PULMONIC STENOSIS

1
PULMONIC STENOSIS
2
What types of pulmonic stenosis (PS) occur in the
dog?

• Supravalvular,
• Valvular,
• Subvalvular,
• Infundibular

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Which type is most common?

• Valvular stenosis

4
Which types may occur secondarily?

• Valvular stenosis may lead to infundibular
  hypertrophy and subvalvular stenosis

5
Review the pathophysiology of PS.

• Pressure overload and hypertrophy of right
  ventricle
• Hypertrophy narrows pulmonary outflow tract,
  increasing outflow obstruction
• Narrowing of outflow tract is greater during
  systole, causing dynamic obstruction
• Post stenotic dilation of pulomonary artery (jet
  lesion) is a result of turbulence
• Tricuspid insufficiency may occur
• Right heart failure leads to ascites and
  hepatomegaly

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What is the outcome of severe untreated PS what
type of cardiac failure will ensue?

• Right heart failure leads to ascites and
  hepatomegaly

7
Explain dynamic PS.
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What breeds of dogs have increased incidence of
PS?

• Beagle, mini schnauzer, bulldog, Samoyed, cocker,
  boxer, mastiff, terriers

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What is the incidence in cats?

• Rare

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What are the common clinical signs?

• Exercise intolerance
• Syncope
• Right sided CHF

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Describe the expected murmur, ECG findings, and
radiographic findings.

• Murmur systolic ejection (crescendo-decrescendo),
  PMI at left heart base
• ECG findings prominent S wave in lead I, II,
  III, aVF
• Rad findings right ventricular enlargement,
  enlargement of main pulmonary artery

12
What would be your recommended treatment for a
4-month-old dog with a pressure gradient of 85
mmHg?

• Balloon valvuloplasty

13
If this patient is a bulldog, what complication
may occur?

• Aberrant left coronary artery
• Why??

14
If PS recurs after the dog is an adult, what
treatment will you recommend?
15
What are the complications of the procedures used
for PS