Image 2: Video of color flow turbulence over the tricuspid valve with complete color filling of the right atrium.

Image 4: ECG: Sinus rhythm 120/min, right axis deviation.

Image 5: Right parasternal 4-chamber long axis ultrasound: Elongated and dysplastic tricuspid valve leaflets are evident. Color flow Doppler evidences significant regurgitation and turbulence.

Images 6 & 7: Right parasternal view of the pulmonary valve demonstrating valvular doming. Pressure gradient across the pulmonary valve was 67 mm Hg, indicating moderate pulmonic stenosis.

Image 8: Apical 4-chamber view revealing a “tethered” septal tricuspid leaflet.

Images 9-12: Apical 4 chamber and 5 chamber views. Hypertrophic right ventricle, dilated right atrium, dysplastic tricuspid valve (Ebstein anomaly) are all visible in these views. Severe tricuspid insufficiency is noted on color flow Doppler. This patient has Ebstein Anomaly which is defined as: a heart defect in which the tricuspid valve is abnormally formed and placed lower than normal in the right ventricle. The tricuspid valve normally has three “flaps” or leaflets. In Ebstein’s anomaly, one or two of the three leaflets are stuck to the wall of the heart and do not move normally. The valve is lower than normal in the right ventricle. Often there’s also a hole (atrial septal defect) in the wall between the heart’s two upper chambers (not present in this patient).

Images 13-15: Short axis view of the tricuspid valve and elongated leaflets with eccentric right ventricular hypertrophy. Color flow Doppler demonstrates the degree of tricuspid insufficiency.

Image 16: Spectral CW Doppler placed over the color flow tirbulence over the tricuspid valve jet reveals a tricuspid insufficiency velocity of 4.5 m/sec.

The dog is scheduled to undergo balloon valvuloplasty for the pulmonic stenosis in the hopes of reducing the pressure gradient to a manageable level long term.