Modler Case Study 4: PS Severe

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Case Study 4: Pulmonic Stenosis Severe

Signalment: 6 month old Doli Apso dog.

Presented because: High intensity heart murmur was heard by the referring Vet during routine examination. The owners had not noticed any symptoms.

Clinical examination: Grade 6/6 heart murmur with a maximum over the left heart base, radiating to the right thoracic wall.

	Image 1

	Image 2

	Video 1

Image 1, Video 1, Image 2: 2.D Echocardiography: Marked concentric hyperthrophy of the right ventricle, moderate enlargement of the right atrium. Pulmonic valve showing typical systolic doming. Valve leaflets do not open properly. Poststenotic dilatation.

	Image 3

Image 3: Colour Flow Doppler: An aera of systolic high grade turbulence beginning within the right ventricular outflow tract slightly below the level of the pulmonic valve and reaching into the pulmonic artery. Moderate pulmonic insufficiency.

	Image 4

Image 4: Spectral Doppler: High velocity profile (7,31 m/s) with a late systolic peak and a velocity curve concave to the left indicating some amount of dynamic stenosis (subvalvular) contributing to a high grade pulmonary valve stenosis.

Diagnosis: Severe pulmonic stenosis (Pressure gradient 213,7 mm Hg) with some dynamic component.

Therapy: There was no atrial septal defect detectable, so we recommended balloon valvuloplasty even though the right atrium was already moderately enlarged

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