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3 responses to “Pulmonic stenosis”
This is a beautiful
This is a beautiful valvular pulmonic stenosis. The right ventricle shows concentric hypertrophy, although only moderate. The pressure gradient is consistent with moderate to severe pulmonic stenosis. Given the high heart rate (excited animal) the PG is likely a bit over-estimated and the stenosis might be just moderate.
If the owners can afford an intervention, I would likely recommend it, because it is effective and safe – and there is a good chance to improve the situation by far. But if the owners are financially limited, watchful waiting and low dose atenolol is ok, since there is at least a chance that the dog can live a normal life span without intervention. My experience is that if you balloon these guys, the owners frequently report that their dog is much more active after the intervention (even though they did not notice exercise intolerance before the intervention).
Thanks Peter, I was actually
Thanks Peter, I was actually just going through other images and got a measurement of 92mm Hg. I will advise referral for a consultation +/- balloon valvuloplasty.
Thank you very much.
One more point:
One more point:
When I diagnose right heart concentric hypertroph I usually do a bubble study of the heart to rule out any R-L shunt (eg foramen ovale). This is an additional information that can be of value. Just take a 5 ml syringe, fill it with heta starch (I think thats how it’s called in English 🙂 ), attach a 3-way stopcock and a second empty syringe. Note that the stopcock and the other syringe are completely empty. Then press the starch from one syringe to the other, again and again until you see that it is not translucent anymore (bubbles). Then immediately inject 2 ml/10 kg into the vein (catheter) while you watch and record a 4 chamber view and see if the left ventricle +/- the left atrium fills with bubbles. Note that there will always be some few bubbles after 5-6 heart beats because of shunts within the lung circuit. A positive bubble study means that there are tons of bubbles.