An 11-month-old male neutered Labrador Retriever was presented for history of a grade 4/6 heart murmur and PMI aortic valve.
An 11-month-old male neutered Labrador Retriever was presented for history of a grade 4/6 heart murmur and PMI aortic valve.
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An 11-month-old male neutered Labrador Retriever was presented for history of a grade 4/6 heart murmur and PMI aortic valve.
An 11-month-old male neutered Labrador Retriever was presented for history of a grade 4/6 heart murmur and PMI aortic valve.
The sonographic findings were consistent with concurrent SAS or severe compensatory elevated velocities owing to the presence of PDA. Interventional cardiologist review is recommended.Theoretically correction of the PDA and balloon valvuloplasty may allow for a significantly diminished LVOT velocity; however, this should be evaluated by cardiologist for possible intervention as to whether the LVOT velocities and aortic valve thickening is primary subaortic stenosis or if it could be managed by correction of the PDA. Given the periodic arrhythmia, excessive EPSS and volume overload of the left atrium and left ventricle I recommend rapid evaluation of this patient for the potential for interventional procedures. Please provide follow-up if possible owing to this interesting, yet precarious presentation. The breeding line should be fully evaluated for murmurs and/or echocardiograms to assess for similar cardiac congenital lesions in the breeding line. Guarded prognosis.
The echocardiogram in this patient presented mild to moderate volume overload of the left ventricle and left atrium with mitral insufficiency. Excessive EPSS measurement was noted. Mild deviation of the atrial septum noted owing to left atrial volume overload. The mitral insufficiency presented a centralized jet on color flow assessment with moderate filling of the left atrium. Contractility was slightly subnormal for this type of pathology. The left ventricular outflow tract revealed a thickened and vegetative aortic valve with excessive outflow velocity at 6.0 m/sec with secondary aortic insufficiency at 5.5 m/sec. This is consistent with subaortic stenosis regarding velocity. However, severe compensatory increased LVOT velocity may be playing a role owing to the PDA. The right heart revealed tricuspid insufficiency and fairly normal right ventricular volumes and right atrial size. Moderate pulmonary hypertension appeared to be present given the tricuspid insufficiency velocity (approximately 4.0 m/s). The pulmonary artery revealed domed pulmonic valve leaflet with irregular changes and significantly excessive outflow velocity. Post valvular dilation also noted with continuous flow on color flow assessment consistent with patent ductus arteriosus. CW Doppler in the deep pulmonary artery, which is in typical position for patent ductus arteriosus measured 5.0 m/sec. Pulmonic outflow velocity at the pulmonic valve was 4.3 m/s consistent with moderate pulmonic stenosis. Dual defect in the pulmonic outflow tract was noted. Pulmonic insufficiency was also noted at 4.0 m/s. Periodic arrhythmia noted. No pericardial or pleural effusion noted. Rapid view of the liver and CVC revealed no evidence of passive congestion.