Pulmonic Stenosis and Balloon Valvuloplasty in Dogs

Daisy resting comfortably at home.

Daisy resting comfortably at home.

Daisy is a 10-month-old, female English bulldog who was diagnosed with severe congenital heart disease called pulmonic stenosis. This condition can lead to congestive heart failure and a poor long-term prognosis if left untreated. Fortunately, we were able to perform a balloon valvuloplasty (cardiac catheterization procedure) at NorthStar VETS to help improve her heart function and quality of life!

Pulmonic stenosis, known as PS, is one of the most common congenital heart diseases in dogs. It can be accompanied by additional heart defects and develop into a life-threatening condition or it can be mild enough to be no more than a surprising incidental finding. Pulmonic stenosis refers to a stenosis or constriction of the right ventricular outflow tract.

Pulmonic stenosis is most commonly seen in English bulldogs like Daisy, as well as Terriers, Miniature Schnauzers, American Cocker Spaniels, Samoyeds, Keeshounds, Mastiffs and Beagles. A hereditary bases for PS has been proven in Beagles and is suspected in other breeds.

Daisy-EchoIn order to understand what pulmonic stenosis is, it is necessary to understand some normal heart anatomy. The heart sits more or less centrally in the chest and is divided into a left side, which receives oxygen-rich blood from the lungs and pumps it to the rest of the body; and a right side, which receives “used” blood from the body and pumps it to the lungs to pick up fresh oxygen. Because the left side of the heart must supply blood to the whole body, its muscle is especially thick and strong while the right side, which only pumps to one nearby area, tends to be thinner. When the ventricles pump, the blood from the left shoots through the aortic valve and the blood from the right side shoots through the pulmonic valve. These valves snap sharply closed after the pumping is done. The area where the blood exits the right ventricle is called the right ventricular outflow tract and it consists of the exit area of the ventricle, the pulmonic valve, and the main pulmonary artery.

In pulmonic stenosis, the right ventricular outflow tract is narrowed either at the actual valve, just before it, or just after it. The most common form of pulmonic stenosis involves a deformed pulmonary valve such that the valve leaflets are too thick, the valve cusps are fused, or the opening is too narrow such as in the formation of an aberrant coronary artery. The heart must pump extra hard to get the blood through this unusually narrow, stiff valve. The right side of the heart becomes thick from all this extra work which may result in abnormal electrical conduction of the heart, leading to arrhythmias. In some cases these arrhythmias can be life-threatening.

A mild case is of little concern and usually does not affect life expectancy. Luckily, most cases are mild and do not require treatment; fairly severe disease is needed for clinical signs to appear.

Approximately 35-percent of dogs with severe pulmonic stenosis will show some or all of the following signs:

  • Tiring easily
  • Fainting spells (from the abnormal electrical heart rhythm)
  • Fluid accumulation in the belly
  • Blue-tinge to the gums, especially with exertion
  • Difficulty breathing
  • Sudden death

In some cases, medications called beta blockers can be used in an attempt to relax the muscles of the heart and open the stenosis. This will not relieve the constriction but could relieve it. In mild forms of the disease, medical management may offer the pet a good quality of life.

Dr. Schneiderman performing heart surgery using the C-arm at NorthStar VETS

Dr. Schneiderman performing heart surgery using the C-arm at NorthStar VETS

Clearly, if the obstruction at the pulmonic valve could be relieved, much of the problem would be solved. Severe pulmonic stenosis cases can be treated by doing just that. A special balloon is inserted into the pulmonic valve where it is inflated, breaking down the obstruction. The size of the balloon catheter is determined by echocardiography as described above. Dogs that have severe pulmonic stenosis should have this procedure regardless of whether or not they are showing clinical signs.

Performing this procedure reduces the risk of sudden death by 53-percent and improves quality of life as well. However, certain types of valve deformity are not amenable to this treatment.

If your family veterinarian believes your pet needs to see a specialist, contact NorthStar VETS at 609.259.8300 to schedule an appointment with one of our veterinary specialists.

Jennifer Schneiderman, DVM, DACVIM (Cardiology)Jennifer Schneiderman, DVM, DACVIM (Cardiology)
Dr. Schneiderman received her Doctorate of Veterinary Medicine degree at Ross University in 2009 before moving back home to Long Island, New York where she completed a one-year rotating internship in small animal medicine and surgery at Atlantic Coast Veterinary Specialists in March 2010. After that, she completed a three-year residency in Cardiology at Atlantic Coast Veterinary Specialists in July 2013 and then stayed on there as a Staff Cardiologist until June 2014. Now a board-certified Veterinary Cardiologist, Dr. Schneiderman joined the NorthStar VETS team in August 2014. Her clinical interests include treatment of congestive heart failure and complex arrhythmias along with an interest in interventional procedures such as pacemaker implantation, balloon valvuloplasty and patent ductus arteriosus occlusion. Outside of work, Dr. Schneiderman enjoys traveling, scuba diving, going to the beach and spending time with her two tuxedo cats.

The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

This entry was posted in Pets, Veterinary Medicine and tagged , , , , , , . Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *