Introduction:
Ascites with accumulation of a pure transudate or modified in the absence of a traumatic event is relatively uncommon in young dogs. When there is no need to consider gastrointestinal or renal disease that is accompanied by loss of protein (and, therefore, loss of intravascular oncotic pressure), congenital liver disease and portosystemic shunt and congenital cardiac malformations.
Among the less common congenital malformations the Cor triatriatum Dexter (CTD) has been reported with surprising frequency and have posted a total of 25 clinical cases since its first description in 1974.
This malformation is an abnormal division of the right atrium that creates two chambers fibromembranoso separated by a septum. Their presence is linked to the lack of regression of the right venous sinus valve during embryonic development.
usual clinical presentation includes persistent ascites due to venous outflow obstruction, exercise intolerance and cachexia.
While it may be asymptomatic, this condition usually requires surgical correction can be done by balloon dilatation or by conventional surgery.
The CTD despite being a rare congenital malformation should be part of the differential diagnosis of ascites, especially in young dogs. Its diagnosis is not without complications because, unlike other heart disease, does not produce an audible breath and chest radiographs may be normal. This necessitates the use of echocardiography or angiography for definitive diagnosis.
report:
was presented at the clinic a male Newfoundland puppy 2 months with weakness and diarrhea. On physical examination the most relevant findings were pale mucous membranes, weak femoral pulse and abdominal distension. Cardiac auscultation was apparently normal.
The direct coprology showed the presence of eggs of Ascaris spp
Hematology produced the following results: RBC 2.27 (4.70 to 8.50), HCT 10% (32.0-55,0) , HGB 4.7 (10.3 to 18.0), MCV 44.1 (60.0 to 77.0),% 10.7% RETIC also also had thrombocytopenia (PLT 40 (175-500))
an extension was observed in the presence of numerous fragmented erythrocytes
biochemistry showed an ALT of 824 (8-75) and a total protein of 4.6 (4.8 to 7.2). The pre and post bile acid fed state were within reference limits
Abdominal ultrasound was observed the presence of free fluid and hepatomegaly with an increase in echogenicity. There were no other alterations.
ascitic fluid analysis showed the existence of a modified transudate reddish, relatively acellular with a protein content obtained by refractometer 3 g / dl.
aggressive fluid therapy was started with Ringer lactate and treatment with fenbendazole and metronidazole. Based on the suspicion of a cardiac malformation as a cause of ascites was recommended a cardiac evaluation.
subsequently underwent an electrocardiogram showed sinus rhythm with a frequency of 178 beats per minute and a P-wave duration of 48 ms.
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| The ECG showed sinus rhythm with P lung. |
The chest radiograph showed signs of moderate cardiomegaly with normal lung fields, and significant alteration was found a moderate increase in the vena cava flow.
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| x LL Right |
echocardiography revealed a membrane dividing the right atrium into two chambers, is membrane presented a communication about 3 mm and a continuous turbulent flow of about 2 m / s compatible with a Cor triatriatum Dexter.
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| right parasternal short axis at the base level for optimized cardiac defect . |
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| off-axis projection from the left which shows the septation of AD |
The membrane blocking the flow of the vena cava flow and not draining the head of normally on the tricuspid valve. The coronary sinus was also blocked and appeared markedly dilated
also also had mild tricuspid regurgitation but no signs of tricuspid dysplasia.
owners are said the possibility of a corrective action but the owners, at the time, refused.
diarrhea had subsided and the patient was in good condition although the abdominal distension persisted. But still showed regenerative anemia had improved hematocrit.
The patient was discharged and she developed a benaceprilo maintenance therapy and spironolactone.
The following month he was readmitted with severe abdominal distension, still showed hypoproteinemia and reticulocytosis but the values \u200b\u200bof ALT and hematocrit were normal. We performed a therapeutic abdominocentesis extracting one liter of ascitic fluid and furosemide was added to treatment.
During the following months the patient was readmitted on several occasions with abdominal distension showing inadequate medical treatment to control clinical signs, was added to therapy and s-adenilmetionina ursochol in order to prevent cardiac cirrhosis and was made several abdominocentesis to relieve abdominal distention.
When the puppy was six months, the owners agreed to perform corrective surgery. At that time the patient showed and signs of cachexia.
preoperative tests in hypoproteinemia and thrombocytopenia were observed finding the rest of the values \u200b\u200bwithin the normal range. The smear still showed the presence of numerous fragmented erythrocytes.
was referred to the veterinary clinic Gran Sasso Milan to perform the surgery. She underwent surgery on beating heart with obstruction of flow. Although technically the surgery was performed without incident, shortly after the patient restore circulation entered a not reversed bradycardia despite drug treatment and then went into asystole not responding or the heart massage and defibrillation died as internal.
Continued on Cor triatriatum Dexter: A report of a case (II)
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