Mitral Valve Dysplasia

Re: Mitral Valve Dysplasia

Andre Escudeiro-Vieites — Fri, 02 Mar 2012 18:32:45 GMT

[quote user="Hannah Bose"]

[quote user="Andre Escudeiro-Vieites"]I don't have an ECG[/quote]

I would feel nervous not having one in the practice. Like soluble insulin.

[/quote]

OK!

I'll order some soluble insulin!!

Jokes apart. Any recomendation for cheap but good ECG kit to use in my brankd new first opinion practice?

I know what book to buy to go with it (thanks Mike)

By the way, with the fantastic support of this community, I think I am going to scan Roxanne again on Mon-like a pro- and get to the bottom of it.

I have been quite busy lately and hadn't been checking these forums so much... lovely to be back!!

Re: Mitral Valve Dysplasia

Andre Escudeiro-Vieites — Fri, 02 Mar 2012 18:20:49 GMT

www.vetsurgeon.org/.../2678.IMG_5F00_0125.MOV

This Video wasn't intended to be shown to anybody, as I was playing for the first time with the Doppler color and also with my new iPhone.

It is sort of a right paraesternal long axis view, probably between a 4 and a 5 chamber view.I froze it and was playing with it when I tried recording it.

In case it is of any help.

SAS?

Sorry, I don't know how to make the image more normal.Just found out It is stretched. That is a real challenge!

Re: Mitral Valve Dysplasia

HMC — Fri, 02 Mar 2012 14:14:33 GMT

[quote user="Andre Escudeiro-Vieites"]I don't have an ECG[/quote]

I would feel nervous not having one in the practice. Like soluble insulin.

Re: Mitral Valve Dysplasia

Mike Martin — Fri, 02 Mar 2012 10:40:25 GMT

I had a quick look through my database. Of the Rotties we have seen with congenital defects, the most common in order are:

SAS
PDA
Mitral dyaplasia
SAS + Mitral dysplasia
SAS + PDA

Also you can view examples of echo findings in the cardiology gallery, if that helps.

Best wishes

Re: Mitral Valve Dysplasia

Mike Martin — Fri, 02 Mar 2012 09:49:33 GMT

This is an interesting mix of findings and the 'jig-saw' pieces are not all fitting together. So in summary (I hope this might be of interest and value)....

Differentials for a left sided systolic murmur (in a puppy) + expected echo findings.....

Aortic (subaortic) stenosis - usually normal; rare mild-moderate LVH. Normal LA (unless concurrent MR)
Pulmonic stenosis - RVH +/- RA dilation when there is TR
Mitral dysplasia - Dilated LA + with dilation of LV too.
VSD - primary murmur is on right, but relative PS on left - LA dilation and some LV dilation
PDA - continuous murmur, but if stethoscope is not in the right place, only the louder systolic portion heard - LA dilation + LV dilation
Puppy (flow) murmur - usually < G3, but can be G4 or 5. Often loudness varies with HR and gradually disappears over a few months. Echo - normal.
Other congenital defects and combination defects - these are rare.

Sorry for the abbreviations, I'm sure you can work them out.

So from Andre's description, I would agree Mitral dysplasia fits best (but the LVH doesn't fit, there may be room for variations in interpretation of the echo I guess). The prognosis for M-Dys is poor I'm afraid. Ruling out a PDA on the basis of auscultation alone very much depends upon your level of experience and ability....! The echo features of M-Dys and PDA will be very similar. but with a PDA you should also see a dilated PA and if you have Doppler - the retrograde flow within the PA. A PDA can be fixed.

Re: Treatment - I would add an ACE inhibitor.

I would not add digoxin without an ECG diagnosis of AF.

Hope this helps....?

Re: Mitral Valve Dysplasia

Andre Escudeiro-Vieites — Fri, 02 Mar 2012 09:25:09 GMT

Thanks guys.

Shouldn't I be hearing a continous murmur,rather than a very clear systolic murmur with a PDA?

Re: Mitral Valve Dysplasia

james herriot lied — Thu, 01 Mar 2012 18:52:56 GMT

I'd equally be looking for PDA as a differential; additionally, do you have doppler, as many of the wall defects are small (although, with early failure I guess an FO would be pretty big)?

Re: Mitral Valve Dysplasia

David Mills — Thu, 01 Mar 2012 17:52:09 GMT

LV hypertrophy is rare in dogs as primary disorder and is almost always secondary to pressure excess due to outflow obstruction (Ao stenosis) or rarely some weird and wonderful things such as R-L shunting PDAs or VSDs but this normally requires pulmonary hypertension concurrenty or as a primary disorder (e.g. insufficient surfactant at birth); I would be surprised to see it in conjunction with MV dysplasia, though strange chord and papillary muscles are often abnormal. LV wall width in dogs can be a difficult thing to judge - hydration status can have a dramatic effect - are you using 2D or M-mode? And what sort of figures were you getting?

Are the ventricles dilated (FS/EF/LVDd or LVDs)? as this could cause mitral regurgitation. Myocarditis (viral - parvovirus) is a possibility. Otherwise PDA would be high on ddx (high grade murmur, L sided HF, female). Interesting one.