Presentation

A 1.5 year old female West Highland White Terrier presented for evaluation of a murmur noted during routine examination. The owner did note exercise intolerance as well as shortness of breath during excitement. Physical examination indicated a grade V/VI left base continuous murmur.

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Thoracic Radiographs

Moderate cardiomegaly (VHS 11.2) with marked left atrial and left ventricular dilation. A ductual aneurysm is present typical of a PDA and there is marked pulmonary over circulation (Fig 1.)

Figure 1: Right lateral (A) and ventrodorsal (B) thoracic radiographs showing marked left sided cardiac enlargement as well as a large ductal aneurysm (White arrows). Also note the marked enlargement of the pulmonary vasculature.

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Echocardiogram

The PDA was confirmed and measurements were made for minimally invasive ductal occlusion using an Amplatz Canine Ductal Occluder (ACDO). The minimum diameter of the ductus was 4 mm, the maximum was ~8 mm while the length measured ~ 5 mm. Severe dilation of the left atrium and left ventricle were also noted.

Figure 2: Transesophageal echocardiographic images of a moderately sized PDA.

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Treatment Plan

Occlusion of PDA with Amplatz Canine Ductal Occluder (ACDO)

Figure 3: Side view of Amplatz Canine Ductal Occluder (ACDO)

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Outcome

Patient was place under general anesthesia and a 5mm ACDO was positioned across the PDA under fluoroscopic guidance. Access was provided via cut down of the femoral artery using a modified Seldinger single wall technique.

Figure 4: Fluoroscopic image taken immediately following placement of the Amplatz Ductal Occluder (ACDO) showing complete occlusion of the PDA.