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-10 year old Dachshund with dyspnea and recent onset of syncope
-history of presumptive pneumonia 6 months ago
-lungs are wet today
-enlarged right heart with flattening of the IVS
-no mitral, aortic, or pulmonic regurgitation
-moderate tricuspid regurgitation
-LA:Ao 1.4; MPA:Ao 1.2; TR velocity of 2.21
Clinical signs are compatible with severe PH but why is the TR velocity not higher?
Also, why are the lungs wet when the LA is small? Something other than edema?
Thanks!
Suzanne
Comments
Hi!
I totally agree on the
Hi!
I totally agree on the large right heart. Also, the pulmonary artery, particularly the right branch, is large. Right ventricular systolic function is low. All these findings support the hypothesis of severe pulmonary hypertension. I guess you are simply understimating the TR gradient. The regurgitation signal on your CW image looks like cut-off at the bottom. I would recommend trying different views in order to achieve the best alignment with the jet (e.g. short axis right, apical left, parasternal left). Also, right systolic function seems to be lower than normal. This means, by measuring the pressure gradient you will likely underestimate pulmonaryl vascular resistance.
The left atrium is small because there’s not much blood passing the pulmonary circulation and endig up inside the left atrium. A wet lung does not have to be wet because of left sided heart failure (in this case the left atrium must be large of course). pneumonia, lung fibrosis or edema of other than cardiac origin can also cause the lung to appear wet.
If you’re right (what I assume) and you put the dog on sildenafil (1-3 mg/kg bid) the left atrium will increase in size if the treatment is effective.
Other causes of PHT would be obstructive disease (heart worms, thrombembolism of various origins), compressive disease (tumor), primary vascular disease etc.
Best regards and Happy New Year
Peter