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.     

Medial insertion of the patent ductus arteriosus characterized by computed tomography angiography in a cat and dog

Surgical ligation of a left-to-right shunting patent ductus arteriosus was attempted in two animals. In both cases, a young cat and dog, ligation was complicated by poor visualization of the ductus resulting in unsuccessful ligation. Post-operatively, both the cat and dog underwent computed tomography angiography to characterize the location and morphology of the patent ductus arteriosus. In both cases, computed tomography angiography revealed a left-to-right shunting patent ductus arteriosus with an insertion location medial to the left pulmonary artery branch compared to the typical location. We hypothesize that this atypical location resulted in a difficult surgical visualization from the left thoracotomy approach. Transvenous coil embolization of the duct from the external jugular vein was performed in both cases and resulted in successful occlusion. Variations in the medial-lateral insertion of the ductus arteriosus may have consequences for surgical intervention. If an atypical location of a patent ductus arteriosus is suspected on transthoracic echocardiography, computed tomography angiography prior to ligation may be useful to further define ductal location and help guide the surgical approach.     

Cardiogenic hypertrophic osteopathy in a dog with a right-to-left shunting patent ductus arteriosus

A 5-year-old castrated male Shetland Sheepdog was examined because of progressive bilateral hind limb thickening. Cyanosis of the preputial mucous membranes was evident, whereas the oral mucous membranes had a normal color. A well-structured, palisade-like periosteal reaction with no underlying bone destruction was evident on radiographs of the hind limbs. The radiographic changes were consistent with hypertrophic osteopathy (HO). Severe right-sided cardiomegaly was seen on thoracic radiographs, and a diagnosis of patent ductus arteriosus with right-to-left shunting was made by means of echocardiography and contrast echoaortography. The cyanotic heart disease was believed to be the cause of the HO. Hypertrophic osteopathy has been associated with a number of diseases in animals and humans. In humans, congenital heart defects that cause cyanosis are among the most common causes of HO.     

Persistent left cranial vena cava associated with multiple congenital anomalies in a six-week-old puppy

A six-week-old male puppy was presented with a distended abdomen, dypsnoea and cyanosis. Auscultation revealed a grade II/VI systolic murmur. Thoracic radiographs showed gross cardiomegaly. An electrocardiogram revealed a narrow-complex tachycardia, deep S waves in leads I, II, III and aVF, and negative P a waves in lead III. Two-dimensional echocardiography showed a high ventricular septal defect and marked dilation of the right-sided chambers. There was also an echolucent structure lateral to the left atrium at a site corresponding to the coronary sinus. Contrast echocardiography revealed right-to-left shunting through the septal defect. Necropsy confirmed the existence of a septal defect in the membranous part of the septum and a persistent left cranial vena cava with dilation of the coronary sinus. In addition, a small patent t ductus arteriosus and tricuspid dysplasia were present.     

Plexogenic pulmonary arteriopathy in a Pembroke Welsh corgi

A 21-month-old, male Pembroke Welsh corgi was referred for investigation of respiratory distress and progressive lethargy. Cardiac evaluation revealed a grade 4 pansystolic murmur over the left and right heart base. A heart murmur, dyspnoea, cyanosis, prolonged capillary refill time and ascites led to the tentative diagnosis of a cardiac malformation with a right-to-left shunt, with likely additional pulmonary disease. Pulmonary hypertension became evident during echocardiography, when the estimated systolic pulmonary artery pressure was over 70 mmHg. Angiography revealed abnormal pulmonary vascular markings consistent with pulmonary hypertension and a small right-to-left shunting patent ductus arteriosus (PDA). The diagnosis of PDA was confirmed at postmortem examination. Histology of the pulmonary arteries showed lesions of plexogenic pulmonary arteriopathy. The question of whether both conditions were separate or part of the same clinical syndrome is discussed in this report.     

Interventional Closure of a Patent Ductus Arteriosus Using an Amplatz Canine Duct Occluder in an Alpaca Cria

A 6‐month old female alpaca cria presented to The Ohio State University for evaluation of a cardiac murmur. Echocardiography revealed a left‐to‐right shunting patent ductus arteriosus, a restrictive left‐to‐right shunting perimembranous ventricular septal defect, and secondary moderate left atrial and ventricular dilation. Aortic root angiography demonstrated a type IIA patent ductus arteriosus (PDA). Interventional closure of the PDA was successfully performed, without complication, using an Amplatz canine duct occluder. This case report describes the materials and methods used for interventional closure of a PDA in an alpaca cria.     

Original investigation of right-to-left shunting patent ductus arteriosus in an Irish setter puppy

A six-month-old, entire female, Irish setter was presented with a two-month history of progressive hindlimb weakness and collapse on exercise. Thoracic auscultation revealed a soft systolic murmur and a split second heart sound. Differential cyanosis and polycythaemia were not observed. Right-to-left shunting patent ductus arteriosus (r-PDA) was confirmed on contrast echocardiography ("bubble study") and selective right ventricular angiography. Comparison of blood gases from the metatarsal and auricular artery confirmed the presence of differential hypoxia. This technique is not known to have been described previously in the diagnostic investigation of r-PDA in dogs.     

Patent ductus arteriosus with pulmonary hypertension in a cat

Patent ductus arteriosus with pulmonary hypertension and right to left shunting of blood flow was diagnosed in a 9-month-old female cat. Because of the pulmonary hypertension, the cat did not have typical signs of patent ductus arteriosus; thus, cardiac angiography and catheterization were utilized to confirm the diagnosis. The patent duct was successfully occluded with a vascular clip.     

Arteriovenous shunts resembling patent ductus arteriosus in dogs: 3 cases

Three dogs presented for the evaluation of cardiac murmurs were diagnosed with aberrant arteriovenous shunts. All cases demonstrated the following findings: 1) relatively soft continuous murmur loudest at the left heart base resembling patent ductus arteriosus (PDA); 2) shunt flow signals in the pulmonary artery on echocardiography; and 3) no PDA on selective angiography, but evidence of anomalous shunting vessels from thoracic aorta to pulmonary vasculature. An aberrant arteriovenous shunt should be considered when a continuous murmur of relatively small intensity is heard.     

Transcatheter embolisation of patent ductus arteriosus using an Amplatzer vascular plug in six dogs

OBJECTIVES: The objective of this study was to assess the feasibility of transcatheter embolisation of a patent ductus arteriosus using an Amplatzer vascular plug (Amplatzer Medical UK) in six dogs. METHODS: The Amplatzer vascular plug is a self-expandable, cylindrical device attached to a delivery cable. In all the dogs, the device was delivered transvenously. Successful device implantation was defined as firm anchorage of the device squarely within the distal part of the ductus arteriosus with no intra- or postoperative dislodgement. Successful occlusion of the ductus arteriosus occurred if a disappearance of the continuous murmur was achieved 24 hours after placement of the Amplatzer vascular plug. RESULTS: The age of the dogs ranged from 16 weeks to 7.5 years. Their weights ranged from 2.9 to 27.6 kg (median 6 kg). Two dogs had congestive heart failure before embolisation. Successful device implantation was achieved in all dogs. Successful occlusion of the ductus arteriosus was achieved in four of the six dogs. Complications included mild lameness, residual shunting, and bruising and pruritus around the surgical wound site. At follow-up, two dogs had a continuous murmur and one required treatment for congestive heart failure. CLINICAL SIGNIFICANCE: This technique may represent a clinically effective and less expensive alternative to the use of an Amplatzer duct occluder (Amplatzer Medical UK) in dogs with medium-sized patent ductus arteriosus. Further investigations are required to fully evaluate its efficacy and safety in various sizes and types of patent ductus arteriosus, and to determine the optimal device size in relation to the size of the ductus.     

Coil embolization of patent ductus arteriosus via the carotid artery in seven dogs

This study was designed to evaluate the feasibility and limitations of transcatheter embolization coil occlusion of patent ductus arteriosus in dogs using a carotid artery approach. Seven dogs examined at the University of California, Davis Veterinary Medical Teaching Hospital in 2002-2003 for evaluation of heart disease had congenital patent ductus arteriosus diagnosed by characteristic physical, electrocardiographic, radiographic, and anatomic and Doppler echocardiographic findings. Dogs were anesthetized for transesophageal echocardiography and transcatheter coil embolization of the ductus via the right external carotid artery. Coil embolization was achieved in all seven cases, using one to four detachable embolization coils. There were no major complications. Minor complications occurred in two dogs (additional coils placed using a femoral arterial approach and coil embolization of a left femoral artery branch). One dog was examined only 24 h post-operatively and had no murmur and trivial residual ductal flow by Doppler echocardiography. The other 6 dogs were clinically healthy when examined up to three years post-intervention. One dog had a very soft continuous murmur and mild residual ductal flow; the other five had no audible continuous murmur, with only one dog having trivial residual ductal flow identified by Doppler echocardiography. Although technically challenging, coil embolization via the carotid artery is a viable alternative approach for transcatheter closure of patent ductus arteriosus in some dogs.     

Right-to-left patent ductus arteriosus with dysplastic left ventricle in a dog

A 6-week-old Siberian Husky pup had an unusual group of congenital heart anomalies that included a right-to-left patent ductus arteriosus, a small left ventricular chamber and ascending aorta, and a dysplastic mitral valve that may have been stenotic. Anomalies were diagnosed, using cardiac catheterization, angiocardiography, and blood gas determinations. Findings were confirmed by postmortem examination.     

Aortic sinus aneurysm communicating with the main pulmonary artery,and a concurrent patent ductus arteriosus,in a dog

This is the first report of an aortic sinus aneurysm with a communication to the main pulmonary artery, resulting in left-to-right shunting, diagnosed in vivo in a dog. There was also a second left-to-right shunt through a patent ductus arteriosus. Computed tomography (CT) angiography was used to confirm both congenital anomalies and assess the relative contributions of the two left-to-right shunts to left-sided volume overload.     

Intracardiac echocardiography: use during transcatheter device closure of a patent ductus arteriosus in a dog

Intracardiac echocardiography (ICE) is used in humans for percutaneous interventional procedures, such as transcatheter device closures. Intracardiac echocardiography provides high-resolution imaging of cardiac structures with two-dimensional, M-mode, Doppler, and also three-dimensional modalities. The present report describes application of ICE during transcatheter occlusion of patent ductus arteriosus using a canine ductal occluder in a dog for which transesophageal echocardiography could not provide an optimal acoustic window.     

Reversed patent ductus arteriosus in a dog.

A 5-year-old cocker spaniel with tachycardia, > 2 s capillary refill time, arrhythmia, split S2 heart sound, right ventricular enlargement, flattened interventricular septum, dilated pulmonary artery, and slight tricuspid valve insufficiency was diagnosed with reversed patent ductus arteriosus (right-to-left vs the more common left-to-right shunt). Two years later, the dog was still stable.     

ECHOCARDIOGRAPHIC AND DOPPLER CHARACTERISTICS OF POSTOPERATIVE DUCTAL ANEURYSM IN A DOG

A patent ductus arteriosus (PDA) was detected in a 10-month-old Pyrenean Shepherd. The PDA was occluded with hemostatic clips. One month after surgery, an aneurysmal dilatation of the ductus was diagnosed using Doppler echocardiography. The authors present the echo-Doppler findings and the follow-up of the ductus aneurysm. The pathogenesis and significance of such an aneurysm are discussed.     

ECHOCARDIOGRAPHIC DIAGNOSIS OF TRANSPOSITION OF THE GREAT ARTERIES IN A NEONATAL FOAL

The clinical and echocardiographic findings in a 19-h-old female foal with a ventricular septal defect, patent foramen ovale, patent ductus arteriosus, and complete transpositon of the great vessels are described. Clinical signs were suggestive of complex congenital heart disease and echocardiography of the foal allowed definitive diagnosis prior to postmortem.     

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.     

Right-to-left shunting patent ductus arteriosus with pulmonary hypertension in a cat

A 16-month-old, neutered female domestic shorthaired cat had tachypnoea, inappetence and a heart murmur, which had been first detected at eight weeks old. Diagnosis of reverse shunting patent ductus arteriosus and pulmonary hypertension was based on a detailed two-dimensional and Doppler echocardiographic examination. This report documents the clinical and imaging findings in this rare feline condition.     

Acute onset of pulmonary necrotising arteritis in a dog with a left-to-right patent ductus arteriosus

A 12-week-old, clinically normal Chihuahua was referred for investigation for a continuous heart murmur. Cardiac evaluation revealed an anatomically and haemodynamically typical left-to-right shunting patent ductus arteriosus. The continuous wave Doppler measurement of peak ductal jet velocity of 5.6 m/s was suggestive of a normal pulmonary to systemic arterial pressure ratio. The dog returned 16 days later with right heart failure and severe pulmonary hypertension. Marked reduction in left-to-right shunting was demonstrated and the ductal jet velocity had decreased to 2.5 m/s. Immediate ductus ligation, oxygen therapy before and after the operation, and administration of hydralazine failed to reduce pulmonary hypertension, and the dog was euthanased. Histopathological examination of the lung showed pulmonary necrotising arteritis with acute and chronic arterial lesions. Chronic pulmonary vascular changes related to high flow have been associated with altered nitric oxide and endothelin responses. These changes may be responsible for the acute onset of pulmonary hypertension due to relatively minor vascular insults in some human and veterinary patients with left-to-right shunts. The potential for acute progression supports the recommendations for early ductus ligation and the prognostic importance of detecting pulmonary hypertension presurgically in patent ductus arteriosus patients.