3 year old Golden Retriever grade 4/6 systolic murmur heard equally on both sides of the chest.
– echoe was performed under sedation (butorphanol/midazolam/alfaxan) due to excessive panting
– no MR, TR or PI noted
– trace AI
– I think there is evidence of aortic stenosis?
What do you think?
Why is there such a loud systolic murmur?
3 year old Golden Retriever grade 4/6 systolic murmur heard equally on both sides of the chest.
– echoe was performed under sedation (butorphanol/midazolam/alfaxan) due to excessive panting
– no MR, TR or PI noted
– trace AI
– I think there is evidence of aortic stenosis?
What do you think?
Why is there such a loud systolic murmur?
[videoembed id=6902] [videoembed id=6903]
Comments
At 3 m/sec this would be mild
At 3 m/sec this would be mild sas. If he is a thin dog then it may sound louder than that she were a very large dog. At 3 years of age with this velocity I do not think this is going to be a big issue for this patient. These are beautiful images do appear to be lined up within 15°. I would recheck him in 6 months to see if there is any differential and LVOT velocities. I am sure Peter can add more to the discussion and I believe he may be on vacation at the moment.
At 3 m/sec this would be mild
At 3 m/sec this would be mild sas. If he is a thin dog then it may sound louder than that she were a very large dog. At 3 years of age with this velocity I do not think this is going to be a big issue for this patient. These are beautiful images do appear to be lined up within 15°. I would recheck him in 6 months to see if there is any differential and LVOT velocities. I am sure Peter can add more to the discussion and I believe he may be on vacation at the moment.
I totally agree with Eric.
I totally agree with Eric. But what I would additionally pay attention to is the aortic valve. If you look at the CDI clip you see that there is not only a central jet but also paravalvular leak.
I´m sure you´ve ruled out a PDA or PS as other possible causes of a heart murmur that could increase the intensity of the murmur. But it could be that the AO velocity is underestimated: I would try to measure it from a subcostal view to compare. If there is a valvular component, the AS jet could be eccentric. And I would once again trace the IVS for a small VSD that could be another source of a loud heart murmur.
I totally agree with Eric.
I totally agree with Eric. But what I would additionally pay attention to is the aortic valve. If you look at the CDI clip you see that there is not only a central jet but also paravalvular leak.
I´m sure you´ve ruled out a PDA or PS as other possible causes of a heart murmur that could increase the intensity of the murmur. But it could be that the AO velocity is underestimated: I would try to measure it from a subcostal view to compare. If there is a valvular component, the AS jet could be eccentric. And I would once again trace the IVS for a small VSD that could be another source of a loud heart murmur.
Thanks Peter!
I have the
Thanks Peter!
I have the feeling that I am missing something with this one! I really need to take a course on screening for congenital disease and get alot more practice with these cases! Where are you seeing the paravalvular leakage? Is it up near where the aorta meets the IVS or am I looking at something different?
I did read in June Boon’s book that the subcostal approach will give a better estimation of Ao velocity and that you may not get it exactly parallel with the walls of the aorta. I also read that if you have aortic stenosis in a young patient, you should always check for other abnormalities as AS is often present with other congenital problems. The pulmonary velocity was under 1 m/sec so this would rule out PS. The pulmonary artery and branches also looked normal to me.
Jacquie
Thanks Peter!
I have the
Thanks Peter!
I have the feeling that I am missing something with this one! I really need to take a course on screening for congenital disease and get alot more practice with these cases! Where are you seeing the paravalvular leakage? Is it up near where the aorta meets the IVS or am I looking at something different?
I did read in June Boon’s book that the subcostal approach will give a better estimation of Ao velocity and that you may not get it exactly parallel with the walls of the aorta. I also read that if you have aortic stenosis in a young patient, you should always check for other abnormalities as AS is often present with other congenital problems. The pulmonary velocity was under 1 m/sec so this would rule out PS. The pulmonary artery and branches also looked normal to me.
Jacquie
Yes, it´s up at the IVS
Yes, it´s up at the IVS border (diastole). REg the subcostal approach: I agree: mostly you get higher velocities from a subcostal window (not always, I had it the other way around too). And of course: If you have one congenital disease you should always search for other concomitant defects. Recently I had a PDA dog with a severe SAS and AI and a PS – just for example. I didn´t expect a significant PS based on the videos you posted because there was no RV hypertrophy to be seen. But e.g. small VSDs can sometimes be loud and not so easy to find.
Congenitals are always a challenge…
Best Regards and sorry for the delayed response!
Peter
Yes, it´s up at the IVS
Yes, it´s up at the IVS border (diastole). REg the subcostal approach: I agree: mostly you get higher velocities from a subcostal window (not always, I had it the other way around too). And of course: If you have one congenital disease you should always search for other concomitant defects. Recently I had a PDA dog with a severe SAS and AI and a PS – just for example. I didn´t expect a significant PS based on the videos you posted because there was no RV hypertrophy to be seen. But e.g. small VSDs can sometimes be loud and not so easy to find.
Congenitals are always a challenge…
Best Regards and sorry for the delayed response!
Peter