4m/s. Any medications we can give (i.e. vasodialator to reduce afterload?) while waiting for referral.
Thanks. Brent.
Comments
Hi!
Yes, I think there is an
Hi!
Yes, I think there is an ASD but in this case it would be easy to confirm with bubbles since the right ventricular pressure is high and the blood will very likely flow from right to left. The tricuspid valve leaflets are very thinkened and consistent with dysplasia (or endocarditis). The high pressure gradient could of course be a consequence of outflow tract obstruction by the mass like lesion. This, however, could be both mass or thrombus. Sometimes it is very difficult to differentiate. What I do is check if there is any attachment to the wall or not (multiple views) and if blood flows around it in multiple views. Is there any disease that could explain clot formation (history of possible endocarditis, fever, protein losing nephropathy,…?). Otherwise I woudl prefer a tumor.
At present, I would not give any cardiac medication unless the patient is in right sided heart failure (ascites). What you can do is give him clopidogrel (1.5-2mg/kg bid).
Best regards!
Peter
Thank you very much for the
Thank you very much for the information! Much appreciated! Brent