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Alimentary > Congenital heart diseases > Flashcards

Congenital heart diseases Flashcards

1
Q

Most common congenital heart diseases in dogs

A

Pulmonic stenosis

Subarotic stenosis

Patent duct arteriosus

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2
Q

Most common congenital heart diseases in cats

A

Ventricular septal defect

Tricuspid dysplasia

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3
Q

Standard echocardiographic views

A

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

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4
Q

MV/TV dysplasia murmur

A

Murmur more apical, close to the sternum

Soft sound

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4
Q

Congenital heart disease murmurs

A

MV/TV dysplasia

Pulmonic stenosis/aortic stenosis

PDA

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5
Q

Murmur of pulmonic stenosis/aortic stenosis

A

High in the chest

Quite a harsh sound

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6
Q

Murmur of PDA

A

Continuous murmur

During systole and diastole, a bit louder in systole

Even higher in the chest, in the axilla area

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7
Q

Pulmonary stenosis

A

Most common congenital heart disease

Common in boxers!, bulldogs, GSDs etc.

usually asymptomatic if murmur discovered early

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8
Q

Physical examination of pulmonic stenosis

A

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

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9
Q

Diagnosis of pulmonic stenosis

A

Thoracic radiographs

ECG

Echocardiography

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10
Q

Valvular stenosis (right ventricular outflow tract obstruction)

A

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

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11
Q

Subvalvular/infundibular stenosis (right ventricular outflow tract obstruction)

A

Anomalous prepulmonic coronary artery

Two coronary arteries but one hole

Compression of coronary arteries

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12
Q

Dianosis of subvalvular/infudibular pulmonary stenosis

A

Echocardiography

Angiography

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13
Q

Treatment of subvalvular/infudibular pulmonary stenosis

A

NOT balloon valvuloplasty

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14
Q

Supravalve stenosis

A

Rare - 0.3% of cases

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15
Q

Mild pulmonary stenosis

A

PA Vmax <3.5m/s

PG <50mmHg

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16
Q

Moderate pulmonary stenosis

A

PA Vmax 3.5-4.5 m/s

PG 50-80 mmHg

17
Q

Severe pulmonary stenosis

A

PA Vmax >4.5 m/s

PG >80mmHg

18
Q

Treatment of mild pulmonary stenosis

A

No clinical signs

No therapy is needed

Excellent prognosis

19
Q

Treatment of moderate pulmonary stenosis

A

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

20
Q

Treatment of severe pulmonary stenosis

A

Balloon valvuloplasty

Surgery: path graft

Transpulmonary stent implantation

21
Q

Balloon valvuloplasty

A
  • 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

22
Q

Patch graft for pulmonary stenosis

A

+/- beta blockers

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

23
Q

Transpulmonary stent implantation

A

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

24
Q

Patent ductus arteriosus

A

Blood shunts from aorta to pulmonary artery

Overloads the lungs (volume)

Congestion of the capillaries and pulmonary oedema

25
Q

History and physical examination of PDA

A

Young dogs are generally aymptomatic

Left sided CHF
§ Large ductus
§ Late diagnosis

Loud continuous left cranial murmur
§ V/VI > precordial thrill

Hyperdynamic femoral pulses

26
Q

Diagnosis of PDA

A

Thoracic radiographs

Echocardiography

27
Q

Indications for PDA closure

A

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)

28
Q

Eisenmenger syndrome

A

Development of pulmonary hypertension associated with a shunting cardiac defect

Left-right shunt -> severe pulmonary vascular disease -> pulmonary hypertension -> shunt reversal right-left

29
Q

Treatment of PDA

A

Surgical ligation

Transcatheter closure

30
Q

Surgical ligation of PDA

A

(very) small dogs (<2-3kg)

Type III ductus

31
Q

Transcatheter closure of PDA

A

Duct morphology

Ostium (minimal ductal diameter)

Reduce fluoroscopy exposure time

Contrast agents can be avoided

32
Q

Device used for transcatheter closure of PDA

A

Amplatz canine duct occluder (ACDO)

  • high rate of complete ductal occlusion (no residual flow)
  • safe and short procedure
  • very low rate of device embolisation
33
Q

Contraindications of transcatheter or surgical closure

A

Severe pulmonary hypertension with right to left shunt

Pulmonary hypertension with bidirectional shunt? Complex cases!
- Sildenafil, trial occlusion with invasive pressure measurement…

34
Q

History and physical examination of subaortic examination

A

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

35
Q

Diagnosis of subaortic stenosis

A

ECG

Thoracic radiographs

Echocardiography

36
Q

Mild subaortic stenosis

A

PA Vmax <3.5 m/s,

PG< 50 mmHg

37
Q

Moderate subaortic stenosis

A

PA Vmax 3.5-4.5 m/s,

PG 50-80 mmHg

38
Q

Severe subaortic stenosis

A

PA Vmax 4.5-5.7 m/s,

PG 80-130 mmHg

39
Q

Very severe subaortic stenosis

A

PA Vmax >5.7 m/s,

PG >130 mmHg

40
Q

Therapy for subarotic stenosis

A

Mild:
- excellent prognosis
- no therapy required

Moderate
- good prognosis
- beta blockers

41
Q

Subaortic stenosis median survival times

A

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]

Alimentary (22 decks)

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