Multiple Congenital Cardiac Anomalies
Accession# 147266
Christina Copple, DVMMonday 2/28/2011
10mth, Male, Pomeranian Late January purchased from breeder with no
known prior medical concerns Episode after a moment of activity --- fell on
side, stiff, dilated pupils, unaware Recovered within minutes
Pants when excited or playing ER DVM: heart murmur & suspected PDA Specialty clinic: findings more consistent with
pulmonic stenosis Referral to NCSU for further evaluation
NCSU cardiology work-up Grade III/VI left apical systolic murmur Normal lung sounds Echocardiogram PCV/TS
Echocardiogram- Rt parasternal short-axis view of ventricles at level of papillary muscles
Severe right ventricular hypertrophy
Flattening of interventricular septum
Echocardiogram – M-mode through ventricles
Single narrow US beam of echoes as distance vs time
Provides time-dependent measurements
chamber dimension
RV hypertrophy RV wall thickness should be 1/3-1/2 that of the LV Lumen of LV normally ~3X diameter of RV lumen
Echocardiogram – Rt parasternal long-axis 4 chamber
view
RV hypertrophy, severe RA enlargement, moderate
Echocardiogram – Rt parasternal short-axis view at heart base of pulmonic valve (zoomed in)
Supravalvular pulmonic stenosis
Post stenotic dilation
Turbulent flow across stenosis
Echocardiogram – Lt parasternal short-axis view of pulmonic valve (payme view)
Echocardiogram – Lt parasternal short-axis view of pulmonic valve
Continuous wave Doppler signal
accurately evaluates high velocities without aliasing
Continuously sends and samples signal
spectral broadening expected as there is no discrimination between laminar vs turbulent flow
Echocardiogram – Lt parasternal short-axis view of pulmonic valve
Maximum velocity
Utilize modified Bernoulli equation
4V2
determine presssure gradient
Presssure gradient ~ 130 mmHg = severe as it is > 80
Echocardiogram – Lt parasternal apical 4 chamber
view
RA enlargement, moderate
Mild tricuspid insufficiency
Echocardiogram – Rt parasternal short-axis view of
ventricles at level of papillary muscles
BONUS Lesion!!
VSD – apical position in muscular septum
With right-to-left shunting
Echocardiogram – Lt parasternal apical 4 chamber
view of VSD with color Doppler
Contrast Echocardiogram – Bubble study with agitated saline!!
Uncommon forms of pulmonic stenosis & VSD Supraventricular pulmonic stenosis
Increased RVOT obstruction Rare, less common than valvular – Giant Schnauzers
Apical VSD in muscular septum Less common than perimembranous
Single opening in LV Multiple openings in RV
Right-to-left shunt due to elevated right sided pressures Decreased O2 content of systemic circulation Humans – neonates and small infants: uncommon,
usually present with heart failure & associated anomalies such as pulmonic stenosis, PDA, aortic coarctation, etc.
PCV = high normal Compensatory Episode either syncopal or cyanotic
What now? Balloon valvuloplasty?
Could help but….. Might result in altered pressure differential
between right and left sides Result in Left-to-Right shunt pulmonary
overcirculation
Amplatzer of VSD? Reduce potential for Left-to-Right shunt Not commonly performed Never performed at NCSU
References Fox, Philip R., Sisson, David, and Moise, N.
Sydney. Textbook of Canine and Feline Cardiology Principles and Clinical Practice. 2nd ed. W.B. Saunders Company. Philadelphia, PA. 1999.
Kumar K, Lock JE, and Geva T. Apical Muscular Ventricular Septal Defects Between The Left Ventricle And The Right Ventricular Infundibulum. Diagnostic And Interventional Considerations. Circualtion. 1997. March 4; 95(5):1207-1213.
Ramesh, et al. Transcatheter Closure of Congential Muscular Ventricular Septal Defect. JIntervenCardiol. 2004; 17:109-115.