Symptomatic partial anomalous pulmonary venous connection in a kitten

Abstract

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.

Feline pulmonary hypertension: are we overlooking an important comorbidity?

“…Most reported are heart murmur (often noted as right-sided systolic), jugular distension or pulsation and auscultatory abnormalities such as crackles and/or wheezes tachypnea, or evidence of thromboembolism. 30,31,35,38,93,94,96 There are few reports of laboratory findings in patients with PH. However, the authors would recommend a minimum database, including assessment for polycythemia, which could indicate right-to-left shunting or chronic hypoxia, heartworm antibody and antigen tests in endemic areas, fecal Baermann floatation for lungworm infections and, if possible, arterial blood gas analysis to assess for hypoxia (although obtaining this can be very difficult in a conscious cat, especially one with difficulty breathing – pulse oximetry might be considered as an alternative).…”

“…30,32,35 Radiographs can demonstrate a variety of abnormalities, including cardiomegaly, pulmonary infiltrates, blunting, tortuosity or enlargement of the pulmonary arteries, or of both the pulmonary arteries and veins, and hepatomegaly. 27,30,38…”

Pulmonary Vein: Embryology, Anatomy, Function and Disease

“…A retrospective study that reviewed 290 dogs with cardiovascular malformations from 1953 to 1965 revealed that only 1 case was diagnosed PAPVC with secundum atrial septal defect [40]. For the published case reports, there are only 3 dogs [41][42][43] and each 1 of chicken [44] and foal [45] that are diagnosed as TAPVC; only 4 dogs [46][47][48] and 2 cats [49,50] are PAPVC. One canine case reported in 1975 did not describe its detail (TAPVC or PAPVC) [51].…”

“…For obtaining the full picture of abnormal development of pulmonary veins, multidetector computed tomography and magnetic resonance imaging both can provide good images. The importance of advanced imaging modules in diagnosing these complex cardiovascular developmental diseases had been emphasized in these years [49,50]. Both of multidetector computed tomography and magnetic resonance imaging are non-invasive, and they can offer multiplanar and three-dimensional reconstructive model.…”

“…Affected animals can exhibit no clinical signs or have symptoms associates with congestive heart failure and pulmonary hypertension. In the total of 6 veterinary cases, half of them were asymptomatic (2 miniature schnauzers [46] and 1 Devon Rex cat [49]) and the other half were presented with signs of decompensation (exercise intolerance in 1 Belgian Malinois dog [47], pulmonary edema in 1 toy poodle [48] and 1 American shorthair kitten [50]). The severity of symptoms depends on the number of affected pulmonary veins, that is, the degree of left-to-right shunt.…”