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Dynamic left ventricular outflow tract obstruction secondary to hypovolemia in a German Shepard dog with splenic hemangiosarcoma.

Aoki T, Sunahara H, Sugimoto K, Ito T, Kanai E, Neo S, Fujii Y, Wakao Y - J. Vet. Med. Sci. (2015)

Bottom Line: A Levine II/VI systolic murmur was present at the heart base.Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus.The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Veterinary Surgery I, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201, Japan.

ABSTRACT
Dynamic left ventricular outflow tract obstruction (DLVOTO) is a common condition in cats and humans. In this case report, a dog is described with DLVOTO secondary to severe intra-abdominal hemorrhage caused by a hemangiosarcoma. The dog was a 9-year-old, 35.7-kg, spayed female German Shepard dog that presented with a history of tachypnea and collapse. A Levine II/VI systolic murmur was present at the heart base. Abdominal ultrasonography revealed a splenic mass and a large amount of ascites. Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus. The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion.

No MeSH data available.


Related in: MedlinePlus

Echocardiogram A) At the first presentation (Day 0): Systolic anterior motion of themitral valve apparatus was observed on the right parasternal left ventricular long axisview (dotted arrow, top). The aortic flow was increased (3.38 m/sec) with a scimitarshape; however, the image quality was not sufficient, because echocardiography wasperformed emergently (bottom). B) Day 9: SAM of the mitral valve apparatus has resolved(top). C) Day 667: Septal leaflet and/or chordae tendineae appear close to the leftventricular outflow tract in systole (arrow, top). The aortic flow was 0.92 m/sec with anormal profile (bottom).
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fig_001: Echocardiogram A) At the first presentation (Day 0): Systolic anterior motion of themitral valve apparatus was observed on the right parasternal left ventricular long axisview (dotted arrow, top). The aortic flow was increased (3.38 m/sec) with a scimitarshape; however, the image quality was not sufficient, because echocardiography wasperformed emergently (bottom). B) Day 9: SAM of the mitral valve apparatus has resolved(top). C) Day 667: Septal leaflet and/or chordae tendineae appear close to the leftventricular outflow tract in systole (arrow, top). The aortic flow was 0.92 m/sec with anormal profile (bottom).

Mentions: On physical examination, the body temperature was 37.7°C, the heart rate was 174 bpm, and therespiration rate was increased (42 /min) and labored. Femoral pulses were detectable, andcapillary refill time was within 1 sec. The systolic blood pressure was measured using aDoppler ultrasound device and was 110 mmHg. Auscultation revealed a systolic murmur with thepunctum maximum over the left heart base (Levine II/VI), which had not been detectedpreviously. Abdominal ultrasonography revealed a splenic mass with an 8-cm diameter and alarge amount of ascites. The ascites properties were not examined at our hospital, because thereferring veterinarian had highly suspected hemorrhage from splenic rupture after performingabdominal fluid analysis. Hematology results revealed a red cell count of 599.0 ×104 cells/µl (reference range: 550.0–850.0 × 104cells/µl); a packed cell volume (PCV) of 41.3% (reference range:37.0–55.0%); a hemoglobin concentration of 13.8 g/dl (reference range:12.0–18.0 g/dl); a mean corpuscular volume of 68.9 fl(reference range: 66–77 fl); and a mean corpuscular hemoglobinconcentration of 33.4 g/dl (reference range: 32.0–36.0g/dl). In addition to these normal values, leukogram was consistent with amature neutrophilia (segmented neutrophil of 27,342 cells/µl, referencerange: 3,000–11,500 cells/µl; lymphocyte of 743 cells/dl,reference range: 1,000–4,800 cells/dl; and monocyte of 1,635cells/µl, reference range: 150–1,350 cells/µl).Biochemical examination revealed a mild azotemia (blood urea nitrogen: 33.4mg/dl, reference range: 9.2–29.9 mg/dl) and a mildhypoproteinemia (total protein: 5.0 g/dl, reference range: 5.1–7.7g/dl). Blood coagulation tests involving fibrin degradation products didnot show any significant abnormalities apart from an elevation of C-reactive protein (2.95mg/dl, reference range: <1.0 mg/dl). Thoracicradiography revealed a reduced heart size (vertebral heart score 9.1 vertebrae [v], referencerange: 9.7 ± 0.5 v [2]) and a narrowed caudal vena cava.Echocardiography showed a reduced normalized left ventricular end-diastolic diameter(LVDd-index) at 0.86, reference range: 1.27–1.85 [5]; areduced normalized end-systolic left ventricular diameter (LVDs-index) at 0.55, referencerange: 0.71–1.26 [5]; and an increased end-diastolicleft ventricular free wall thickness [LVFd] at 1.38 cm, reference range: 0.66–1.36 cm [5]. The LA/Ao ratio was 1.27. The aortic velocity was 3.38m/sec with a scimitar-shaped profile caused by the systolic anterior motion (SAM) of themitral valve apparatus; however, because this examination was performed emergently, the imagequality was not sufficient (Fig. 1AFig. 1.


Dynamic left ventricular outflow tract obstruction secondary to hypovolemia in a German Shepard dog with splenic hemangiosarcoma.

Aoki T, Sunahara H, Sugimoto K, Ito T, Kanai E, Neo S, Fujii Y, Wakao Y - J. Vet. Med. Sci. (2015)

Echocardiogram A) At the first presentation (Day 0): Systolic anterior motion of themitral valve apparatus was observed on the right parasternal left ventricular long axisview (dotted arrow, top). The aortic flow was increased (3.38 m/sec) with a scimitarshape; however, the image quality was not sufficient, because echocardiography wasperformed emergently (bottom). B) Day 9: SAM of the mitral valve apparatus has resolved(top). C) Day 667: Septal leaflet and/or chordae tendineae appear close to the leftventricular outflow tract in systole (arrow, top). The aortic flow was 0.92 m/sec with anormal profile (bottom).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591166&req=5

fig_001: Echocardiogram A) At the first presentation (Day 0): Systolic anterior motion of themitral valve apparatus was observed on the right parasternal left ventricular long axisview (dotted arrow, top). The aortic flow was increased (3.38 m/sec) with a scimitarshape; however, the image quality was not sufficient, because echocardiography wasperformed emergently (bottom). B) Day 9: SAM of the mitral valve apparatus has resolved(top). C) Day 667: Septal leaflet and/or chordae tendineae appear close to the leftventricular outflow tract in systole (arrow, top). The aortic flow was 0.92 m/sec with anormal profile (bottom).
Mentions: On physical examination, the body temperature was 37.7°C, the heart rate was 174 bpm, and therespiration rate was increased (42 /min) and labored. Femoral pulses were detectable, andcapillary refill time was within 1 sec. The systolic blood pressure was measured using aDoppler ultrasound device and was 110 mmHg. Auscultation revealed a systolic murmur with thepunctum maximum over the left heart base (Levine II/VI), which had not been detectedpreviously. Abdominal ultrasonography revealed a splenic mass with an 8-cm diameter and alarge amount of ascites. The ascites properties were not examined at our hospital, because thereferring veterinarian had highly suspected hemorrhage from splenic rupture after performingabdominal fluid analysis. Hematology results revealed a red cell count of 599.0 ×104 cells/µl (reference range: 550.0–850.0 × 104cells/µl); a packed cell volume (PCV) of 41.3% (reference range:37.0–55.0%); a hemoglobin concentration of 13.8 g/dl (reference range:12.0–18.0 g/dl); a mean corpuscular volume of 68.9 fl(reference range: 66–77 fl); and a mean corpuscular hemoglobinconcentration of 33.4 g/dl (reference range: 32.0–36.0g/dl). In addition to these normal values, leukogram was consistent with amature neutrophilia (segmented neutrophil of 27,342 cells/µl, referencerange: 3,000–11,500 cells/µl; lymphocyte of 743 cells/dl,reference range: 1,000–4,800 cells/dl; and monocyte of 1,635cells/µl, reference range: 150–1,350 cells/µl).Biochemical examination revealed a mild azotemia (blood urea nitrogen: 33.4mg/dl, reference range: 9.2–29.9 mg/dl) and a mildhypoproteinemia (total protein: 5.0 g/dl, reference range: 5.1–7.7g/dl). Blood coagulation tests involving fibrin degradation products didnot show any significant abnormalities apart from an elevation of C-reactive protein (2.95mg/dl, reference range: <1.0 mg/dl). Thoracicradiography revealed a reduced heart size (vertebral heart score 9.1 vertebrae [v], referencerange: 9.7 ± 0.5 v [2]) and a narrowed caudal vena cava.Echocardiography showed a reduced normalized left ventricular end-diastolic diameter(LVDd-index) at 0.86, reference range: 1.27–1.85 [5]; areduced normalized end-systolic left ventricular diameter (LVDs-index) at 0.55, referencerange: 0.71–1.26 [5]; and an increased end-diastolicleft ventricular free wall thickness [LVFd] at 1.38 cm, reference range: 0.66–1.36 cm [5]. The LA/Ao ratio was 1.27. The aortic velocity was 3.38m/sec with a scimitar-shaped profile caused by the systolic anterior motion (SAM) of themitral valve apparatus; however, because this examination was performed emergently, the imagequality was not sufficient (Fig. 1AFig. 1.

Bottom Line: A Levine II/VI systolic murmur was present at the heart base.Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus.The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Veterinary Surgery I, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201, Japan.

ABSTRACT
Dynamic left ventricular outflow tract obstruction (DLVOTO) is a common condition in cats and humans. In this case report, a dog is described with DLVOTO secondary to severe intra-abdominal hemorrhage caused by a hemangiosarcoma. The dog was a 9-year-old, 35.7-kg, spayed female German Shepard dog that presented with a history of tachypnea and collapse. A Levine II/VI systolic murmur was present at the heart base. Abdominal ultrasonography revealed a splenic mass and a large amount of ascites. Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus. The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion.

No MeSH data available.


Related in: MedlinePlus