Congenital heart diseases

Question 1

Most common congenital heart diseases in dogs

Answer 1

Pulmonic stenosis

Subarotic stenosis

Patent duct arteriosus

Question 2

Most common congenital heart diseases in cats

Answer 2

Ventricular septal defect

Tricuspid dysplasia

Question 3

Standard echocardiographic views

Answer 3

RPS long axis 4 chamber view

RPS long axis 5 chamber view (slightly rotated probe)

RPS short axis view at papillary muscle level (left atrial size and LA:Ao ratio)

RPS short axis view at heart base (to view pulmonary artery and check for stenosis)

Left apical 5 chamber view

Question 4

MV/TV dysplasia murmur

Answer 4

Murmur more apical, close to the sternum

Soft sound

Question 4

Congenital heart disease murmurs

Answer 4

MV/TV dysplasia

Pulmonic stenosis/aortic stenosis

PDA

Question 5

Murmur of pulmonic stenosis/aortic stenosis

Answer 5

High in the chest

Quite a harsh sound

Question 6

Murmur of PDA

Answer 6

Continuous murmur

During systole and diastole, a bit louder in systole

Even higher in the chest, in the axilla area

Question 7

Pulmonary stenosis

Answer 7

Most common congenital heart disease

Common in boxers!, bulldogs, GSDs etc.

usually asymptomatic if murmur discovered early

Question 8

Physical examination of pulmonic stenosis

Answer 8

Left-sided systolic heart murmur, PMI heart base
§ Murmur grade generally correlates with stenosis severity

Normal pulse quality

If right sided CHF
§ Distended jugular veins
§ Hepatomegaly
§ Ascites

Question 9

Diagnosis of pulmonic stenosis

Answer 9

Thoracic radiographs

ECG

Echocardiography

Question 10

Valvular stenosis (right ventricular outflow tract obstruction)

Answer 10

A type of pulmonic stenosis

Most common

Type A: pulmonic leaflet thickening and fusion (normal PA diameter)

Type B: pulmonic annular hypoplasia and markedly thickened leaflets

OR type A and B

Question 11

Subvalvular/infundibular stenosis (right ventricular outflow tract obstruction)

Answer 11

Anomalous prepulmonic coronary artery

Two coronary arteries but one hole

Compression of coronary arteries

Question 12

Dianosis of subvalvular/infudibular pulmonary stenosis

Answer 12

Echocardiography

Angiography

Question 13

Treatment of subvalvular/infudibular pulmonary stenosis

Answer 13

NOT balloon valvuloplasty

Question 14

Supravalve stenosis

Answer 14

Rare - 0.3% of cases

Question 15

Mild pulmonary stenosis

Answer 15

PA Vmax <3.5m/s

PG <50mmHg

Question 16

Moderate pulmonary stenosis

Answer 16

PA Vmax 3.5-4.5 m/s

PG 50-80 mmHg

Question 17

Severe pulmonary stenosis

Answer 17

PA Vmax >4.5 m/s

PG >80mmHg

Question 18

Treatment of mild pulmonary stenosis

Answer 18

No clinical signs

No therapy is needed

Excellent prognosis

Question 19

Treatment of moderate pulmonary stenosis

Answer 19

Balloon valvuloplasty is only indicated if it is associated with tricuspid dysplasia and/or right-to-left shunt (VSD or ASD)

Question 20

Treatment of severe pulmonary stenosis

Answer 20

Balloon valvuloplasty

Surgery: path graft

Transpulmonary stent implantation

Question 21

Balloon valvuloplasty

Answer 21

• fracture, ruptures, or stretches the obstructive tissue
• less traumatic and less risky than surgical options

Complications: arrhythmias, right bundle branch block, TV damage, death

Success is when pressure goes to < 50mmHg, not always possible

Contraindications
- PS caused by aberrent coronary artery > conservative BVP? Balloon 0.6-1x PA annulus

Question 22

Patch graft for pulmonary stenosis

Answer 22

+/- beta blockers

Negative chronotropic and inotropic effects > improve coronary perfusion, decrease myocardial O2 consumption

Question 23

Transpulmonary stent implantation

Answer 23

A little metallic tube to keep an artery open

Likely to become one of the main techniques

Indications
- Severe PS after unsuccessful routine balloon valvuloplasty
- Anomalous coronary arteries

Question 24

Patent ductus arteriosus

Answer 24

Blood shunts from aorta to pulmonary artery Overloads the lungs (volume) Congestion of the capillaries and pulmonary oedema

Question 25

History and physical examination of PDA

Answer 25

Young dogs are generally aymptomatic Left sided CHF § Large ductus § Late diagnosis Loud continuous left cranial murmur § V/VI > precordial thrill Hyperdynamic femoral pulses

Question 26

Diagnosis of PDA

Answer 26

Thoracic radiographs Echocardiography

Question 27

Indications for PDA closure

Answer 27

All left-to-right PDAs should be closed! § 50% 1 year survival rate if left uncorrected If ductus is closed at an early age § Excellent prognosis § Normal life expectancy If ductus remains patent § Left-sided CHF § Eisenmenger syndrome: pulmonary hypertension > reversed PDA (right-to-left)

Question 28

Eisenmenger syndrome

Answer 28

Development of pulmonary hypertension associated with a shunting cardiac defect Left-right shunt -> severe pulmonary vascular disease -> pulmonary hypertension -> shunt reversal right-left

Question 29

Treatment of PDA

Answer 29

Surgical ligation Transcatheter closure

Question 30

Surgical ligation of PDA

Answer 30

(very) small dogs (<2-3kg) Type III ductus

Question 31

Transcatheter closure of PDA

Answer 31

Duct morphology Ostium (minimal ductal diameter) Reduce fluoroscopy exposure time Contrast agents can be avoided

Question 32

Device used for transcatheter closure of PDA

Answer 32

Amplatz canine duct occluder (ACDO) - high rate of complete ductal occlusion (no residual flow) - safe and short procedure - very low rate of device embolisation

Question 33

Contraindications of transcatheter or surgical closure

Answer 33

Severe pulmonary hypertension with right to left shunt Pulmonary hypertension with bidirectional shunt? Complex cases! - Sildenafil, trial occlusion with invasive pressure measurement…

Question 34

History and physical examination of subaortic examination

Answer 34

Heart murmur detected at initial vet examination Exercise intolerance, syncope… sudden death Left sided systolic heart murmur, PMI left base Murmur grade correlates with stenosis severity

Question 35

Diagnosis of subaortic stenosis

Answer 35

ECG Thoracic radiographs Echocardiography

Question 36

Mild subaortic stenosis

Answer 36

PA Vmax <3.5 m/s, PG< 50 mmHg

Question 37

Moderate subaortic stenosis

Answer 37

PA Vmax 3.5-4.5 m/s, PG 50-80 mmHg

Question 38

Severe subaortic stenosis

Answer 38

PA Vmax 4.5-5.7 m/s, PG 80-130 mmHg

Question 39

Very severe subaortic stenosis

Answer 39

PA Vmax >5.7 m/s, PG >130 mmHg

Question 40

Therapy for subarotic stenosis

Answer 40

Mild: - excellent prognosis - no therapy required Moderate - good prognosis - beta blockers

Question 41

Subaortic stenosis median survival times

Answer 41

Mild 10.6yrs [1.0-14.8] Moderate 9.9yrs [6.0-13] Severe 7.3yrs [1.0-11.8] Very severe 3.0yrs [0.7-7.0]