Yoon Hakyoung, Kim Jaehwan, Nahm Sang-Soep, Eom Kidong
Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, 143-701, Republic of Korea.
Veterinary Medical Teaching Hospital, Konkuk University, Seoul, 143-701, Republic of Korea.
Acta Vet Scand. 2017 Jul 11;59(1):45. doi: 10.1186/s13028-017-0314-z.
Congenital pulmonary valve stenosis and patent ductus arteriosus are common congenital heart defects in dogs. However, concurrence of atypical pulmonary valve stenosis and patent ductus arteriosus is uncommon. This report describes the anatomic, histopathologic, and echocardiographic features in a dog with concomitant pulmonary valve stenosis and patent ductus arteriosus with atypical pulmonary valve dysplasia that included a fibrous band of tissue.
A 1.5-year-old intact female Chihuahua dog weighing 3.3 kg presented with a continuous grade VI cardiac murmur, poor exercise tolerance, and an intermittent cough. Echocardiography indicated pulmonary valve stenosis, a thickened dysplastic valve without annular hypoplasia, and a type IIA patent ductus arteriosus. The pulmonary valve was thick line-shaped in systole and dome-shaped towards the right ventricular outflow tract in diastole. The dog suffered a fatal cardiac arrest during an attempted balloon pulmonary valvuloplasty. Necropsy revealed pulmonary valve dysplasia, commissural fusion, and incomplete opening and closing of the pulmonary valve because of a fibrous band of tissue causing adhesion between the right ventricular outflow tract and the dysplastic intermediate cusp of the valve.
A fibrous band of tissue between the right ventricular outflow track and the pulmonary valve should be considered as a cause of pulmonary valve stenosis. Pulmonary valve stenosis and patent ductus arteriosus can have conflicting effects on diastolic and systolic dysfunction, respectively. Therefore, beta-blockers should always be used carefully, particularly in patients with a heart defect where there is concern about left ventricular systolic function.
先天性肺动脉瓣狭窄和动脉导管未闭是犬类常见的先天性心脏缺陷。然而,非典型肺动脉瓣狭窄与动脉导管未闭同时存在的情况并不常见。本报告描述了一只患有肺动脉瓣狭窄和动脉导管未闭且伴有非典型肺动脉瓣发育异常(包括一条纤维组织带)的犬的解剖学、组织病理学和超声心动图特征。
一只1.5岁、体重3.3千克的未绝育雌性吉娃娃犬,出现持续性六级心脏杂音、运动耐量差和间歇性咳嗽。超声心动图显示肺动脉瓣狭窄、瓣膜增厚且发育异常但无瓣环发育不全,以及IIA型动脉导管未闭。肺动脉瓣在收缩期呈粗线状,舒张期朝向右心室流出道呈圆顶状。这只犬在尝试进行球囊肺动脉瓣成形术时发生致命性心脏骤停。尸检发现肺动脉瓣发育异常、瓣叶融合,以及由于一条纤维组织带导致右心室流出道与发育异常的瓣膜中间瓣叶粘连,致使肺动脉瓣开闭不全。
右心室流出道与肺动脉瓣之间的纤维组织带应被视为肺动脉瓣狭窄的一个病因。肺动脉瓣狭窄和动脉导管未闭分别对舒张功能和收缩功能可能产生相互矛盾的影响。因此,应谨慎使用β受体阻滞剂,尤其是对于存在左心室收缩功能问题的心脏缺陷患者。