HI,
This is concerning a 7 yr old cat with severe HCM (now deceased). The cat also had hyperthyroidism and CRF. The HCM was definitely not hyperT4 related….biggest left auricle on the planet!
My question is about SAM. On the left apical 5 chamber view there is a MR jet seen at the same time as the normal flow into the LVOT. However, both are laminar. PW across both valves is also laminar.
HI,
This is concerning a 7 yr old cat with severe HCM (now deceased). The cat also had hyperthyroidism and CRF. The HCM was definitely not hyperT4 related….biggest left auricle on the planet!
My question is about SAM. On the left apical 5 chamber view there is a MR jet seen at the same time as the normal flow into the LVOT. However, both are laminar. PW across both valves is also laminar.
Kittleson’s text says that MR in HCM cats is due to SAM. However, in this cat, the flow across the LVOT is not turbulent, on 2D cine loop, the MV does not go toward the IVS during systoli, and on m-mode, there is no abnomral excursion of the MV during systoli.
Might this cat have congenital MR in addition to HCM? I’ll post the left apical colour view.
Thanks
Karen
Comments
Hi!
Sure, congenital
Hi!
Sure, congenital Mitral dysplasia is possible. But I would rather think of mitral valve degeneration and secondary MR. Typically, the jet is no orientated towards the posterior wall of the LA but more centrally (right parasternal 5 chamber views). SAM should be seen on 2D-clips and Mitral valve M-Mode, as you already mentioned. I see frequently cats with thickened mitral valve leaflets and subsequent MR.
Do you have a PA023 probe? This might make it easier to see changes of the MV. If you got a right parasternal 5 chamber view with color availabe, you are welcome to post it so that I can have a look at it.
Best Regards!
Peter
Hi!
Sure, congenital
Hi!
Sure, congenital Mitral dysplasia is possible. But I would rather think of mitral valve degeneration and secondary MR. Typically, the jet is no orientated towards the posterior wall of the LA but more centrally (right parasternal 5 chamber views). SAM should be seen on 2D-clips and Mitral valve M-Mode, as you already mentioned. I see frequently cats with thickened mitral valve leaflets and subsequent MR.
Do you have a PA023 probe? This might make it easier to see changes of the MV. If you got a right parasternal 5 chamber view with color availabe, you are welcome to post it so that I can have a look at it.
Best Regards!
Peter
Thanks Peter,
I do have the
Thanks Peter,
I do have the views requested, now i just have to figure out how to add images to a reply.
Thanks Peter,
I do have the
Thanks Peter,
I do have the views requested, now i just have to figure out how to add images to a reply.
I added two rt parasternal
I added two rt parasternal long axis views to the original post. I’ll try to add the m-mode too.
I added two rt parasternal
I added two rt parasternal long axis views to the original post. I’ll try to add the m-mode too.
Pretty images Karen. I don’t
Pretty images Karen. I don’t know if MR only in SAM cases is that clear cut. I see MR in non SAM Non HCM cases in cats, MR in non SAM HCM cases and MR in SAM HCM cases. MR is MR for whatever reason whether HCM or not..infectious?? congential?? Aquired as a degenerative process I don’t think we can put it in a category but call it as part of the presentation. Maybe that was the thought process that Kittleson and colleagues had at the time of writing the text as things change the more we see and know. Writing a text myself i realize that even some of the things that get published may have changes by the time the text is actually printed.
Peter, what is the universal thought amongst cardiologists, if any, on MR in cats at this time now that i put my 2 cents out there:)
Pretty images Karen. I don’t
Pretty images Karen. I don’t know if MR only in SAM cases is that clear cut. I see MR in non SAM Non HCM cases in cats, MR in non SAM HCM cases and MR in SAM HCM cases. MR is MR for whatever reason whether HCM or not..infectious?? congential?? Aquired as a degenerative process I don’t think we can put it in a category but call it as part of the presentation. Maybe that was the thought process that Kittleson and colleagues had at the time of writing the text as things change the more we see and know. Writing a text myself i realize that even some of the things that get published may have changes by the time the text is actually printed.
Peter, what is the universal thought amongst cardiologists, if any, on MR in cats at this time now that i put my 2 cents out there:)
Hi Karen!
On the first image
Hi Karen!
On the first image I get the impression that this is a more central jet, This makes SAM less likely. This is supported by the fact that the LVOt jet is laminar. Mitral degeneration is a common finding in cats with cardiomyopathy. These cats frequently have mitral regurgitation. mitral dysplasia mostly involves not only the valve leaflets but also the chordae and the papillary muscles.
SAM always causes some degree of mitral regurgitation (orientated towards the posterior wall). But – of course – there are cases where SAM is accompanied by primary mitral valve disease. If there is only mild mitral regurgitation without SAM, the heart murmur is very soft.
To you have a color clip to upload?
Many thanks!
peter
Hi Karen!
On the first image
Hi Karen!
On the first image I get the impression that this is a more central jet, This makes SAM less likely. This is supported by the fact that the LVOt jet is laminar. Mitral degeneration is a common finding in cats with cardiomyopathy. These cats frequently have mitral regurgitation. mitral dysplasia mostly involves not only the valve leaflets but also the chordae and the papillary muscles.
SAM always causes some degree of mitral regurgitation (orientated towards the posterior wall). But – of course – there are cases where SAM is accompanied by primary mitral valve disease. If there is only mild mitral regurgitation without SAM, the heart murmur is very soft.
To you have a color clip to upload?
Many thanks!
peter
thanks Peter and Eric. I was
thanks Peter and Eric. I was pretty convinced from the beginning that this was not SAM, but the remark in the text threw me off. Nice to have a quick source to get some expert opinions.
Karen
thanks Peter and Eric. I was
thanks Peter and Eric. I was pretty convinced from the beginning that this was not SAM, but the remark in the text threw me off. Nice to have a quick source to get some expert opinions.
Karen