Partial anomalous pulmonary venous connection in 2 Miniature Schnauzers

Use of cardiac gated computed tomography in the diagnosis of a rare congenital cardiovascular anomaly in an adult alpaca

A 5-year-old female alpaca was presented with respiratory distress and lethargy. Thoracic radiographs revealed a cranioventrally distributed alveolar pattern, caudodorsal bronchial pattern, cardiomegaly, increased soft tissue opaque content in the ventral thorax, and rounded soft tissue opaque structures craniodorsal to the carina. Cardiac gated CT demonstrated a patent ductus arteriosus, ventricular septal defect, complete left atrioventricular valve atresia, partial anomalous venous connections from the cranial pulmonary veins to the azygous and cranial vena cava, severe right-sided cardiomegaly, pleural and peritoneal fluid, and severe hepatic congestion. These findings were confirmed with necropsy.

Pulmonary Vein: Embryology, Anatomy, Function and Disease

Four pulmonary veins come from respective lung lobes drain oxygen-rich blood back to the left atrium. Failure of incorporation with the left atrium can lead to a condition, called Cor triatriatum sinister, that the left atrium is separated into two chambers by an abortive fibrous tissue. The venous system of lung and whole body communicate with each other in the earlier time and they will be disconnected in the following developmental process. Total or partial anomalous pulmonary venous connection refers to that there is/are some degree of the communication exists after birth, which can occur in different sites. In the veterinary field, retrospective studies and several case reports have been published to describe these rare congenital cardiovascular diseases in several species. More cases are need for better understanding their clinical manifestation, treatment options and outcomes.

Symptomatic partial anomalous pulmonary venous connection in a kitten

A 3-month-old intact female American Shorthair cat, with syncope and tachypnea, underwent cardiac examination which identified no heart murmur or gallop. Thoracic radiography disclosed mild generalized enlargement of the cardiac silhouette and a bronchial and interstitial pattern throughout the lungs. Echocardiography identified tubular structures near the left atrium. After agitated saline contrast imaging, persistent left cranial vena cava with unroofed coronary sinus was suspected. Computed tomography angiography showed the right cranial, right caudal and left caudal pulmonary veins draining into the coronary sinus and flowing into the right atrium. The left cranial pulmonary vein drained normally into the left atrium. Partial anomalous pulmonary venous connection (PAPVC) was diagnosed. The kitten was treated with diuretics but died of heart failure 2 months later. Permission for necropsy was not granted. This case represents symptomatic PAPVC in a kitten. Most pulmonary veins were connected abnormally with the coronary sinus. The prognosis was grave because of refractory heart failure.

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.

Total anomalous pulmonary venous connection in a mature dog

A 2-year 10-month, male neutered, crossbreed dog presented for evaluation of cyanosis and exercise intolerance. Doppler echocardiography revealed severe dilation of the right atrium and right ventricle with moderate pulmonary hypertension. Right-to-left shunting across a large ostium secundum atrial septal defect was confirmed by contrast echocardiography. Thoracic radiography revealed a vascular pattern together with cardiomegaly. Computed tomography angiography identified an anomalous pulmonary venous connection in which all pulmonary veins, apart from the right middle vein, coalesced into a single, large aneurysmal vein that then drained into the right atrium via the cranial vena cava. The distal opening of the right middle pulmonary vein could not be determined. A presumptive diagnosis of partial anomalous pulmonary venous connection was made. The dog was medically managed with sildenafil (1.5 mg/kg by mouth [PO] every 8 h) and remained clinically stable for 2 months before euthanasia due to worsening exercise intolerance. On postmortem examination, all pulmonary veins, including the right middle vein, were shown to communicate with a single, large central vein. This large vein then connected with the right atrium via the cranial vena cava, consistent with a total anomalous pulmonary venous connection. This case report describes a rare congenital abnormality which has not been previously reported in a mature dog.

Partial anomalous pulmonary venous connection in a dog

A 2-year-old male intact Belgian Malinois was presented for exercise intolerance. A grade III/VI left basilar systolic murmur was detected. Echocardiography revealed moderate right atrial and ventricular dilation and increased pulmonic outflow velocity. Thoracic radiographs showed right heart enlargement and a dilated caudal vena cava. In addition, on the left lateral projection, an enlarged aberrant right cranial pulmonary lobar vein was suspected to be diverging ventrally from the course of the right cranial lobar bronchus and inserting more ventrally than normal in the region of the right atrium. A left-to-right pulmonary vascular shunt was suspected, and the patient underwent further diagnostics under general anesthesia. An agitated saline study was positive, suggestive of a concurrent right to left shunt. A right heart catheterization was performed. Angiography was inconclusive. Oximetry testing revealed an increase in oxygen saturation within the right atrium at the level of the caudal cava supportive of a left-to-right shunt in this region. Computed tomography angiography revealed a large single pulmonary vein that anomalously entered into the caudolateral aspect of the right atrium (left-to-right shunt) and was suspicious for a small arteriovenous malformation between the right caudal pulmonary artery and the right pulmonary vein returning to the left atrium (right to left shunt). The patient was diagnosed with a partial anomalous pulmonary venous connection and a possible arteriovenous malformation.

Sequential segmental classification of feline congenital heart disease

Feline congenital heart disease is less commonly encountered in veterinary medicine than acquired feline heart diseases such as cardiomyopathy. Understanding the wide spectrum of congenital cardiovascular disease demands a familiarity with a variety of lesions, occurring both in isolation and in combination, along with an appreciation of complex nomenclature and variable classification schemes. This review begins with an overview of congenital heart disease in the cat, including proposed etiologies and prevalence, examination approaches, and principles of therapy. Specific congenital defects are presented and organized by a sequential segmental classification with respect to their morphologic lesions. Highlights of diagnosis, treatment options, and prognosis are offered. It is hoped that this review will provide a framework for approaching congenital heart disease in the cat, and more broadly in other animal species based on the sequential segmental approach, which represents an adaptation of the common methodology used in children and adults with congenital heart disease.

Partial anomalous pulmonary venous connection with suspected pulmonary hypertension in a cat

Partial anomalous pulmonary venous connection has previously been reported in the dog, but never in a cat. A 14-month-old Devon Rex cat was presented for echocardiography to evaluate a heart murmur noticed during a routine examination. The pertinent finding was right-sided cardiomegaly in the absence of an atrial septal defect or tricuspid regurgitation; pulmonary hypertension was suspected. A thoracic computed tomographic angiography study identified a partial anomalous pulmonary venous connection with the lobar veins of the left caudal, right middle, right caudal and accessory lung lobes draining into the caudal vena cava. The resultant volume overload is an easily overlooked differential diagnosis for right-sided cardiac enlargement. This is the first such report of this anomaly in a cat.