Case Study

Mitral and tricuspid insufficiency in a 9 year old FS Cavalier King Charles Spaniel

A 9-year-old FS Cavalier King Charles Spaniel with a history of mitral valve prolapse and early pulmonary hypertension was presented for coughing and progression of the heart murmur from grade III/VI to grade V/VI. The dog was being treated with 5 mg of Enalapril twice daily. Systolic blood pressure was elevated (170).

A 9-year-old FS Cavalier King Charles Spaniel with a history of mitral valve prolapse and early pulmonary hypertension was presented for coughing and progression of the heart murmur from grade III/VI to grade V/VI. The dog was being treated with 5 mg of Enalapril twice daily. Systolic blood pressure was elevated (170).

DX

Mitral insufficiency and tricuspid insufficiency

Sonographic Differential Diagnosis

Mitral valve insufficiency with left atrial enlargement. Tricuspid valve insufficiency. This clinical picture is consistent with stage C1 valvular disease.

Image Interpretation

The left atrium presented chronic dilation with impingement of the atrial septum into the right atrium. Significant prolapse and vegetative changes were noted. The anterior leaflet of the mitral valve revealed moderate to severe insufficiency based on color flow filling of the left atrium. Mitral insufficiency velocity measured 5.83 m/sec. The tricuspid valve revealed insufficiency with minor vegetative lesions. Tricuspid insufficiency velocity measured 2.63 m/sec.

Comments

Treatment recommendations include continuing the ace inhibitor at 0.5 mg/kg b.i.d., starting Lasix at 2-4 mg/kg b.i.d. and Pimobendan at 0.25 mg/kg b.i.d. Hycodan can be utilized for cough. A recheck echocardiogram is recommended in 1-2 months as well as repeat blood pressure.

Clinical Differential Diagnosis

Valve disease (progressive mitral valve disease, vegetative endocarditis, chordae tendineae rupture), heart worm disease, lung disease (pulmonary hypertension, fibrosis, pneumonia, bronchial disease, neoplasia), tracheo-bronchitis.