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Multiple Congenital Cardiac Anomalies Accession# 147266

Multiple Congenital Cardiac Anomalies Accession# 147266. Christina Copple , DVM Monday 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

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Multiple Congenital Cardiac Anomalies Accession# 147266

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  1. Multiple Congenital Cardiac AnomaliesAccession# 147266 Christina Copple, DVM Monday 2/28/2011

  2. 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

  3. NCSU cardiology work-up • Grade III/VI left apical systolic murmur • Normal lung sounds • Echocardiogram • PCV/TS

  4. Echocardiogram- Rt parasternal short-axis view of ventricles at level of papillary muscles • Severe right ventricular hypertrophy • Flattening of interventricular septum

  5. 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

  6. Echocardiogram – Rtparasternal long-axis 4 chamber view • RV hypertrophy, severe • RA enlargement, moderate

  7. Echocardiogram – Rt parasternal short-axis view at heart base of pulmonic valve (zoomed in) • Supravalvular pulmonic stenosis • Post stenotic dilation • Turbulent flow across stenosis

  8. Echocardiogram – Lt parasternal short-axis view of pulmonic valve (payme view)

  9. 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

  10. 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

  11. Echocardiogram – Lt parasternal apical 4 chamber view • RA enlargement, moderate • Mild tricuspid insufficiency

  12. Wait, There’s More!!

  13. Echocardiogram – Rtparasternal short-axis view of ventricles at level of papillary muscles • BONUS Lesion!! • VSD – apical position in muscular septum • With right-to-left shunting

  14. Echocardiogram – Lt parasternal apical 4 chamber view of VSD with color Doppler

  15. Contrast Echocardiogram – Bubble study with agitated saline!!

  16. 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

  17. 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

  18. 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.

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