-11 month old, ME, DSH. Hydrocephalus. Grade 5 machinery heart murmur.Severe exercise (and handling) intolerance. –
-Echocardio scheduled to confirm PDA for potential surgery. Examination is extremely challenging due to resp distress. No standard views other than right parasternal (but on sternal recumbency). Findings suggest:
-no PDA.
-11 month old, ME, DSH. Hydrocephalus. Grade 5 machinery heart murmur.Severe exercise (and handling) intolerance. –
-Echocardio scheduled to confirm PDA for potential surgery. Examination is extremely challenging due to resp distress. No standard views other than right parasternal (but on sternal recumbency). Findings suggest:
-no PDA.
-Presence of: AV canal and cor triatriatum sinister. There is a band proximal to left atrium creating a proximal cavity with turbulent flow that on other views appears to come from RVOT (so RVOT appears somehow connected to LA). LVOT appears to communicate with right atrium. Both atriums are communicated via a large ASD with what appears bidirectional flow.
– Mitral and tricuspid valves malformation as well as aortic and pulmonic valves malformation.
– Right atrial and ventricular dilation (RV also mildly hypertrophied-concentric) indicating volume and pressure overload. There is flattening of the IVS during systole, indicating high right ventricular pressure.
Do you think this assessment is correct? It has taken me many many reviews of the clips (MANY!) to try and figure out what was happening, so I may have got a bit carried away, imagining things?
I do not think patient has currently congestive heart failure (hepatic veins distended but no ascites and no pulm oedema/pleural effusion) so I believe the respiratory distress might be due to low oxygenated blood.
How could we best help this kitty for the rest of his limited life? ACEIs and anything else?
Thank you so much.
Comments
EL, I’m sure it’s too long of
EL, I’m sure it’s too long of a post for your liking. I do apologize…i thought it could be a good archive case. If I’m right, that is…
This is a beautiful case.
This is a beautiful case. Sorry for the delay we have been slammed. A telemed consult with one of our cardiologists would be best here rgearding any tx but I am seeing a whopping asd, RVH, biatrial enlargement with a 1.5:1 RA:LA ratio and bidirectional flow so Eisenmenger’s is in the house. Wihtout right failure yet but coming im sure … I imagine the respiratory distress is exercise induced? If so maybe atenolol..
Thanks!!!! So you don’t think
Thanks!!!! So you don’t think there is A/V canal? Just ASD?
And do you think that is cor triatriatim sinister, too?
Thank so.much for the answer. I will discuss with owner about telemed referral.
Sorry, the exercise
Sorry, the exercise intolerance is with exercise or just minor handling, too.
My boss has just mentioned there is a link between hydrocephaly and congenital malformations in kittens when the mother is vaccinated with panleucopenia vac and pregnant. I’l investigate this further.
Hi!
Thanks for posting!
I
Hi!
Thanks for posting!
I think what you refer to as septum between 2 la chambers is the separation between the right pulmonary artery and the left atrium. In a cor triatriatum or supravalvular mitral stenoses (dependent on where the auricle is seated) the LA is usually very huge. This would as well support the theory that there is RVOT obstruction like pulmonic stenosis since there is turbulence within that right pulmonary artery. Otherwise pulmonary hypertension can be considered. Re the ASD: I’m not completely sure where that blood comes from. ASD is certainly possible but also color bleeding. The right ventricular dilation would suggest an ASD. But if there is pulmonic stenosis present, why would there be so much L-R shunting across the ASD (increased RV pressure and restriction to filling due to hypertrophy). This is certainly an interesting case but required assessment of all your measurements and findings… These cases sometimes take me quite a lot of time for thorough assessment…
Sorry that I cannot help further –
Regards!
Peter
Thanks Peter. My doubt about
Thanks Peter. My doubt about the LA for triatriatim was that one exactly. Whether it was PA cause in some views it has turbulence. But in other views it looks like the flow goes really through a first chamber and directly into a second one. I thought the lack of LA enlargement could have been due to the ASD and the general chronic remodelling…ill see if I can see other videos…i took so many. Thank you for the input.
I will try and persuade owners for full telemed although this kitty is stray…and the person who brought it in quite cost concerned.