Echocardiographic detection of tricuspid atresia in two foals

M-mode, 2-dimensional, and contrast echocardiographic studies were used to detect tricuspid atresia in 2 foals. M-mode echocardiographic findings included a small right ventricle, large left ventricle, large mitral valve excursion, large left atrium (foal 2), dropout of the cranial aspect of the aortic root, and a thick band of echoes in the tricuspid valve region. These findings were confirmed by 2-dimensional echocardiography. In addition, a large right atrium, persistent foramen ovale, ventricular septal defect, and large mitral valve apparatus were imaged. One foal also had a thick right atrial wall. Contrast echocardiography confirmed the intracardiac flow of blood from right to left atrium and then to the left ventricle, followed by simultaneous opacification of the right ventricle and aorta. The use of these echocardiographic techniques enables accurate antemortem diagnosis and prognosis of tricuspid atresia in the foal.     

Surgical correction of ventricular septal defect with aortic regurgitation in a dog

An 8-month-old entire Miniature Dachshund, weighing 4.2 kg, was presented for examination following delvelopment of a cough. Ventricular septal defect had been diagnosed tentatively in its infancy on the basis of a cardiac murmur detected by auscultation and echocardiography. Echocardiography using a B mode right parasternal long-axis view showed a defect at the atrioventricular junction and a thickened cusp of the aortic valve prolapsing into the defect. Colour-flow Doppler showed shunt blood flow across the defect at the level of the atrioventricular junction, from left to right. The sinus of Valsalva was dilated, with turbulent blood flow. Aortic regurgitation was also observed. Cardiac catheterisation studies confirmed the diagnosis of a supracristal ventricular septal defect with aortic regurgitation. Despite medication with digoxin, enalapril and aminophylin, started from the first admission, left ventricular internal dimensions gradually increased, and fractional shortening of the left ventricle gradually decreased. Surgery, with the aid of extracorporeal circulation, to close the ventricular septal defect, was performed 1 year after the initial examination. The aortic valve was left untreated. Postoperatively, the systolic murmur disappeared. Shunt flow from the left to the right ventricle was no longer observed on echocardiography, however there was still a small amount of aortic regurgitation during diastole visualised with colour-flow Doppler echocardiography. The prolapse of the cusp of the aortic valve on B-mode echocardiography was no longer observed and thickening of the cusp had not progressed. Left ventricular function measurement using M mode echocardiography showed a reduced left ventricular volume overload with reduced left ventricular internal dimensions and increased fractional shortening. The cough was relieved and no follow-up medication was scheduled. Early surgical closure of the ventricular septal defect improved the patient's condition and controlled prolapse and thickening of the aortic valve.     

Hypoplastic left ventricular syndrome in a foal

A necropsy diagnosis of hypoplastic left ventricular syndrome was made in a day-old foal. The cardiac abnormalities included mitral and aortic valve atresia, patent ductus arteriosus, and a secundum atrial septal defect. The left ventricle was hypoplastic and nonfunctional. The brief survival of the foal was a consequence of left-to-right shunting through the atrial septal defect and right-to-left shunting through the patent ductus. The information is presented to demonstrate the existence of the syndrome as a congenital defect in the horse and to clarify the necropsy findings for the practitioner to diagnose if seen.     

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.     

Echocardiographic diagnosis of an anomaly of the tricuspid valve in a male pygmy goat.

A 3-year-old male pygmy goat was evaluated because of a grade III/V plateau pansystolic murmur that was auscultated over the tricuspid valve area and a grade II/V plateau pansystolic murmur that was auscultated over the left heart base. Echocardiography revealed a large right atrium and ventricle, an atrial septal defect, and a dysplastic tricuspid valve displaced apically into the right ventricle. Contrast echocardiography and color-flow Doppler echocardiography revealed flow from right to left through the atrial septal defect and severe tricuspid regurgitation. A diagnosis of tricuspid valve dysplasia and severe tricuspid regurgitation was made. This anomaly (Ebstein's anomaly) of the tricuspid valve should be considered in goats that have systolic, with or without diastolic, murmurs over the tricuspic valve. Two-dimensional echocardiography can confirm the diagnosis of the anomaly. The associated tricuspid regurgitation and interatrial right-to-left shunt flow can be detected and semiquantitated by use of contrast, continuous wave, and color-flow Doppler echocardiography.     

Tricuspid atresia in a foal

An Arabian crossbred foal was examined because of a suspected congenital cardiac anomaly. There was a grade V/V crescendo-decresendo holosystolic murmur and thrill in the left 4th intercostal space. The foal was slightly cyanotic and polycythemic. Electrocardiography suggested left ventricular hypertrophy. Angiography and cardiac and vascular pressure recordings led to a diagnosis of pulmonic stenosis. The foal died after cardiac bypass and corrective surgery. Postmortem examination revealed an enlarged right atrium, atresia of the tricuspid orifice, a large, fenestrated patent foramen ovale, eccentric left ventricular hypertrophy, and a large interventricular septal defect. The right ventricle had a small lumen and a relatively thick wall. There was valvular and supravalvular pulmonic stenosis, with poststenotic dilatation of the pulmonary artery. A single coronary artery originated from the anterior sinus of the aorta.     

Surgical correction of a partial atrioventricular septal defect with a ventricular septal defect in a dog

Echocardiography of a dog with a cardiac murmur revealed an ostium primum septal defect, a ventricular septal defect, and mitral valve malformation with regurgitation. The mitral valve and tricuspid valve were separated and displaced at the same level as the ventricular septum. The mitral valve had a cleft in the septal cusp. Cardiac catheterization and angiocardiography showed a left-to-right shunt and a "goose-neck sign," which indicated an elongated left ventricular outflow tract. The diagnosis of a partial atrioventricular septal defect with ventricular septal defect was made. Surgical correction was successfully performed under extracorpo-real circulation using a cardiopulmonary bypass system.     

Anatomically corrected malposition (ACM) with subpulmonary infundibulum in a calf: clinico-morphologic case report.

A Japanese black calf with cyanosis, tachycardia, tachypnea and systolic murmur died of hypoxemia and cardiac insufficiency on the 38th day after birth. We could not establish the diagnosis during it's life. However, anatomically corrected malposition (ACM) with ventricular septal defect was confirmed at autopsy. There was situs solitus of the viscera and atria with atrio-ventricular discordance and ventriculo-arterial concordance. The ventricles demonstrated l-loop, i.e. on the right-sided ventricle there was a markedly enlarged morphologic left ventricle, and on the left-sided ventricle there was a hypoplastic morphologic right ventricle with a stenotic tricuspid valve and Ebstein-like deformity. The right posterior aorta originated from the left ventricle. The pulmonary artery arose from the left-sided right ventricle via infundibulum. There was a fibrous continuity between the aortic and mitral valve. We considered that this is the first reported case of bovine ACM.     

Right to left patent ductus arteriosus,acute bronchointerstitial pneumonia,pulmonary hypertension and cor pulmonale in a foal

Patent ductus arteriosus (PDA) is a rare congenital cardiac defect in foals causing left to right shunting from the aorta to pulmonary artery. In extremely rare conditions, complications with pulmonary hypertension can result in right to left shunting (Eisenmenger's physiology); however, reversed or right to left shunting has not yet been precisely described in PDA-affected equids. This report describes a unique and unusual case of right to left PDA associated with acute respiratory distress syndrome in a 20-day-old male foal. A holosystolic murmur over the tricuspid valve area and adventitious pulmonary sounds respectively on cardiac and thoracic auscultations, caudodorsally interstitial and bronchointerstitial pulmonary opacities on thoracic radiography, right atrial and ventricular dilatations with paradoxical ventricular septal motion, increased ratio of pulmonary artery internal diameter to the aorta and tricuspid valve regurgitation on echocardiography were detected. Post-mortem and histopathological examinations revealed consolidated, dark red and diffusely enlarged lungs with granular appearance, marked enlargement of the right atrium and ventricle, pulmonary artery thickening and enlargement, patency of the ductus arteriosus, hyaline membrane formation, type II pneumocyte proliferation, hypertrophy and thickening of the pulmonary arteries medial layers and right ventricular myocardial cells distortion and hypertrophy. The findings suggest a right to left shunting through the persistent patency of the ductus arteriosus, pulmonary hypertension and cor pulmonale. We proposed pulmonary hypertension associated with bronchointerstitial pneumonia as a cause of this unusual case of PDA with reversed shunt direction.     

Common atrioventricular canal in a foal

A 3-week-old Thoroughbred colt was presented for weakness and cyanosis. A pansystolic regurgitant murmur and other physical findings suggested that the foal developed pulmonary oedema as a consequence of congenital heart disease. A large atrial septal defect, a high ventricular septal defect and dysplasia of the atrioventricular valves were visualised echocardiographically. A persistent common atrioventricular canal was observed at necropsy.     

Antibiotics: Their application in veterinary practice

A 3-week-old Thoroughbred colt was presented for weakness and cyanosis. A pansystolic regurgitant murmur and other physical findings suggested that the foal developed pulmonary oedema as a consequence of congenital heart disease. A large atria1 septal defect, a high ventricular septal defect and dysplasia of the atrioventricular valves were visualised echocardiographically. A persistent common atrioventricular canal was observed at necropsy.     

Gerbode type defect and third degree atrioventricular block in association with bacterial endocarditis in a dog

Gerbode type defects are rare left ventricular outflow tract–right atrial communications in people that may be congenital or acquired; they have been reported only once previously in dogs. Acquired forms in humans have been reported secondary to bacterial endocarditis, trauma, and valve replacement surgery, among other causes. We report a case of left ventricular outflow tract to right atrium and right ventricle communications (Gerbode type defect) in association with aortic and tricuspid valve bacterial endocarditis in a geriatric dog. The dog also developed third degree atrioventricular block and had underlying subaortic stenosis. The authors hypothesize that the Gerbode type defect in this case was acquired secondary to invasion and destruction of the membranous interventricular septum due to bacterial endocarditis.     

Double-outlet right ventricle in an Angus calf

Double-outlet right ventricle (DORV) is a conotruncal malformation where both great arteries arise from the right ventricle. Anatomic variations of DORV are classified according to the position of the great arteries in relation to each other, the relationship between a ventricular septal defect (VSD) and the great arteries, and the presence and degree of pulmonary stenosis. The prevalence of congenital cardiac defects in bovine fetuses has been reported at approximately 0.7 %, with VSDs representing the most common congenital cardiac defect. DORV has been described in veterinary literature in few cats and dogs, a foal, and 2 calves with variable clinical and pathologic documentation. In this report, we describe the angiographic, echocardiographic, and postmortem examination findings in a calf with a DORV with concurrent pulmonary stenosis, subaortic VSD, patent ductus arteriosus (PDA), aberrant left subclavian artery, and a tracheal malformation.     

Echocardiographic Detection of Flail Left Atrioventricular Valve Cusp From Ruptured Chordae Tendineae in 4 Dogs

Echocardiography was used to identify a flail left atrioventricular valve cusp caused by ruptured chordae tendineae in each of 4 dogs; two-dimensional echocardiography was superior to M-mode echocardiography in identifying the flail cusps. The following findings on two-dimensional imaging were characteristic: the tip of the flail cusp extended beyond the line of left atrioventricular valve cusp closure and pointed toward the left atrium in systole; the tip was thrust into the left ventricle, and then toward the left ventricular outflow tract in diastole, forming a convex surface to the cusp, which faced toward the left ventricle. The flail motion of the left atrioventricular valve cusp was best observed in the right parasternal long axis or left apical four-chamber views, in a plane parallel to the long axis of the left ventricle and left atrium. Rupture of chordae tendineae leading to flail cusp was attributed to chronic valve degeneration (endocardiosis) in all 4 dogs. Echocardiographic or clinical diagnoses were confirmed by postmortem gross and microscopic studies in all dogs.     

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.     

Double outlet right ventricle in a calf.

Double outlet right ventricle, a rare congenital heart anomaly of either animals or man, was diagnosed in a three day old Brangus heifer. The clinical course was brief, consisting of terminal recumbency, dyspnea and cyanosis. Upon necropsy, the heart was enlarged as a result of marked dilatation of the right atrium and the right ventricle. The aorta arose from the right ventricle while the left ventricle ended blindly near the ventral cusp of the left atrioventricular valve. The wall of the left ventricle was thickened, reducing the ventricular lumen.     

Common ventricle with separate pulmonary outflow chamber in a horse

On the basis of clinical and laboratory examinations, a ventricular septal defect or a variant of the tetralogy of Fallot was suspected in a 3-year-old filly with a history of poor growth rate and exercise intolerance. The filly was euthanatized and found to have a 3-chambered heart (cor triloculare biatriatum). The heart had 2 normally formed atria and a large common ventricle into which the right and left atrioventricular orifices opened and from which the aorta arose. There was a small separate chamber from which the pulmonary trunk originated. This chamber communicated with the common ventricle through a large oval opening along the dorsal border of the displaced, interventricular septum.     

A clinical case of single left ventricle in a Holstein calf

A 15-day-old Holstein calf with lethargy and tachypnea presented to the Veterinary Teaching Hospital at Obihiro University of Agriculture and Veterinary Medicine for evaluation of suspected congenital heart defect. A Levine grade 6 systolic murmur was noted at right apical site auscultation and phonocardiogram also recorded systolic a murmur. Electrocardiography findings include increased R and S waves, R wave split, and negative T waves without arrhythmia. Echocardiography revealed a single ventricle with a trace of the right ventricular wall, atrioventricular valve regurgitation, and turbulent in a single ventricle. Arterial blood analysis showed a marked decrease in oxygen saturation of 78% and oxygen partial pressure of 44 mmHg. Post-mortem examination confirmed the diagnosis of a single left ventricle.     

Congestive heart failure associated with myxomatous degeneration of the left atrioventricular valve in a parakeet

Congestive heart failure was diagnosed in a 27-year-old Indian ringneck parakeet with exercise-induced dyspnea. A grade IV/VI holosystolic murmur that radiated to the right sternal area was auscultated over the left side of the sternum. Radiography revealed progressive cardiomegaly, hepatomegaly, pulmonary edema, and accumulation of fluid within the coelomic cavity. Echocardiography revealed biatrial enlargement and enlargement of the right ventricle. Doppler recording revealed high velocity left and right atrioventricular valve regurgitation. Treatment with digoxin and furosemide alleviated clinical signs for approximately 10 months. Gross postmortem examination revealed cardiac enlargement and eccentric hypertrophy of both ventricles on cross-section. Pulmonary congestion and edema, hepatomegaly, hepatic congestion, and ascites were also evident. Histologic examination of the heart revealed myxomatous degeneration of the left atrioventricular valve, muscular hypertrophy of the right atrioventricular valve, and biventricular chronic myofiber degeneration and necrosis.