Diagnóstico ecocardiográfico de defeito do septo interventricular com agravo de síndrome de Eisenmenger em cão adulto – relato de caso

Thays Ribeiro Pacó,João Marcelo Azevedo De Paula Antunes,Zacarias Jacinto De Souza Júnior,Caroline Coelho Rocha

doi:10.21708/avb.2022.16.1.10159

Thays Ribeiro Pacó, João Marcelo Azevedo De Paula Antunes + Show 2 more

Open Access

https://doi.org/10.21708/avb.2022.16.1.10159

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Abstract

Interventricular septal defect (IVSD) is a congenital heart disease characterized by communication or non-closure of the interventricular septum in the embryonic or postnatal period, causing a failure in the separation between the systemic and pulmonary circulation. The severity of the hemodynamic consequences depends on the extent of the defect and the magnitude of the flow through it. Blood flow commonly occurs from left to right, because systemic vascular resistance is greater than pulmonary resistance. This report describes the echocardiographic findings in a 4-year-old male Poodle treated at the Veterinary Hospital with a history of exercise intolerance, cyanosis and episodes of syncope. On echocardiography, perimembranous IVSD was diagnosed with atrial and right ventricular dilatation, discontinuity of the interventricular septum in the subaortic region measuring approximately 5 mm. In the Doppler evaluation, reverse turbulent flow was evidenced, characterizing shunt from right to left (Eisenmenger syndrome). Despite preserved systolic function, abnormal relaxation was observed. Doppler echocardiography was a fundamental complementary imaging test for the diagnosis of this congenital heart disease since its suspicion is not commonly raised in adult patients. Doppler echocardiography allowed us to identify the defect, define its size and extension, determine the direction of blood flow as well as its hemodynamic consequences.

Highlights

Congenital alterations result from morphophysiological irregularities observed at birth due to genetics, environmental factors, or a combination of both
Cardiac malformations can be incompatible with fetal life or allow the individual to survive to adulthood, with functional impairments (BUSSADORI; PRADELLI, 2015)
VSD is characterized by failure of the interventricular septum (IVS) to close during the embryonic or postnatal period (SOUSA FILHO et al, 2015; VOROS et al, 2011)

Summary

INTRODUCTION

Congenital alterations result from morphophysiological irregularities observed at birth due to genetics, environmental factors, or a combination of both. Moderate left-to-right shunts mainly generate clinical signs of left congestive heart failure (CHF), such as exercise intolerance, dyspnea, apathy, systolic murmur, and syncope, due to pulmonary edema and compression of the main bronchi by left atrial dilatation. In cases of stenosis or development of pulmonary hypertension, the shunt flow direction can be reversed; this phenomenon, known as Eisenmenger syndrome, leads to increased severity of clinical signs (BUSSADORI; PRADELLI, 2015). Echocardiography has been the basis for the diagnosis of VSD, as it is a dynamic, noninvasive method capable of identifying, locating, and measuring the septal defect and its hemodynamic repercussions, as well as defining the degree and direction of shunt flow through this passage by means of Doppler sonography (BUSSADORI; PRADELLI, 2015; CASTRO et al, 2009; SOUSA FILHO et al, 2015).

DISCUSSION

CONCLUSIONS