Reversal of echocardiographic right-sided heart pathology in a dog with severe pulmonary hypertension: a case report

Abstract

Pathologic right-sided heart changes are a common echocardiographic finding in patients with pulmonary hypertension (PH). Canines with PH may have right heart pathology documented via echocardiographic color Doppler interrogation including tricuspid valve regurgitation, pulmonic valve insufficiency, elevated pulmonary arterial systolic pressure, elevated pulmonary arterial diastolic pressure, and alterations in ejection profiles. Two-dimensional echocardiographic findings may include right ventricular hypertrophy, interventricular septal flattening, paradoxical interventricular septal motion, pulmonary artery dilation, and potentially abnormal left heart dimensions. In veterinary medicine, much confidence is given to the measurement of pulmonary arterial systolic pressure estimated from tricuspid valve regurgitation to grade the severity of PH and monitor its improvement with little emphasis placed on the integration of two-dimensional echocardiographic right and left heart pathology in conjunction with Doppler findings. To the authors’ knowledge, marked improvement and/or resolution of echocardiographic-documented right heart pathology have not been previously reported in the veterinary literature. This case report documents profound echocardiographic improvement of right-sided heart disease in a dog with severe PH.

Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017–2021): 135 cases

“…Several studies have evaluated the effect of sildenafil on TR and right heart parameters with varying results. 14,[21][22][23][24] In 1 study, sildenafil significantly improved pulmonary arterial pressure from baseline in comparison to placebo therapy. 24 It is possible that patients in our study who were started on sildenafil prior to echocardiogram could have had alterations to their measurable TR or PI for diagnosis as well as effects to their right heart parameters.…”

“…Others may have received phosphodiesterase‐5 inhibitors. Several studies have evaluated the effect of sildenafil on TR and right heart parameters with varying results 14,21–24 . In 1 study, sildenafil significantly improved pulmonary arterial pressure from baseline in comparison to placebo therapy 24 .…”

“…1 Right heart changes secondary to PH include right ventricular hypertrophy, PA/trunk enlargement, right ventricular or atrial enlargement, flattening of the interventricular septum, and prominent papillary muscles. 1,3,6,[11][12][13][14] Signs of a congestive state have also been evaluated in patients with PH including CVC distention, gallbladder edema, hepatic vein distention, and peritoneal effusion. 1,3,11,12,15 A previous study reported that an echocardiographic 10-point pulmonary hypertension score (PHS), based on these anatomical changes, accurately identified patients with moderate to severe PCPH.…”

“…These include changes to the ventricles (site 1), the pulmonary artery (PA) (site 2), and the right atrium and caudal vena cava (CVC) (site 3) 1 . Right heart changes secondary to PH include right ventricular hypertrophy, PA/trunk enlargement, right ventricular or atrial enlargement, flattening of the interventricular septum, and prominent papillary muscles 1,3,6,11–14 . Signs of a congestive state have also been evaluated in patients with PH including CVC distention, gallbladder edema, hepatic vein distention, and peritoneal effusion 1,3,11,12,15 .…”

Graded balloon atrial septostomy for palliation of congenital pulmonary hypertension in a dog: A case report

“…Antiplatelet treatment alone, however, usually is insufficient to result in resolution of thromboembolic PH, and laboratory and angiographic findings did not support thromboembolic PH. Sildenafil may be primarily responsible for improvement or resolution of PH over time, but this is considered less likely because it is uncommon for sildenafil to reverse pulmonary arterial changes, although it may delay progression of disease and minimize clinical signs . The sildenafil dosage was atypical because of the size of the dog, but within the range that typically is utilized in dogs with severe PH .…”