Case Study

Compensated Ventricular Septal Defect, Aortic Insufficiency, Tetralogy of Fallot in a 6 month old F German Shepherd

A 6-month-old female German shepherd dog was presented for evaluation of a grade IV/VI systolic machinery murmur. No clinical signs were present. Presurgical evaluation was prescribed prior to ovariohysterectomy.

A 6-month-old female German shepherd dog was presented for evaluation of a grade IV/VI systolic machinery murmur. No clinical signs were present. Presurgical evaluation was prescribed prior to ovariohysterectomy.

Sonographic Differential Diagnosis

Left to right septal defect. Pulmonic stenosis. Right ventricular hypertrophy and dextraposition of the aorta. This is consistent with Tetralogy of Fallot and secondary aortic insufficiency with vegetative lesion in the preaortic region.

Image Interpretation

The cardiac presentation in this patient presented mild eccentric hypertrophy of the left ventricle. However, the left ventricle presented adequate contractility and normal volume. A lembus was noted in the preaortic area adjacent to the mitral annulus particularly evident in the apical view. The ventricular septum appeared vegetative with ventricular septal defect. It measured 5.7 cm/sec in the left to right flow. Dextraposition of the aorta was noted. Right ventricular hypertrophy was mild but present. The aortic valve itself was insufficient with a thin jet at 5 m/sec. The pulmonic valve was slightly thickened with outflow velocity that was excessive at 3.4 m/sec. This is consistent with pulmonic stenosis.

DX

Tetralogy of Fallot, secondary aortic insufficiency with vegetative lesion in the preaortic region.

Outcome

No interventional cardiology at the time would have been curative. Ovariohysterectomy was recommended to ensure that breeding does not occur with this patient given the congenital defects. Prophylactic antibiotics were recommended with Clavamox or similar for a week prior to surgery and 3 weeks post surgery as the patient is predisposed to endocarditis potential. This cardiac presentation was not ideal for anesthetic procedure; however, as the patient is still growing it was determined that it would be the best time to perform the ovariohysterectomy as opposed to waiting for further developmental issues to occur.

Clinical Differential Diagnosis

Congenital – PDA, aortic/pulmonic stenosis, tricuspid dysplasia, ASD/VSD Bacterial endocarditis

Sampling

None