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Case 38
- Ostium secundum atrial septal defect (large)
 | Brie, a 15 month old female standard poodle, presented
to the UC Davis Cardiology Service for evaluation
of a heart murmur. |
| Physical examination: HR 88bpm, regular rhythm, grade
I-II/VI left basilar systolic murmur, split S2, femoral pulses strong and
synchronous. Eupneic, normal bronchovesicular
sounds all lung fields. |
| Radiographs: Enlarged right heart with an enlarged
main pulmonary artery. Pulmonary arteries and veins are prominent. |
| Echocardiogram: Objective findings: IVSd
1.0 cm, EDD 3.1 cm,
LVPWd 0.9 cm, IVSs 1.5 cm, ESD 2.4,
LVPWs 1.1 cm, LA:AO 2.6/2.2 = 1.2,
FS 25%, Aortic velocity 0.97 m/s, pulmonic velocity 1.54 m/s.
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| Subjective findings: Large
atrial septal defect in the upper interatrial septum and left-to-right
shunting throughout diastole and most of systole
readily visible on color and spectral Doppler.
Moderate to severe right ventricular eccentric
(volume overload) hypertrophy.
Trivial to mild mitral valve insufficiency. Trivial tricuspid valve
insufficiency. Trivial pulmonic insufficiency. A contrast echocardiogram
identified a broad negative contrast region in the right atrium associated
with left to right shunting at the atrial level and
rare microbubbles identified in the left atrium. |
| Echocardiographic shunt quantification: Pulmonic valve
imaged from the right parasternal short axis view: pulmonic radius 1.13cm,
VTI 24cm, HR 88bpm producing Qp of 8.5 L/min.
Aortic valve imaged from the right parasternal short axis view: aortic
radius 1.04cm, aortic flow assessed from the left apical
four-chamber view with VTI 13.1cm, HR 99bpm producing Qs of
3.9 L/min. Qp:Qs = 2.2.
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| ECG: HR 72bpm, normal sinus rhythm,
MEA - 120degrees, deep S waves in leads II,
III and aVF (but lead I has deep Q rather than S waves), increased QRS
duration 0.08sec. aberrant conduction consistent with right bundle branch
block. |
| Conclusion: Large ostium
secundum atrial septal defect (ASD) of
mild-moderate size. Correction of this ASD either via surgery or
via a transvascular device implantation
may be considered. |
- Brie is a 15 month old intact female standard poodle
who presented to the cardiology service for an exaggerated response to
preanesthetic drugs. Your veterinarian diagnosed Brie with an atrial septal
defect.
- On physical exam we found a soft murmur consistent
with the above mentioned diagnosis. On echocardiogram we confirmed the
presence of a mild to moderate-sized atrial septal defect.
- Dogs with small atrial septal defects live normal
lives without any problems. Large atrial septal defects
may result in right heart failure (abdominal fluid accumulation).
Brie's defect is relatively large
and may warrant the risk involved with surgical
correction or transvascular occlusion.
- Recent studies on a family of Standard Poodles in
Texas with ASDs have suggested an autosomal dominant mechanism of
inheritance. If true, this would mean that at least one of Brie's parents
also may have an ASD and that half of her
offspring could also have ASDs. Please contact us if you are interested in
screening her family members.
- Thank you bringing Brie to the UC Davis Cardiology
Service.
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