Image 1: The cranial and caudal mitral valve leaflets demonstrated mildly vegetative contour as seen in this apical view in the center 9 o`clock position.
Image 2: M-mode of left ventricle shows severe dilation with thinned septal and posterior walls.
Image 3: Moderate to severe mitral valve regurgitation shown on Continuous wave Doppler.
History
A 4-year-old Pit Bull mixed breed was presented for evaluation of coughing over a 2-3 week period. Tachycardia was present on physical examination. Survey radiographs showed generalized cardiomegaly and possible pulmonary edema. Blood work and heartworm testing were both normal.
The cranial and caudal mitral valve leaflets demonstrated mildly vegetative contour. End point to septal separation (EPSS) was excessive consistent with dilated cardiomyopathy. The left ventricle demonstrated mildly excessive volume, and normal to subnormal septal and free wall diastolic thicknesses. Ventricular function was deemed subnormal expressed by the fractional shortening. Significant tricuspid valve insufficiency was noted. This is consistent with pulmonary hypertension.
Sonographic Differential Diagnosis
Dilated cardiomyopathy with concurrent pulmonary hypertension and both right and left sided congestive heart failure. Mitral insufficiency velocity was 4.2 m/sec. This patient is at risk for sudden death. Taurine level and electrocardiogram would be warranted. Immediate therapy with Lasix at 2-3 mg/kg b.i.d. would be recommended. Ace inhibitor therapy at 0.5 mg/kg s.i.d. progressing to b.i.d. over the next 5-7 days would be recommended as long as renal values remain normal. Pimobendan would be indicated immediately at 0.25 mg/kg b.i.d. Recheck echocardiogram in 3-4 weeks. Potential Sildenafil therapy may be necessary.
Sampling
None
DX
Dilated cardiomyopathy, pulmonary hypertension, right and left sided heart failure
Outcome
The patient was doing well at last communication.
Videos
Video 1: The left ventricle demonstrated mildly excessive volume, and normal to subnormal septal and free wall diastolic thicknesses.
Video 2: Color doppler of the mitral valve.
Video 3: The cranial and caudal mitral valve leaflets demonstrated mildly vegetative contour.
