Difference between revisions of "Tricuspid Valve Dysplasia"

Latest revision as of 17:34, 17 October 2013

Introduction

The condition should be described as a congenital malformation of the tricuspid valve (right atrioventricular valve) and its supporting structures (chordae tendineae, papillary muscles, valvular leaflets) resulting in tricuspid stenosis (narrowing) or regurgitation (insufficiency). Tricuspid valve dysplasia leads to increased volume load on the right atrium and ventricle towards the end of diastole. A stenotic tricuspid valve can limit ventricular filling during diastole and increased pressure as a result of increased volume can cause right-sided congestive heart failure.

Signalment

This is a condition which is common in dogs and cats, quite common in horses and rare in large animals. Predisposed breeds of dog include the Labrador Retrievers, German Shepherds, Boxers and Great Danes. It is the second most common congenital abnormality seen in cats.

Clinical Signs

Often presence of a murmur on physical exam is the only clinical sign. Other clinical signs vary depending on the severity of the disease but will include exercise intolerance, dyspnea, weight loss, poor appetite and abdominal distension.

Diagnosis

Physical examination findings will reveal a right-sided soft systolic murmur (tricuspid regurgitation), a right-sided diastolic murmur and jugular pulses and distension in severe cases. Femoral pulses are usually normal to weak and there may be signs of right-sided congestive heart failure in severe cases.

Radiographic findings may include right atrial and right ventricular enlargement, caudal vena cava enlargement, pulmonary underperfusion and signs of right sided heart failure.

Echocardiographic findings include right ventricular and atrial dilation and abnormalities of the tricuspid valve. Doppler shows tricuspid regurgitation and/or stenosis.

Electrocardiographic (ECG) study can show classic signs of right atrial and ventricular enlargement, atrial arrhythmias as well as ventricular conduction problems.

Treatment

Treatment is usually palliative. Signs of right sided congestive heart failure can be controlled pharmacologically, as can arrhythmias. Thoracocentesis should be performed when needed to relieve pleural effusion. Abdominocentesis when needed to relieve peritoneal effusion.

Prognosis

Mild to moderate cases can lead a normal life. Severe cases have a poor prognosis, however, if heart failure is controlled these patients can live several years.

References

Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition), W.B. Saunders Company

Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2), W.B. Saunders Company

Fossum, T. W. et. al. (2007) Small Animal Surgery (Third Edition), Mosby Elsevier

Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition), Merial

Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition), Mosby Elsevier.

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-{{review}}
+{{OpenPagesTop}}
+== Introduction ==
-{{dog}}{{cat}}{{horse}}
+The condition should be described as a congenital malformation of the tricuspid valve (right atrioventricular valve) and its supporting structures (chordae tendineae, papillary muscles, valvular leaflets) resulting in tricuspid stenosis (narrowing) or regurgitation (insufficiency). Tricuspid valve dysplasia leads to increased volume load on the right atrium and ventricle towards the end of diastole. A stenotic tricuspid valve can limit ventricular filling during diastole and increased pressure as a result of increased volume can cause [[Heart Failure, Right-Sided|right-sided congestive heart failure]].
-*Common in dogs & cats
-*Rare in large animals
+==Signalment==
-*Horses do get tricuspid atresia
+This is a condition which is common in dogs and cats, quite common in horses and rare in large animals. Predisposed breeds of dog include the Labrador Retrievers, German Shepherds, Boxers and Great Danes. It is the second most common congenital abnormality seen in cats.
-===Signalment===
-Genetics & Predisposed Breeds: Labrador Retrievers, German Shepherds, Boxers, Great Danes
+== Clinical Signs ==
-===Description===
+Often presence of a [[Heart Murmurs|murmur]] on physical exam is the only clinical sign. Other clinical signs vary depending on the severity of the disease but will include exercise intolerance, dyspnea, weight loss, poor appetite and abdominal distension.
-*Congenital malformation of the tricuspid valve (right atrioventricular valve) and its supporting structures (chordae tendineae, papillary muscles, valvular leaflets) results in tricuspid stenosis (narrowing) or regurgitation (insufficiency)
+== Diagnosis ==
-*Tricuspid valve dysplasia leads to increased volume load on the right atrium and ventricle towards the end of diastole.
+Physical examination findings will reveal a right-sided soft systolic murmur (tricuspid regurgitation), a right-sided diastolic murmur and jugular pulses and distension in severe cases. Femoral pulses are usually normal to weak and there may be signs of right-sided congestive heart failure in severe cases.
-*A stenotic tricuspid valve can limit ventricular filling during diastole.
+Radiographic findings may include right atrial and right ventricular enlargement, caudal vena cava enlargement, pulmonary underperfusion and signs of right sided heart failure.
-*Increased pressure as a result of increased volume can cause right-sided congestive heart failure.
+Echocardiographic findings include right ventricular and atrial dilation and abnormalities of the tricuspid valve. Doppler shows tricuspid regurgitation and/or stenosis.
-===Diagnosis===
+Electrocardiographic (ECG) study can show classic signs of right atrial and ventricular enlargement, atrial arrhythmias as well as ventricular conduction problems.
-====History & Clinical Signs====
--Exercise intolerance
--Dyspnea
+== Treatment ==
--Weight Loss
+Treatment is usually palliative. Signs of right sided congestive heart failure can be controlled pharmacologically, as can [[:Category:Arrhythmia|arrhythmias]]. Thoracocentesis should be performed when needed to relieve pleural effusion. Abdominocentesis when needed to relieve peritoneal effusion.
--Poor appetite
--Abdominal distension
+== Prognosis ==
-====Physical Exam====
+Mild to moderate cases can lead a normal life. Severe cases have a poor prognosis, however, if heart failure is controlled these patients can live several years.
--Right-sided soft systolic murmur (tricuspid regurgitation)
--Right-sided diastolic murmur
+== References ==
--Jugular pulses & distension (severe case)
+Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition), W.B. Saunders Company
--Femoral pulses are normal to weak
+Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2), W.B. Saunders Company
--Signs of right-sided congestive heart failure (severe case)
+Fossum, T. W. et. al. (2007) Small Animal Surgery (Third Edition), Mosby Elsevier
-====Radiographic Findings====
+Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition), Merial
--Right atrial and right ventricular enlargement
+Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition), Mosby Elsevier.
--Caudal vena cava enlargement
--Pulmonary underperfusion
+{{review}}
--Signs of right sided heart failure
-====Echocardiographic Findings====
--Right ventricular and atrial dilation
--Abnormalities of tricuspid valve
-Doppler shows tricuspid regurgitation and/or stenosis
-====Electrocardiographic (ECG)====
--Classic signs of right atrial and ventricular enlargement
--Atrial arrhythmias
--Ventricular conduction problems
-===Treatment===
-Palliative Treatment
--Pharmacologically control right sided congestive heart failure
--Pharmacologically control arrhythmias
--Thoracentesis when needed to relieve pleural effusion
--Abdominocentesis when needed to relieve peritoneal effusion
-===Prognosis===
-'''Mild/Moderate Cases'''
--Normal life
-'''Severe Cases'''
--Poor (However, if heart failure is controlled these patients can live several years.)
-==From Pathology==
-Tricuspid regurgitation results in volume overload of the right atrium and may progress to right heart failure.<br>
-'''''Ebstein's Anomaly:''''' Atrioventricular ring is displaced ventrally into the right ventricle so that part of the wall of the right atrium is made up of ventricular wall.
-''Incidence:''
-*Second most common congenital anomaly seen in cats.
-*Also reported in large breeds of dog including Weimeraner.
-''Clinical Signs:''
-*Often the murmur is the only clinical sign; low grade and pansystolic with increased intensity over the tricuspid area.
-*May also see right sided failure, signs include; ascites, hepatomegaly and splenomegaly.
-''Diagnosis:''
+{{OpenPages}}
-*Right ventricular enlargement on radiology and ECG.
-[[Category:Cardiovascular_System_-_Developmental_Pathology]]
+[[Category:Cardiovascular_System_-_Developmental_Pathology]] [[Category:Expert_Review]] [[Category:Cardiac_Diseases_-_Dog]] [[Category:Cardiac_Diseases_-_Cat]] [[Category:Cardiac_Diseases_-_Horse]]
+[[Category:Cardiology Section]]