Aortopulmonary fistula in a Warmblood mare associated with an aortic aneurysm and supravalvular aortic stenosis.
Abstract: This case report describes the clinical presentation, the necropsy findings, and genetic results of a 13-year-old Warmblood mare presented with colic and a bilaterally loud, holosystolic murmur. Echocardiographic examination revealed the presence of a thoracic aortic aneurysm, an aortic pseudoaneurysm, a periaortic hematoma (circumferential cuffing by perivascular hemorrhage), and aortopulmonary fistulation. A supravalvular aortic stenosis (SVAS) was visible during echocardiography. Necropsy confirmed that the thoracic aortic aneurysm had ruptured and connected to the pseudoaneurysm, which fistulated into the pulmonary artery. Histologically, the aneurysm wall revealed chronic lesions such as fibrosis, mucin depositions, mineralizations, and elastin fragmentation. The mid abdominal aorta showed lesions suggestive of a systemic elastin arteriopathy. Molecular analysis, however, could not attribute this disease to a variant in the elastin gene, the most common causative gene for SVAS. To the authors' knowledge, this case report describes a case of aortopulmonary fistulation in a Warmblood horse associated with the presence of SVAS and an aortic aneurysm.
© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Publication Date: 2020-09-14 PubMed ID: 32926466PubMed Central: PMC7517844DOI: 10.1111/jvim.15893Google Scholar: Lookup
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Summary
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The research article is a case study on a 13-year-old Warmblood mare that was presented with colic and a loud heart murmur. Through echocardiogram and necropsy, it was found that the mare had a thoracic aortic aneurysm, a pseudoaneurysm, a hematoma, aortopulmonary fistulation, and supravalvular aortic stenosis. However, molecular analysis revealed that the condition could not be attributed to a common causal gene for such issues.
Case Presentation and Findings
- This clinical case study revolves around a 13-year-old Warmblood mare that displayed symptoms of colic (intestinal disorder), and a strong, bilaterally loud, holosystolic (throughout the entire heartbeat) murmur.
- During echocardiographic examination, abnormal development or issues with the heart and blood vessels were identified. Those included a thoracic aortic aneurysm (abnormal enlargement of the aorta), a pseudoaneurysm (a false aneurysm), periaortic hematoma (circumferential cuffing by perivascular hemorrhage or blood clot around the aorta), and aortopulmonary fistulation (an abnormal connection between the aorta and components of the pulmonary system).
- Supravalvular aortic stenosis (SVAS), a heart disorder that narrows the aorta above the aortic valve, was also found visible during the echocardiogram.
Necropsy Results
- The necropsy confirmed the aforementioned diagnosis. The thoracic aortic aneurysm was found to have ruptured, leading to an abnormal communication with the pseudoaneurysm, creating a fistula into the pulmonary artery.
- When observed histologically, or at a microscopic level, the wall of the aneurysm showed signs of chronic lesions such as fibrosis (formation of fibrous tissue), mucin depositions (deposits of a protein that forms mucus), mineralisations (mineral deposits), and elastin fragmentation.
- Similar lesions hinting at systemic elastin arteriopathy were also located in the mid abdominal aorta.
Genetic Investigation
- To understand molecular implications, analysis was carried out on the elastin gene – commonly associated with SVAS. Interestingly, this illness could not be attributed to a variant of this gene in the studied case.
- This investigative report marks a unique case study as it is one of the first to document aortopulmonary fistulation in a Warmblood horse, associated with the presence of an SVAS and an aortic aneurysm.
Cite This Article
APA
Saey V, Decloedt A, Van Poucke M, Peelman L, van Loon G, Vanderperren K, Ducatelle R, Chiers K.
(2020).
Aortopulmonary fistula in a Warmblood mare associated with an aortic aneurysm and supravalvular aortic stenosis.
J Vet Intern Med, 34(5), 2152-2157.
https://doi.org/10.1111/jvim.15893 Publication
Researcher Affiliations
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
MeSH Terms
- Animals
- Aortic Aneurysm / veterinary
- Aortic Stenosis, Supravalvular / veterinary
- Arterio-Arterial Fistula / diagnostic imaging
- Arterio-Arterial Fistula / veterinary
- Female
- Horse Diseases / diagnostic imaging
- Horses
- Pulmonary Artery / abnormalities
- Pulmonary Artery / diagnostic imaging
Conflict of Interest Statement
Authors declare no conflict of interest.
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