Hi there,
I’ve never diagnosed a PDA before and was needing some help and guidance.
4 year entire male, schnauzer. Owner had recently adopted dog from breeder. Breeder mentioned dog always had a murmur but nothing was done to investigate it.
Physical examination auscultated a machinery murmur, point of maximal intensity is located on the Left cranial chest. Clinical signs include an occasional cough but otherwise fine.
Hi there,
I’ve never diagnosed a PDA before and was needing some help and guidance.
4 year entire male, schnauzer. Owner had recently adopted dog from breeder. Breeder mentioned dog always had a murmur but nothing was done to investigate it.
Physical examination auscultated a machinery murmur, point of maximal intensity is located on the Left cranial chest. Clinical signs include an occasional cough but otherwise fine.
Echocardiogram revealed a mild mitral regurgitation, LV and LA dilation in diastole, EPSS of 5.8mm, no LV hypertrophy. Turbulence seen on PA colour doppler. However on spectral doppler, the peak velocity during systole is less then 4.5-5.5m/s. (normal aortic-pulmonic gradient is 80-120mmHg).
I wasn’t sure where to look for the patent ductus or how it looked!
Is this study sufficient enough to diagnose a PDA and proceed with surgery? Do dogs typically not show clinical signs with PDA and what is the life expectency if surgery was not done?
Comments
If you go to Peter Modler’s
If you go to Peter Modler’s page and peruse his case studies you can see the differences between pulmonic stenosis and PDA which are usually the 2 diffs here
http://sonopath.com/about/specialists/peter-modler-dvm-dipl-tzt
PS will give the systolic velocites over the PV at > 2.5 sec and certainly the 4-5 m/sec fits here. usually PS comes with PI that you can measure with cursor prior to the PV.
Refer to attached image adaptation for the normals dvd echo and abdomen (http://sonopath.com/products/dvd)
With PDA the turbulence is maximum in the deep PA past the PV and PI if present is usually minimum unless primary PV issues are present as well. The flow in the PDA is holosystolic as opposed to a triangular envelope like you get in a PS on CW.
In your Doppler images you have a lot of lung interference with is dampering your doppler signals and making them mushy so if you get that lung out of the way with angle adjustment and forefinger pressure ont he right lung, and then use CF over the PV and the deep PA and then sample with PW pre pv, at the pv, after the pv, and then deep pa (progressive arrows in the attached image) and then do the same with the CW you will clean this up a bit and the diff between PS and PDA should be well defined.
Hope this helps. Great post!
That was really helpful!
That was really helpful! Thank you so much!
I am getting the animal back in for me to do more measurements:) Will keep you updated!
If you go to Peter Modler’s
If you go to Peter Modler’s page and peruse his case studies you can see the differences between pulmonic stenosis and PDA which are usually the 2 diffs here
http://sonopath.com/about/specialists/peter-modler-dvm-dipl-tzt
PS will give the systolic velocites over the PV at > 2.5 sec and certainly the 4-5 m/sec fits here. usually PS comes with PI that you can measure with cursor prior to the PV.
Refer to attached image adaptation for the normals dvd echo and abdomen (http://sonopath.com/products/dvd)
With PDA the turbulence is maximum in the deep PA past the PV and PI if present is usually minimum unless primary PV issues are present as well. The flow in the PDA is holosystolic as opposed to a triangular envelope like you get in a PS on CW.
In your Doppler images you have a lot of lung interference with is dampering your doppler signals and making them mushy so if you get that lung out of the way with angle adjustment and forefinger pressure ont he right lung, and then use CF over the PV and the deep PA and then sample with PW pre pv, at the pv, after the pv, and then deep pa (progressive arrows in the attached image) and then do the same with the CW you will clean this up a bit and the diff between PS and PDA should be well defined.
Hope this helps. Great post!
That was really helpful!
That was really helpful! Thank you so much!
I am getting the animal back in for me to do more measurements:) Will keep you updated!
U bet… good to hear! Good
U bet… good to hear! Good luck… fyi once you address this well you will remember it for a lifetime when these come up again because they will. Its like riding a bike you never forget. I remember when I addressed the same thing in 2002 and my mentor at that time helped me clean it up and I never forgot it. Passing it forward:)
U bet… good to hear! Good
U bet… good to hear! Good luck… fyi once you address this well you will remember it for a lifetime when these come up again because they will. Its like riding a bike you never forget. I remember when I addressed the same thing in 2002 and my mentor at that time helped me clean it up and I never forgot it. Passing it forward:)
Hi EL,
Got the dog back but I
Hi EL,
Got the dog back but I was unable to visualised the PDA(more like I was unsure if it was the PDA) nor any stenosis. I did CW pre PV, post PV and deep PA. The flow pattern was consistently holosystolic.
Pre PV: 352.0 cm/s
post PV:328.0cm/s
deep PA: 358.7cm/s, 412.4cm/s
In your attached image, is that the Left parasternal long axis view of the heart? I’ve attached a couple of views which I thought might be the PDA but wasn’t sure if it was an artifact or the bifurfication of the PA.
PS: I”ll be refering him to a cardiologist sonographer as I wasn’t confident to make the call for PDA.
Hi EL,
Got the dog back but I
Hi EL,
Got the dog back but I was unable to visualised the PDA(more like I was unsure if it was the PDA) nor any stenosis. I did CW pre PV, post PV and deep PA. The flow pattern was consistently holosystolic.
Pre PV: 352.0 cm/s
post PV:328.0cm/s
deep PA: 358.7cm/s, 412.4cm/s
In your attached image, is that the Left parasternal long axis view of the heart? I’ve attached a couple of views which I thought might be the PDA but wasn’t sure if it was an artifact or the bifurfication of the PA.
PS: I”ll be refering him to a cardiologist sonographer as I wasn’t confident to make the call for PDA.
The pV looks a bit elongated
The pV looks a bit elongated to me but the turbulence pattern fits PDA better. I would think with this much disorganized turbulence in that position holosystolic best fits here. I’m leaning toward pda.
The pV looks a bit elongated
The pV looks a bit elongated to me but the turbulence pattern fits PDA better. I would think with this much disorganized turbulence in that position holosystolic best fits here. I’m leaning toward pda.