Congenital cardiac disease in dogs

Aortic stenosis is a heritable cardiac anomaly most common in German Shepherds, Boxers and Newfoundlands, and less common in Pugs, English Bulldogs, Boston Terriers, Fox Terriers, Schnauzers and Bassets. Clinical signs are associated with secondary left-sided heart failure and include coughing, moist rales, exercise intolerance, arrhythmias and a weak femoral pulse. It causes an ejection-type crescendo-decrescendo, systolic murmur best heard on the left side near the elbow. The ECG may be normal or may show signs of left ventricular hypertrophy, including an axis of less than 40 degrees, a QRS complex of greater than 60 seconds in duration, R waves greater than 3 mv in amplitude, ST segment slurring or depression, or T waves of an amplitude greater than 25% of that of R waves. A LAT radiograph usually reveals an enlarged cardiac silhouette, loss of the cranial cardiac waist, and normal pulmonary vasculature, while DV projections show an elongated cardiac silhouette, rounding of the left ventricular border, and a normal descending aorta. Nonselective angiocardiography reveals poststenotic dilatation of the aorta. Treatment of severely affected dogs involves surgical correction.     

Congenital cardiac disease in dogs

Thoracic conformation, age, amount of body fat, and stage of respiration and cardiac contraction affect the cardiac silhouette. Deep-chested dogs have an upright, narrow cardiac silhouette about 2 1/2 intercostal spaces wide, while barrel-chested dogs have a round, wide silhouette about 3 1/2 intercostal spaces wide. On LAT films the vessels to a lung lobe should be of equal size and 0.25-1.2 times the diameter of the upper third of the 4th rib at the 4th intercostal space. On DV projections, vessels to the caudal lung lobe should be no larger than the diameter of the 9th rib. Signs of right ventricular enlargement include loss of the cranial waist, increased width of the cardiac silhouette, increased sternal contact of the heart, and an elevated cardiac apex. Signs of left ventricular enlargement include an elevated carina, loss of the caudal waist, and a more perpendicular caudal cardiac border. Signs of left atrial enlargement include separation of mainstem bronchi, compression of the bronchus to the left caudal lung lobe, and an increased distance from the carina to the dorsal border of the caudal vena cava. Enlargement of the aorta and main pulmonary artery segment on a LAT view appears as a soft tissue density obscuring the cranial waist. Pulmonary vascular fields are usually hypervascular in patent ductus arteriosus and interventricular septal defects, normal in uncomplicated aortic or pulmonic stenosis, and hypovascular in tetralogy of Fallot.     

Ventricular septal defect with aortic valve insufficiency in a New Zealand White rabbit

A heart murmur was detected in a 10 mo old, female New Zealand White rabbit. Auscultation revealed cardiac murmurs both at the left and right hemithorax. Phonocardiography confirmed the systolic-diastolic nature of the left-sided and the systolic character of the right-sided murmur. Electrocardiography showed normal sinus rhythm; tall R waves and large T waves in lead II; and deep S waves in leads II, III, and aVF. Thoracic radiography demonstrated generalized cardiomegaly with prominent pulmonary vasculature. Echocardiography revealed a perimembraneous ventricular septal defect with aortic insufficiency. Signs of biventricular volume overload, relative pulmonic stenosis, and pulmonary valve insufficiency were also seen as consequences of the defect. Necropsy demonstrated a ventricular septal defect just below the aortic valve, a dilated pulmonary trunk, dilated and hypertrophied ventricles, dilated atria, and rightward displacement of the aortic root. Cardiac histopathology showed ventricular cardiomyocyte degeneration (swelling and hypereosinophilia of the cytoplasm with a loss of cross striation, and nuclear hyperchromasia), cartilaginous metaplasia of the aorta, and subendocardial fibrosis of the right ventricular flow tract.     

Congenital cardiac disease in dogs

Pulmonic stenosis is caused by a malformed pulmonic valve, stricture of the right ventricular outflow tract or stricture of the pulmonary artery. English Bulldogs, Beagles, Samoyeds, Fox Terriers and Chihuahuas are predisposed. Clinical signs in severely affected dogs include exercise intolerance, stunting, dyspnea, syncope and ascites. Auscultation reveals a high-frequency, crescendo-decrescendo murmur during systole, loudest over the left side of the thorax, near the sternal cardiac border. An ECG may reveal a right-axis deviation of greater than 120 degrees, S waves in leads I, II and III, deep S waves in CV6LL, CV6LU and V10, Q waves deeper than 0.5 mv in leads II, III and AVF, and positive T waves in lead V10. Plain film LAT thoracic radiographs reveal an elevated carina, increased sternal contact of the heart, loss of the cranial cardiac waist and a widened cardiac silhouette, with normal pulmonary vasculature. A DV projection reveals an inverted "D" shape of the right ventricle and a pulmonary artery bulge. A nonselective angiocardiogram reveals poststenotic dilation of the main pulmonary artery. Treatment involves surgical correction of the stenosis.     

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.     

Abnormal heart sounds and murmurs of the dog

Abstract— —In addition to physiological murmurs as found in association with fever and anemia, a number of organic murmurs resulting from cardiac lesions frequently occur in dogs. These include the pansystolic regurgitant murmur of mitral and tricuspid insufficiency and interventricular septal defect, the ejection systolic murmur of aortic and pulmonic stenosis and the continuous murmur of patent ductus arteriosus. The arterial diastolic murmur of aortic insufficiency occurs less frequently; that of pulmonic insufficiency is even less often encountered. The passive atrioventricular diastolic murmurs and atriosystolic murmurs of relative or absolute mitral or tricuspid stenosis are extremely rare. The most frequently heard abnormal transients in the dog are the ventricular diastolic gallop, the systolic click, and the presystolic atrial gallop. Splitting of the second heart sound is a fairly common finding in areas where heartworm heart disease is prevalent. Paradoxical splitting of S₂ is only occasionally observed. Résumé— —En surcoit des souffles physiologiques comme constatés en association à la fiévre et l'anémie, de nombreux souffles organiques résultant de lésions cardiaquessurvenant fréquemment chez le chien. Ceux-ci comprennent le souffle pansystolique régurgitant d'insuffisance mitrale et tricuspide et de défaut de la cloison interventriculaire, le souffle d'éjection systolique de retricissement aortique et pulmonaire et le souffle continuel patent du canal arteriosus. Le souffle arteriel diastolique de l'insuffisance aortique se présente moins fréquemment; celui de l'insuffisance pulmonaire survient encour moins souvent. Les souffles passifs atrioventriculaires diastoliques et les souffles atriosystoliques de retrecissement relatifs ou obsolus mitral ou tricuspide sont extrêmement rares. Les transitions anormalies les plus souvent survenues chez le chien sont le galop ventriculaire diastolique, le clic systolique, et le galop artériel presystolique. La séparation du son du second coeur et assez commune dans les régions ou les maladies cardiaques prévalent. La séparation paradoxale de S est occasionnellement observée. Zusammenfassung— —Ausser physiologischen Geraeuschen in Verbindung mit Fieber und Anaemic treten eine Anzahl von organischen Geraeuschen als Resultat von Herzstoerungen haeufig bei Hunden auf. Diese umfassen das pansystolische rueckfliessende Geraeusch der mitralen und trik-uspidalen Insuffizienz und des interventrikularen Septum-Defekts, das Ejektions-systolische Geraeusch der Aorten- und Pulmonal-Stenose und das Dauer-Geraeusch des offenen Duktus arteriosus. Das arterielle diastolische Geraeusch der Aorten-Insuffizienz tritt weniger haeufig auf, das der Pulmonal-Insuffizienz noch seltener. Die passiven atrioventrikulaeren diastolischen Geraeusche und atrio-systolischen Geraeusche der relativen oder absoluten mitralen oder trikuspidalen Stenose sind ausserordentlich selten. Die am haeufigsten gehoerten anormalen vorueber-gehenden Geraeusche beim Hund sind der ventrikulaere diastolische Galopp-Rhythmus, das systolische Einschnappen und der praesystolische atriale Galopp-Rhythmus. Spaltung des zweiten Herztones ist eine ziemlich haeufiger Befund in Gegenden, wo die Herzwurm-Krankheit haeufig ist. Paradoxe Spaltung des zweiten Tones wird nur gelegentlich beobachtet.     

Pulmonic stenosis in the dog: 29 cases (1975-1984)

In a retrospective study of 29 dogs with congenital pulmonic stenosis, we evaluated the clinical, radiographic, angiocardiographic, and cardiac catheterization data. Eighteen dogs had no clinical signs of disease and were referred for evaluation of a previously detected cardiac murmur, 5 dogs had congestive right-sided heart failure, and 5 dogs were examined for exercise intolerance or syncope. Dogs with heart failure tended to be older than dogs without clinical signs of heart failure (19.3 months vs 12 months). All dogs had radiographic or electrocardiographic evidence of right ventricular enlargement. Poststenotic dilatation of the main pulmonary artery and apparent pulmonary undercirculation were observed frequently on survey radiographs. Isolated pulmonic valve dysplasia, representing a range of angiographic pulmonic valve abnormalities, was evident in 88% of the available 26 angiographic studies, whereas subvalvular stenosis was uncommon and observed in only 2 dogs. Muscular hypertrophy of the right ventricular infundibulum and supraventricular crest were observed in 96% and 25% of the angiocardiograms, respectively. Poststenotic dilatation of the main pulmonary artery was observed in every dog. A ratio between the width of the main pulmonary artery and the valve annulus was useful in identifying pulmonic stenosis and distinguishing this anomaly from other congenital malformations. The degree of poststenotic dilatation did not appear to be related to the severity of the systolic pressure gradient, which ranged from 20 to 228 mm of Hg (mean, 93 mm of Hg).(ABSTRACT TRUNCATED AT 250 WORDS)     

Analysis of murmur intensity, duration and frequency components in dogs with aortic stenosis

A study was undertaken to investigate the relationship between murmur intensity, murmur duration, duration to peak intensity and frequency components with degree of aortic stenosis in boxers. Measurements were made from phonocardiograms obtained from 35 boxers with ejection-type murmurs, and values were compared with those obtained for aortic flow velocity measured by Doppler echocardiography. Murmur intensity graded by auscultation was significantly correlated with aortic flow velocity (P<0·001), and murmur duration, expressed as a percentage of systole, was significantly correlated with aortic flow velocity (P<0·001), independent of heart rate. Dogs with early systolic murmurs not exceeding 50 per cent of systole had aortic flow velocities of less than 1·5 m/second and no echocardiographic abnormalities, in contrast with dogs with murmurs of longer duration. Dogs with only high frequency components had lower aortic velocities than those that also had components in the medium frequency range (P<0·01).     

Time-frequency and complexity analyses for differentiation of physiologic murmurs from heart murmurs caused by aortic stenosis in Boxers

OBJECTIVE: To investigate whether time-frequency and complexity analyses of heart murmurs can be used to differentiate physiologic murmurs from murmurs caused by aortic stenosis (AS) in Boxers. ANIMALS: 27 Boxers with murmurs. PROCEDURES: Dogs were evaluated via auscultation and echocardiography. Analyses of time-frequency properties (TFPs; ie, maximal murmur frequency and duration of murmur frequency > 200 Hz) and correlation dimension (T(2)) of murmurs were performed on phonocardiographic sound data. Time-frequency property and T(2) analyses of low-intensity murmurs in 16 dogs without AS were performed at 7 weeks and 12 months of age. Additionally, TFP and T(2) analyses were performed on data obtained from 11 adult AS-affected dogs with murmurs. RESULTS: In dogs with low-intensity murmurs, TFP or T(2) values at 7 weeks and 12 months did not differ significantly. For differentiation of physiologic murmurs from murmurs caused by mild AS, duration of murmur frequency > 200 Hz was useful and the combination assessment of duration of frequency > 200 Hz and T(2) of the murmur had a sensitivity of 94% and a specificity of 82%. Maximal murmur frequency did not differentiate dogs with AS from those without AS. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that assessment of the duration of murmur frequency > 200 Hz can be used to distinguish physiologic heart murmurs from murmurs caused by mild AS in Boxers. Combination of this analysis with T(2) analysis may be a useful complementary method for diagnostic assessment of cardiovascular function in dogs.     

DOPPLER ECHOCARDIOGRAPHY IN THE NORMAL DOG: PART II

Doppler echocardiography was used to determine blood flow velocities in the normal canine heart. The areas examined were the mitral valve, left atrium, tricuspid valve, right atrium, aortic valve, left ventricular outflow tract, pulmonic valve and right ventricular outflow tract. This study then statistically evaluated the influence of breed, age, sex, heart rate, mass and various interactions of these factors on the cardiac flow values determined. Mass and heart rate had the most significant effect on the various determinations with decreasing mass and increasing heart rates generally resulting in increasing peak and mean velocities. The pulmonary artery was statistically judged as being the flow area most susceptible to such influences. Comparisons were made between pulsed and continuous wave Doppler for peak velocities over the four valve areas with only aortic flow, as measured from the left caudal view, showing a significant difference between the two techniques. Mitral flow as compared to tricuspid flow showed a statistically significant difference between peak late diastolic velocities only. The ratio of early mitral diastolic flow to late mitral diastolic flow was always greater than one. Pulmonary flow showed a number of statistically significant differences when compared to aortic flow.     

Echocardiography of the normal bovine heart: technique and ultrasonographic appearance

Fifty-one clinically healthy cows were examined ultrasonographically from the third and fourth intercostal spaces on both sides of the thorax. A 3.0 MHz transducer was used and the heart was examined in the caudal long, caudal short and cranial long axes on the right side, and in the caudal and cranial long axes on the left side. In each position the optimal transducer orientation and the images of the structures were recorded. In the caudal long axis view of the heart on the right (transducer positioned at the fourth intercostal space), all four chambers were visible with the transducer positioned 8 to 10 cm dorsal to the level of the olecranon. The left ventricular outflow tract, consisting of the aortic valve and ascending aorta, were visible in the same position with the transducer rotated 10 to 40 degrees clockwise. In the caudal short axis view of the heart on the right, the left and right ventricles were visible in cross-section with the transducer held at right angles to the ribs in the fourth intercostal space, 3 to 6 cm dorsal to the olecranon and tipped slightly dorsally. In the cranial long axis view of the heart on the right, the right ventricular outflow tract, consisting of the pulmonary valve and pulmonary artery, was visible in the third intercostal space, 8 to 10 cm dorsal to the olecranon with the transducer angled craniodorsally and rotated 10 to 20 degrees clockwise. In the caudal long axis view of the heart on the left, the left and right ventricles and the left ventricular outflow tract were visible with the transducer placed in the fourth intercostal space. In the cranial long axis view on the left, the right ventricular outflow tract was visible.     

A practitioner's approach to canine cardiology

This paper is intended to be a guide for the practitioner to the diagnosis, prognosis and treatment of heart disease in the dog. Diagnosis and treatment of heart disease is based on a thorough clinical examination specifically auscultation of the chest and examination of the pulse augmented by radiography and electrocardiography.Cardiology is an exciting subject and recent advances in therapy have improved not only the life expectancy of dogs with heart disease but also the quality of life. The most important factor is to recognize that the problem is cardiac in origin. The elderly animal with a cough and a heart murmur must be examined and investigated thoroughly before assuming that the murmur and cough are connected. Overall incidence of heart disease has been estimated at 11 · 3% with the congenital type accounting for 0 · 5% (Detweiler & Patterson, 1965).Congenital heart disease should be detected early in life, and certainly no later than at presentation of the puppy for primary vaccination, but will only be diagnosed if the puppy is thoroughly auscultated. The more common congenital cardiac defects, in approximate order of incidence, are patent ductus arteriosus, pulmonic stenosis, aortic stenosis, persistent right aortic arch, ventricular septal defect, tetralogy of Fallot and atrial septal defect (Patterson, 1965). Early diagnosis is important as, particularly with patent ductus, surgery performed at an early stage can be curative. Pulmonic stenosis can also be treated surgically and successful treatment of tetralogy of Fallot using cardiopulmonary bypass has been reported (Herrtage, Hall & English, 1983). Septal defects are also amenable to treatment by using cardiopulmonary bypass.Persistent right aortic arch will not cause a heart problem but vomiting will occur in the young dog. Chronic valvular fibrosis with mitral, followed by tricuspid, insufficiencies is the most usual acquired heart disease. It has been estimated that in dogs over eight years old 70% are likely to suffer from valvular heart disease but not necessarily showing clinical signs.     

Hereditary congenital heart defects in dogs

Congenital heart defects is probably the most common class of malformations found in dogs, occurring with a frequency approaching 1 per cent in animals presented to veterinary clinics. The frequency is significantly higher among purebred dogs than in dogs of mixed breeding and specific anatomic malformations occur with highest frequency in certain breeds. Genetic studies of patent ductus arteriosus, pulmonic stenosis, subaortic stenosis, ventricular septal defect, tetralogy of Fallot and persistent aortic arch have confirmed that these are specific heritable defects, the genes for which are concentrated in a number of different breeds. Each of these defects is inherited in a complex manner consistent with a polygenic basis. This paper will describe evidence supporting the view that the common forms of congenital heart disease in the dog are polygenic threshold traits. The general criteria for recognition of polygenic traits and methods for their control will be discussed.     

Evaluation of platelet function in dogs with cardiac disease using the PFA‐100 platelet function analyzer

Background: Cardiac disease has the potential to alter platelet function in dogs. Evaluation of platelet function using the PFA‐100 analyzer in dogs of multiple breeds and with a broad range of cardiac conditions would help clarify the effect of cardiac disease on platelets. Objectives: The objective of this study was to assess differences in closure time (CT) in dogs with cardiac disease associated with murmurs, when compared with that of healthy dogs. Methods: Thirty‐nine dogs with cardiac murmurs and turbulent blood flow as determined echocardiographically were included in the study. The dogs represented 23 different breeds. Dogs with murmurs were further divided into those with atrioventricular valvular insufficiency (n=23) and subaortic stenosis (n=9). Fifty‐eight clinically healthy dogs were used as controls. CTs were determined in duplicate on a PFA‐100 analyzer using collagen/ADP cartridges. Results: Compared with CTs in the control group (mean±SD, 57.6±5.9 seconds; median, 56.5 seconds; reference interval, 48.0–77.0 seconds), dogs with valvular insufficiency (mean±SD, 81.9±26.3 seconds; median, 78.0 seconds; range, 52.5–187 seconds), subaortic stenosis (71.4±16.5 seconds; median, 66.0 seconds; range, 51.5–95.0 seconds), and all dogs with murmurs combined (79.6±24.1 seconds; median, 74.0 seconds; range, 48.0–187 seconds) had significantly prolonged CTs (P<.01). Conclusions: The PFA‐100 analyzer is useful in detecting platelet function defects in dogs with cardiac murmurs, most notably those caused by mitral and/or tricuspid valvular insufficiency or subaortic stenosis. The form of turbulent blood flow does not appear to be an important factor in platelet hypofunction in these forms of cardiac disease.     

Assessment of survey radiography as a method for diagnosis of congenital cardiac disease in dogs.

In order to assess the diagnostic accuracy of survey radiography for canine congenital cardiac anomalies, thoracic radiographs of 57 dogs with congenital cardiac anomalies, 31 normal dogs and 27 dogs with acquired cardiac disease were mixed, and reviewed by two independent observers, who were blinded to any patient information. The congenital anomalies were aortic stenosis (n=25), pulmonic stenosis (n=10), patent ductus arteriosus (n=9), ventricular septal defect (n=8), tricuspid dysplasia (n=3) and mitral dysplasia (n=2). Both observers were moderately accurate at identifying dogs with cardiac disease. Their ability to distinguish dogs with congenital versus acquired cardiac disease was poorer and this assessment was probably influenced by the recognition of patients that were skeletally immature, which biased observers towards a diagnosis of congenital cardiac anomaly. The diagnosis rate for specific congenital anomalies was also poor (the differential list included a correct diagnosis in only 40 and 37 per cent of cases). Radiographic signs of specific cardiac chamber enlargement or pulmonary vascular abnormalities were recognised by both observers in only 20 per cent of instances in which they might be expected. They were, however, recognised more frequently in dogs with anomalies that imposed a volume load on the heart than in dogs with anomalies that induced a pressure load on the organ. It is concluded that survey radiography is an inaccurate method for diagnosis of canine congenital cardiac anomalies because of the difficulty of recognising radiographic signs, which are not present in many cases.     

Phonocardiography in the horse: 1. The intracardiac phonocardiogram.

Using microtransducers, the intracardiac phonocardiogram was recorded in 8 horses from the right heart and in 6 of them also on the left side. All 4 heart sounds were recorded but not in all sites. Their timing was related to pressure events. Systolic ejection murmurs were recorded in both the pulmonary artery and the aorta. Diastolic murmurs were recorded in 2 horses with aortic regurgitation, with maximum amplitude in the left ventricle. The findings were similar to those reported in man and agree with some of the recent concepts on heart sound production.     

Doppler echocardiographic study of left and right ventricular function during dobutamine stress testing in conscious healthy dogs.

OBJECTIVE: To evaluate left and right ventricular filling and ejection performances by use of Doppler echocardiography in healthy, conscious dogs submitted to dobutamine stress testing. ANIMALS: 10 unsedated, healthy adult Beagles. PROCEDURE: Doppler echocardiography was performed during cardiac stress testing on each dog twice at 24-hour intervals. Dobutamine was infused in 10 micrograms/kg of body weight/min incremental dosages, from 12.5 to 42.5 micrograms/kg/min. Duration of each step was 15 minutes. Doppler measurements were recorded at baseline and at each stage of dobutamine infusion, whereas aortic diameter was measured at baseline and at peak dosage by use of two-dimensional echocardiography. RESULTS: Dobutamine infusion induced a significant increase in velocity time integrals and in peak flow velocities at the aortic, pulmonic, mitral, and tricuspid valves. Acceleration time-to-deceleration time ratio at the aortic wave also was increased significantly. On the other hand, ejection time, acceleration time, and deceleration time at the aortic and pulmonic valves and peak flow velocity of the E wave-to-peak flow velocity of the A wave ratio at the mitral and tricuspid valves decreased significantly during the test. The acceleration time-to-deceleration time ratio at the pulmonic wave was unchanged. A significant, progressive increase in cardiac index also was observed during dobutamine infusion, with a maximal increase of 104% from baseline. This was mediated initially by an increase in stroke index and, at higher dosages, by an increase in heart rate. CONCLUSIONS AND CLINICAL RELEVANCE: Doppler echocardiography performed during dobutamine stress testing may be a reliable method of assessing myocardial function in dogs with cardiovascular disease.     

DIAGNOSIS OF COMMON CONGENITAL HEART ANOMALIES IN THE DOG USING SURVEY AND NONSELECTIVE CONTRAST RADIOGRAPHY

The most common canine congenital heart anomalies include patient ductus arteriosus, ventricular septal defects, tetralogy of Fallot, pulmonic stenosis, and aortic stenosis. Survey radiography and nonselective (venous) angiography can allow the practicing veterinarian to confirm the diagnosis in many of these patients. Typical radiographic findings using these diagnostic procedures are reviewed. Nonselective angiocardiography is a relatively easy, rapid, and noninvasive procedure which can be performed using conventional equipment. The major disadvantage of this special procedure is that the superimposition of opacified structures can make the identification of some left-to-right shunts difficult. Dilution of contrast medium can occur if a rapid bolus injection is not made.     

Outcome in 55 dogs with pulmonic stenosis that did not undergo balloon valvuloplasty or surgery

Objective : To determine the outcome, independent predictors of cardiac death, and the Doppler‐derived pressure gradient cut‐off for predicting cardiac death in dogs with pulmonic stenosis, with or without tricuspid regurgitation, that do not undergo balloon valvuloplasty or valve surgery. Methods : Review of medical records of two UK referral centres between July 1997 and October 2008 for all cases of pulmonic stenosis that had no balloon valvuloplasty or valve surgery. Inclusion criteria included a diagnosis of pulmonic stenosis; spectral Doppler pulmonic velocity greater than 1·6 m/s; characteristic valve leaflet morphological abnormalities. Exclusion criteria included concurrent significant cardiac defects, including tricuspid dysplasia. Dogs with tricuspid regurgitation were included. Dogs were classified according to Doppler‐derived pressure gradients into mild, moderate or severe pulmonic stenosis categories. Results : Presence of tricuspid regurgitation and severe stenosis were independent predictors of cardiac death. A pulmonic pressure gradient of more than 60 mmHg was associated with 86% sensitivity, and 71% specificity of predicting cardiac death. Clinical Significance : There is an increased probability of cardiac death in those cases which have a pulmonary pressure gradient greater than 60 mmHg and tricuspid regurgitation, though the effect of severity of tricuspid regurgitation on outcome was not measurable because of small sample sizes. These animals might benefit from intervention.     

TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF THE LEFT VENTRICULAR OUTFLOW TRACT, AORTIC VALVE AND ASCENDING AORTA IN BOXER DOGS WITH HEART MURMURS

The study was aimed at evaluating the anatomy of the left ventricular outflow tract, aortic valve, and ascending aorta by means of multiplane transesophageal echocardiography in Boxer dogs with left basilar heart murmurs and at comparing two-dimensional (2D) transthoracic to transesophageal echocardiography for the diagnosis of subaortic stenosis in this breed. Twenty-eight Boxers were included in the study and allocated to four groups according to physical and routine transthoracic 2D and Doppler echocardiography findings: group A--dogs with low grade (I-II/VI) heart murmurs without overt evidence of aortic stenosis (14 dogs); group B--dogs with type 1 subaortic stenosis (seven dogs); group C--dogs with type 2 subaortic stenosis (five dogs); group D--dogs with type 3 subaortic stenosis (two dogs). Anatomic lesions were not discovered by transesophageal echocardiography in dogs belonging to group A. Transesophageal imaging confirmed the type of subaortic stenosis, as graded by transthoracic echocardiography, in diseased animals (groups BCD). Morphologic information obtained by transesophageal echocardiography in Boxer dogs was similar to that obtained by transthoracic echocardiography.