Management:
A cardiac ultrasound examination confirmed severe pulmonic stenosis. The velocity (speed) of pulmonic blood flow reflects the pressure gradient between the right ventricle and main pulmonary artery, which in turn reflects the severity of stenosis. The peak pulmonic velocity was 5.2 m/s. Anything greater than 5.0 m/s is considered severe. Severe pulmonic stenosis may result in syncope, sudden death, and right-sided congestive heart failure. Therefore, intervention is generally recommended for severe cases. Balloon valvuloplasty is usually the interventional procedure of choice (Read about the treatment of pulmonic stenosis). In addition, any affected dog, regardless of severity, should not be used for breeding.
Balloon valvuloplasty was performed four months after initial presentation.
See images from Carly's surgery
Angiocardiogram
Balloon one
Balloon two
The procedure reduced the peak pulmonic velocity to 3.0 m/s, successfully reducing the severity of disease to mild stenosis. Carly recovered well from the procedure and went home with her owners the following day.
Prognosis:
Severe pulmonic stenosis, left uncorrected, may result in syncope, sudden death, or right-sided congestive heart failure early in life. Mild pulmonic stenosis, on the other hand, is tolerated very well and generally does not impact negatively on quality or length of life. It remains to be seen whether dogs with severe stenosis that is corrected to mild stenosis have the same excellent prognosis as dogs with mild stenosis from the beginning. It is believed, however, that reducing the severity of stenosis will result in prevention or correction of clinical signs and prevention of sudden death or congestive heart failure. Accordingly, her prognosis is expected to be very good as long as the stenosis remains mild. Periodic re-evaluations will be performed to follow her progress over time |
