Modler Case Study 5: Subaortic Stenosis Case

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Case Study 5: Subaortic Stenosis Case

A 1-year-old French Bulldog was referred because of a heart murmur that was heard during routine
examination. The owner had not noticed any problems. Clinical examination revealed a 4/6 systolic murmur with a maximum over the left heart base. Mucous membranes were pink, capillary refill time 1.5 sec.
Pulse quality was a little bit weaker than normal.

No X-rays were performed because there was no clinical sign of pulmonary congestion.
Heart ultrasound showed moderate left ventricular concentric hypertrophy.

	Image 1

Image 1: There was some ring formation beneath the aortic valve with the most prominent portion originating from the interventricular septum.

	Image 2

	Image 3

Image 2 and 3: Colour Doppler showed a massive turbulence across the aortic valve and a mild aortic insufficiency (Image 2 apical, Image 3 Right Parasternal Long Axis).

	Image 4

Image 4: Right parastenal long axis view demonstrates color flow turbulence indicative of aortic insufficiency that accompanies subaortic stenosis.

	Image 5

	Image 6

	Video 1

	Video 2

Video 1 and 2: Videos of the right parasternal long axis view (Video 1) apical view (Video 2) demonstrate the mosaic color flow Doppler pattern indicating the turbulence in the region. The pressure gradient was estimated using spectral Doppler (Image 5 CW Spectral Doppler Suboptimal Angle > 15 Degrees Theta, Image 6 Optimal Angle < 15 Deg Theta). Maximal velocity was 5,92 m/s; which corresponds to a pressure
gradient of 140 mm Hg.

Hence, the diagnosis was high grade Subaortic Stenosis. Therapy was initiated using Atenolol at a starting dosage of 0,5 mg/kg bid and titrated weekly up to 1,5 mg/kg bid.

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