RE: Does this cat with PPDH also have pulmonary hypertension?

Sarah Keir — Mon, 06 Nov 2023 09:02:09 GMT

www.vetsurgeon.org/.../2605.R-parasternal-cranial-pulmonic-valve.mp4

RE: Does this cat with PPDH also have pulmonary hypertension?

Sarah Keir — Mon, 06 Nov 2023 09:01:41 GMT

www.vetsurgeon.org/.../R-parasternal-view.mp4

RE: Does this cat with PPDH also have pulmonary hypertension?

Sarah Keir — Mon, 06 Nov 2023 09:01:17 GMT

www.vetsurgeon.org/.../R-parasternal-cranial-pulmonic-valve.mp4

RE: Does this cat with PPDH also have pulmonary hypertension?

Sarah Keir — Mon, 06 Nov 2023 08:51:05 GMT

Hi Jo

Thank you for your detailed reply. I had tried to attach videos to the original post but they haven't appeared - I'll try again.

Maximal tricuspid regurgitation velocity was only 0.7m/s and there was no interventricular septal flattening. I was unsure if the false tendon in the RV might be contributing to the TR except the pulmonary artery is wider than the root of the aorta. I visualised the pulmonary artery as far as the bifurcation and no turbulence seen that would fit with a PDA.

I'm going to offer to rescan the cat after it is had surgery - perhaps a couple of weeks after then a few months.

Many Thanks

Sarah

RE: Does this cat with PPDH also have pulmonary hypertension?

Joanna Dukes-McEwan — Sun, 05 Nov 2023 16:35:01 GMT

Hi Sarah

Yes, cats do get pulmonary hypertension. Since you have anatomical changes suggesting a high probability of pulmonary hypertension, this would be compatible. Did you manage to get a tricuspid regurgitation velocity to provide a little more evidence? The only thing to be cautious of - if the abdominal contents are between the right chest wall and the heart on your right parasternal views, the right heart will be much more prominent than if in the near field on a standard echo. Was there any other evidence suggesting pressure load on the right ventricle, such as flattening of the interventricular septum?

Cats are more likely than dogs to develop pulmonary hypertension with shunting congenital heart disease (especially PDA) - even if not sufficient to reverse the shunt to an rPDA. This seems reactive - since if we close the PDA, the pulmonary hypertension resolves. In addition, reversible pulmonary hypertension associated with respiratory disease has also been reported.

As you know, congenital heart disease is common in cats with PPDH - but you seem to have searched and did not find any echocardiographic evidence of a congenital heart defect.

If the only defect in the cat is the PPDH, I guess it could be the cause of the pulmonary hypertension. If abdominal contents are reducing thoracic capacity and lung function, this could be a cause of the tachypnoea and the pulmonary hypertension. I guess you do not know until the surgery is done and the cat reassessed subsequently. There could be compression of the pulmonary vasculature, or perhaps the cat retained foetal type pulmonary vasculature - there is an experimental cat study I have attached a reference for, for human congenital diaphragmatic hernia (Major et al 1993).

Another differential or associated with pulmonary hypertension could be pulmonary thromboembolism.

Hope that helps a little

Best wishes

Prof Jo Dukes-McEwan

University of Liverpool Small Animal Teaching Hospital, head of the cardiology service.

Selected references:

Vezzosi, T., and K. E. Schober. "Doppler-derived echocardiographic evidence of pulmonary hypertension in cats with left-sided congestive heart failure." Journal of veterinary cardiology 23 (2019): 58-68.

Escalda, Joao, Siddharth Sudunagunta, and Hannah Hodgkiss-Geere. "Pulmonary hypertension in cats: causes and echocardiographic assessment." BSAVA Congress Proceedings 2020. BSAVA Library, 2020.

Baron Toaldo M, Guglielmini C, Diana A, Giunti M, Dondi F, Cipone M. Reversible pulmonary hypertension in a cat. Journal of Small Animal Practice. 2011 May;52(5):271-7.

Vezzosi T, Perrucci S, Parisi F, Morelli S, Maestrini M, Mennuni G, Traversa D, Poli A. Fatal pulmonary hypertension and right-sided congestive heart failure in a kitten infected with Aelurostrongylus abstrusus. Animals. 2020 Dec 1;10(12):2263.

Evola MG, Edmondson EF, Reichle JK, Biller DS, Mitchell CW, Valdés‐Martínez A. Radiographic and histopathologic characteristics of pulmonary fibrosis in nine cats. Veterinary Radiology & Ultrasound. 2014 Mar;55(2):133-40.

Dirven M, Szatmári V, van den Ingh T, Nijsse R. Reversible pulmonary hypertension associated with lungworm infection in a young cat. Journal of Veterinary Cardiology. 2012 Sep 1;14(3):465-74.

Major D, Cloutier R, Fournier L, Paradis D, Pichette J. A new method of treatment for pulmonary hypertension in congenital diaphragmatic hernia: experimental study in cats. Journal of pediatric surgery. 1993 Sep 1;28(9):1090-2.