Aortic Stenosis in a Rottweiler puppy

This 3 month old puppy was referred for echo after incidental discovery of a heart murmur when attending for his vaccinations.

His parasternal long-axis view was relatively unremarkable apart from mildly increased left ventricular wall thickness.

 

Inspection with colour Doppler showed turbulent flow across the aortic valve, suggestive of stenosis, as well as an eccentric jet of regurgitation which is also shown in the colour M-mode below.

 

Colour M-mode

 

 

 

 

 

 

 

 

 

 

 

 

 

Valve morphology

The zoomed clip below shows the morphology of the valve.

 

In the same clip played at a slower speed, it is possible to see some fusion of the commissures.

 

From the long-axis view, the restricted opening of the leaflets is even more obvious. The leaflets should open up against the sinuses, but in this puppy, they form a narrowed tunnel-like orifice during systole which measures 5.3mm in diameter (LVOT diameter measures 10.4mm).

 

narrowed aortic valve

 

 

 

 

 

 

 

 

 

 

The pulmonary valve was also quite noticeable from the short-axis view. Velocities through the valve were at the upper limits of normal, with mild regurgitation.

 

 

Pulmonary valve trace

 

 

 

 

 

 

 

 

 

 

 

 

 

Spectral Doppler of the aortic valve

The aortic regurgitation was visible from the apical views, but we were not able to obtain a complete trace due to the eccentricity of the jet.

 

Even from the subcostal / subxiphoid view, it was not possible to obtain a clear trace.

 

Visually, however, the aortic regurgitation appears to be moderate in severity.

We achieved our peak aortic valve velocity from the subxiphoid view, obtaining just over 6m/s (a gradient of over 144mmHg), indicating severe aortic stenosis.

Peak AV velocity

 

 

 

 

 

 

 

 

 

 

 

 

Balloon valvuloplasty is a successful treatment of congenital aortic stenosis in dogs, but can exacerbate regurgitation.