Case Studies In Small Animal

Cardiovascular Medicine

Case 26

Tiffany was diagnosed with mandibular micrognathia with resulting palatal defect from LmandC at the VMTH on her initial visit. Her owners were given the treatment options of orthodontic appliance or crown amputation with partial pulpectomy. The latter option was strongly advised and chosen by the owners. They returned several days later for the dental procedure. Transesophageal echocardiography was performed during the same anesthetic period.

Transesophageal Echocardiography

The transesophageal echocardiogram (TEE) shows more clearly the same abnormality seen on the transthoracic echocardiograms. There is a clear ridge of tissue between the right ventricle (RV) and the right ventricular outflow tract (RVOT) producing an obstruction to blood flow . The right atrium (RA) is severely enlarged. This frame is taken during diastole and also shows the presence of spontaneous contrast in the right atrium and flowing into the right ventricle. This is due to slow (sluggish) blood flow allowing red cells to aggregate. The spontaneous contrast disappeared in systole when the high velocity jet of tricuspid regurgitation stirred the red cells up again.

Color flow Doppler TEE

The color flow Doppler demonstrates turbulent flow from the right ventricle (RV) into the right atrium (RA) due to tricuspid regurgitation and into the right ventricular outflow tract (RVOT) due to the obstruction to blood flow. Continuous wave Doppler again documented the peak systolic velocity across the tricuspid valve to be approximately 5 meters/second (image not shown).

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