Right ventricular aneurysm and atrial septal defect in a cat

This case report shows the development of a right ventricular aneurysm in a cat with a large atrial septal defect. Despite this complex cardiac pathology, the cat lived normally for more than 4 years and developed fatal congestive heart failure.     

Double-outlet right atrium in a 9 year-old cat

Double-outlet right atrium (DORA) is a type of atrioventricular septal defect that is described as an extreme leftward deviation of the lower portion of the interatrial septum, resulting in insertion into the atrial wall left and posterior to the mitral orifice. This rare anomaly, which has been reported in humans and only just recently in cats, was identified by transthoracic echocardiography in a 9 year-old cat that was presented for further evaluation of a tachyarrhythmia and cardiomegaly. This case report describes the diagnostic findings in this cat and summarizes the anatomy, classification and clinical consequences of this rare congenital heart defect.     

Cor triatriatum sinister with incomplete atrioventricular septal defect in a cat

An 11-month-old, 3 kg, female domestic shorthair cat was referred to evaluate cardiac structure and function. Echocardiography revealed the membrane dividing the left atrium into two chambers, a large defect in the lower part of the atrial septum, and turbulent blood flow from the distal left atrium into the right atrium. These findings suggested cor triatriatum sinister (CTS) with incomplete atrioventricular septal defect (AVSD). The cat was treated with medications for management of congestive heart failure. In the end, she died from right-sided heart failure 17 months after the initial presentation. At necropsy, a fibromuscular membrane with a round orifice in the left atrium and an ostium primum defect were confirmed, and the definitive diagnosis of CTS with incomplete AVSD was made. To our knowledge, this study presents the first case report of CTS with incomplete AVSD in a cat.     

Echocardiographic diagnosis of congenital membranous ventricular septal aneurysm in the dog and cat

Membranous ventricular septal aneurysm was diagnosed by echocardiography in 17 dogs and three cats. The aneurysm appeared as a thin membrane protruding into the right ventricle from the margins of a congenital ventricular septal defect (VSD). The aneurysm was intact in nine dogs and two cats and perforated by a small VSD in eight dogs and one cat. Other congenital heart defects were present in seven dogs. In all animals, the aneurysm was an incidental finding observed during echocardiographic examination, and it did not appear to directly cause any cardiac dysfunction.     

Role of computed tomography angiography in the differentiation of feline truncus arteriosus communis from pulmonary atresia with ventricular septal defect

Two domestic shorthair cats, a 6-month-old castrated male and a 7-month-old intact female, were diagnosed with complex congenital heart disease. Transthoracic echocardiography in both cats revealed a dilated arterial trunk overriding the interventricular septum with a large ventricular septal defect. The pulmonary trunk and branch pulmonary arteries were not visible using standard echocardiographic views in either cat. The differential diagnosis for both cats included truncus arteriosus communis vs. pulmonary atresia with ventricular septal defect. Each cat underwent computed tomography angiography to determine the origin and extent of the pulmonary blood supply and to better define extra-cardiac anatomy. Computed tomography angiography led to a diagnosis of truncus arteriosus communis with unrestricted pulmonary blood flow in one cat, whereas the other cat was diagnosed with pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals serving as the primary source of pulmonary blood flow. Computed tomography angiography allowed for the ante mortem differentiation of truncus arteriosus communis from pulmonary atresia with ventricular septal defect in these two cats, leading to an accurate diagnosis and providing valuable information to therapeutic decision-making for each case.     

Atrial septal defect of the persistent ostium primum type with hypoplastic right ventricle in a Welsh pony foal.

Valvular competency of the foramen ovale (patent foramen ovale) is regarded as a common finding in the neonatal foal and usually occurs in isolation. True atrial septal defects appear to be uncommon and are usually associated with other congenital cardiac lesions. The present report describes a case of atrial septal defect type 1 (persistent ostium primum) complicated by hypoplastic right ventricle, and tricuspid dysplasia, in a Welsh Mountain pony foal, and discusses the embryogenesis of the abnormality. A critical review of the literature suggests that atrial septal defects may occur more frequently than they are reported, and that on occasion they may be described erroneously as patent foramen ovale. The clinical significance of uncomplicated discontinuity of the atrial septum is slight, depending upon the size and location of the defect. Complicated atrial septal defects vary in clinical significance according to the nature of the associated defects.     

Transcatheter closure of aneurysmal perimembranous ventricular septal defect with the canine duct occluder in two dogs

Congenital membranous ventricular septal aneurysm has been reported in dogs and can be associated with a perimembranous ventricular septal defect (VSD). The windsock-like ventricular septal aneurysm is formed by tissue of the membranous ventricular septum and portions of the septal leaflet of the tricuspid valve. We report two dogs that underwent transcatheter closure of perimembranous VSD associated with membranous ventricular septal aneurysm using a commercial device marketed for transcatheter closure of patent ductus arteriosus, the canine duct occluder. Partial closure was achieved in the first dog with reduction in left heart dimensions documented on echocardiography both at one day and nine months after procedure. In the second dog, three-dimensional transesophageal echocardiography, cardiac computed tomography, and a three-dimensionally printed whole heart model were used to evaluate feasibility for transcatheter device closure. Complete closure of the VSD was subsequently achieved. Both cases had good short- to medium-term outcomes, no perioperative complications were observed, and both dogs are apparently healthy and receiving no cardiac medications at 34 months and 17 months after procedure. Transcatheter attenuation of perimembranous VSD with membranous ventricular septal aneurysm is clinically feasible using the canine duct occluder, and multimodal cardiac imaging allows accurate assessment and planning prior to transcatheter intervention for structural heart disease in dogs.     

Fossa ovalis tear causing right to left shunting in a Cavalier King Charles Spaniel

Left atrial tear is an infrequent sequela of severe mitral regurgitation due to myxomatous mitral valve degeneration. Interatrial septal tear due to mitral regurgitation causing a left-to-right shunt is uncommon. Right to left shunting secondary to acute interatrial septal tear is very rarely reported in the human literature, and has not been reported in the veterinary literature in a dog. This case describes the clinical, radiographic, echocardiographic, gross pathologic, and histopathologic features of a dog presented in acute respiratory distress secondary to acute onset right to left shunting through the interatrial septum. This was later documented to be due to a tear in the septum secondary to tricuspid regurgitation and pulmonary hypertension. The presence of an acquired right to left shunting atrial septal defect is of clinical and prognostic significance, and should be considered in cases of acute respiratory distress.     

Heart failure due to atrial standstill in a cat

A 7.5-year-old male Persian cat with a history of asymptomatic hypertrophic cardiomyopathy was examined for severe lethargy and dyspnoea. Physical examination revealed bradycardia (60 beats/ minute), and ECG investigation revealed persistent atrial standstill that was most likely caused by atrial fibrosis. Persistent atrial standstill is a very rare cardiac condition in cats and is characterized by a complete lack of mechanical, electrical, and possibly endocrine function of the atria. Several pathophysiological mechanisms can cause atrial standstill and include hyperkalaemia, intoxication, and atrialfibrosis. On the basis of the clinical findings, atrial fibrosis was the most likely cause of atrial standstill in this cat. Treatment depends on the underlying cause, but pacemaker implantation can be considered if there are structural abnormalities. The prognosis is guarded in such cases. In this particular case, the cat was euthanized at the owner's request.     

Diagnosis of right coronary artery to right atrial fistula in a dog using two-dimensional echocardiography

A five-year-old boxer dog developed cardiac murmurs, complete heart block and car-diomegaly associated with vegetative bacterial endocarditis. Using two-dimensional echocardiography, vegetative lesions of the aortic valves and extension of the vegetations into the proximal right coronary artery and adjacent atrial septum were identified. The vegetation within the atrial septum appeared as a cavitated mass which protruded into the right atrium. Fistulae within the atrial septal vegetation permitting communication between the coronary artery and right atrium were observed with colour Doppler echocardiography. The dog died despite medical treatment. Post mortem examination confirmed the echo-cardiographic findings. Vegetative endocarditis with invasion into the right coronary artery and atrial septum producing fistulae and communication with the right atrium has not been reported previously in dogs. Doppler echocardiography proved useful in demonstrating the abnormal anatomy, intraluminal fistular blood flow and its communication with the right atrium.     

Partial anomalous pulmonary venous connection with portosystemic shunt in a cat

A nine-month-old castrated male domestic shorthair presented for evaluation with a three-month history of hematuria. Portosystemic shunts and calculi within the bladder were suspected, and computed tomography angiography was performed. Computed tomography angiography identified an extrahepatic portosystemic shunt and a partial anomalous pulmonary venous connection, with the lobar vein of the right caudal lobe draining into the caudal vena cava. After anesthesia was administered to the cat, tachypnea and wheezing respiratory sounds were observed, and thoracic radiography revealed the right middle lung lobe atelectasis and an unstructured interstitial pattern in the left cranial lobe. Echocardiography showed left and right atrial enlargement and slight interventricular septal flattening in diastole. Based on these findings, cardiogenic pulmonary edema was suspected, and the cat was treated with furosemide. The clinical symptoms were resolved the next day. Closure of the extrahepatic portosystemic shunt was performed on days 47 and 157. Left atrial enlargement and interventricular septal flattening were attenuated after the procedure. At the time of writing this report (seventeen months after diagnosis), the cat exhibited no clinical signs, but subjective right atrial enlargement remained at approximately the same level. This report represents the first case of a partial anomalous pulmonary venous connection and a portosystemic shunt in a cat.     

Echocardiography, electrocardiography, and radiography of cats with dilatation cardiomyopathy, hypertrophic cardiomyopathy, and hyperthyroidism

The echocardiographic, ECG, and radiographic findings of sequentially examined cats with dilatation cardiomyopathy (DCM, n = 7), hypertrophic cardiomyopathy (HCM, n = 8), and hyperthyroidism (HT, n = 20) were compared with those of healthy control cats (n = 11). Cats with DCM were easily differentiated from healthy cats by echocardiography and from cats with HCM and HT by a dilated left ventricle at end-diastole with a mean +/- SD of 2.20 +/- 0.36 cm, reduced fractional shortening (2.9% +/- 3.7%), reduced aortic amplitude (0.07 +/- 0.05 cm), reduced left ventricular wall amplitude (0.09 +/- 0.09 cm), and increased E-point septal separation (0.83 +/- 0.29 cm). The cats with HCM were most consistently recognized echocardiographically by increased left ventricular wall thickness at end-diastole (0.75 +/- 0.12 cm). Some cats with HT had abnormal echocardiograms with left ventricular wall hypertrophy. These cats could usually be differentiated from the cats with HCM because of normal or increased ventricular wall amplitude, aortic amplitude, or percentage of thickening of the left ventricular wall and interventricular septum. Left atrial enlargement (left atrial diameter greater than 1.57 cm or left atrium/aorta greater than 1.75) was commonly detected by the echocardiogram in cats with DCM, HCM, or HT. The echocardiogram was helpful in differentiating the type of cardiomyopathy (DCM, HCM, or HT) when plain thoracic radiographs indicated that cardiomegaly existed. The ECG may have indicated incorrectly that there was left ventricular enlargement in some cats with HT, and it did not indicate consistently that left ventricular enlargement existed when present in cats with DCM or HCM. The ECG was a poor indicator of left atrial enlargement in all cats.     

Atrial septal defect in five dogs

The clinical, electrocardiographic, radiographic, and two-dimensional, M-mode and Doppler echocardiographic findings of five cases of canine ostium secundum type atrial septal defect (ASD) are described. The atrial septal anomaly was associated with other congenital cardiac abnormalities in two dogs: ventricular septal defect in one case and tricuspid dysplasia in the other. ASD was found in addition to dilated cardiomyopathy and suspected atrial thrombosis in one geriatric dog, but was the only cardiac abnormality detected in the remaining two dogs. Colour Doppler imaging facilitated the diagnosis of ASD in all subjects. The long-term prognosis for dogs with isolated and small-sized ASD is usually good, but can be compromised by the presence of concurrent congenital or acquired cardiac diseases.     

End-stage hypertrophic cardiomyopathy in a cat

A 14-year-old Persian cat was referred for evaluation of the progression of hypertrophic cardiomyopathy (HCM) after an acute episode of congestive heart failure. The diagnosis of HCM had been made almost 13 years ago. Echocardiography and electrocardiography revealed end-stage hypertrophic cardiomyopathy and multifocal atrial tachycardia. The patient was discharged on medical management with a grave prognosis.     

Trifoliate left atrioventricular valve with and without intact septal structures in four dogs: echocardiographic findings and surgical repair

Trifoliate left atrioventricular (AV) valve with common atrioventricular junction is considered part of the spectrum of atrioventricular septal defect. This valve morphology is typically associated with defects in the AV septum resulting in communication at the atrial or ventricular level, but has also been described as an isolated defect in the setting of a common AV junction without AV septal defect. Trifoliate left AV valve exhibits a line of apposition between the bridging leaflets that is directed toward the inlet interventricular septum, distinguishing it from isolated mitral valve cleft in which the orientation of the bridging leaflets are toward the left ventricular outflow tract. The echocardiographic findings of four dogs with trifoliate left AV valve are described; two with intact septal structures and two with large ostium primum defects. Three dogs underwent open surgical repair using different approaches depending on the presence or absence of a septal defect. One of these underwent concurrent surgical repair for right AV valve dysplasia. One dog with intact septal structures underwent interventional closure of a concurrent patent ductus arteriosus. Current terminology associated with trileaflet left AV valve malformations is reviewed.     

Pathology of end-stage remodeling in a family of cats with hypertrophic cardiomyopathy

End-stage hypertrophic cardiomyopathy (ES-HCM), affecting 5-10% of human hypertrophic cardiomyopathy (HCM) patients, is characterized by relative thinning of the ventricular walls and septum with dilation of the ventricular lumen, decreased fractional shortening, and progression to heart failure. C. J. Baty and others recently documented similar progressive changes to ES-HCM in a family of four cats through serial echocardiograms. At the time of heart failure, these cats exhibited changes similar to those exhibited by human ES-HCM patients. Our objectives were to describe the pathologic alterations associated with ES-HCM and investigate the pathogenesis in three of the four cats. Grossly, there was left atrial dilation with relative thinning of the interventricular septum (IVS) and left ventricular free wall (LVFW). The left atrium contained large thrombi in two of the three cats, and all three cats died following thromboembolization of the aortic bifurcation. Histologically, all three cats had subendocardial and myocardial fibrosis, predominantly of the IVS and LVFW, and one cat had acute, multifocal, myocardial infarcts with mononuclear inflammatory cell infiltrates. The pathogenesis of ES-HCM is uncertain, but theories implicate occlusion of the coronary blood flow by thickening of the coronary vessels, coronary vascular thromboembolism or coronary vessel spasm, apoptosis of myocytes, and myocardial hypertrophy beyond the ability of the vasculature to supply blood. Apoptosis assays did not reveal any apoptotic myocytes. Considering the hypercoagulative state of these cats, coronary vascular thromboembolism could be a major contributing factor. We cannot exclude apoptosis or coronary vessel spasm on the basis of the data presented.     

Plexogenic pulmonary arteriopathy in a cat with non‐restrictive ventricular septal defect and chronic pulmonary hypertension

A 10‐week‐old, male, domestic long‐hair cat was medically managed for congenital heart disease over a period of 8 years. Regular clinical examinations, including sequential echocardiography, documented a non‐restrictive paramembranous ventricular septal defect, secundum‐type atrial septal defect and aortic dextroposition. Pulmonary arterial hypertension was diagnosed by the presence of high‐velocity tricuspid regurgitation, bidirectional low velocity flow across the ventricular septal defect, pulmonary arterial dilation and severe right ventricular hypertrophy without evidence of pulmonary outflow tract obstruction. The cat remained clinically stable until it died suddenly at 8 years of age. Histopathology of the lungs found evidence of plexogenic pulmonary arteriopathy. Despite severe pulmonary vascular lesions, other post‐mortem evidence of right heart failure was lacking and death was attributed to a fatal cardiac arrhythmia. In this case report of a cat with chronic pulmonary hypertension over 8 years, plexogenic lesions were found on histopathology. The microscopic findings resemble those previously reported in dogs.     

Dysplasia of the tricuspid valve in the dog and cat.

Dysplasia of the tricuspid valve in 14 dogs and 13 cats was studied. The clinical, electrocardiographic, radiographic, hemodynamic, angiocardiographic, and pathologic findings were reviewed in each species. Alterations of the tricuspid valve complex included long, thick septal leaflets adhered to the septum; absent or short, stout fused chordae tendineae; hypertrophic fused papillary muscles; insertion of papillary muscles directly into the lateral leaflets; incomplete development of the valvular tissue; and enlargement of the right atrium and ventricle. Additional intracardiac anomalies included malformation of the mitral valve complex (5 dogs and 3 cats), ventricular septal defect (3 dogs and 3 cats), pulmonary stenosis (1 dog and 1 cat), aortic stenosis (1 dog and 1 cat), and persistent left cranial vena cava (1 dog).     

Arrhythmogenic right ventricular cardiomyopathy associated with severe left ventricular involvement in a cat

An 8-year-old, 4 kg, intact female, domestic shorthaired cat was referred for tachypnea and pleural effusion. A 24-h Holter recording showed numerous polymorphic ventricular premature complexes with left and right bundle branch block morphology. Echocardiographic examination revealed right atrial and ventricular dilation. The right ventricular free wall was thin and aneurysmal. The cat died 10 days after initiation of antiarrhythmic therapy. Gross and histopathological findings were consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC) associated with severe left ventricular involvement.     

猫肥厚型心肌病与心肌纤维化

肥厚型心肌病是猫最常见的原发性心脏疾病,典型特征为心脏左心室肥厚。心肌纤维化是猫肥厚型心肌病的标志性病理变化,其可导致心脏功能障碍和节律异常,是心肌病患猫预后不良的重要因素。对于猫肥厚型心肌病与心肌纤维化,目前缺乏针对性治疗,新型治疗方法亟需开发。本综述总结了猫肥厚型心肌病的病理特征以及目前关于猫心肌纤维化发病机制的研究进展,拟通过探索心肌纤维化的发病机制,从而为猫肥厚型心肌病新型治疗药物的开发寻找突破点。