Transthoracic echocardiography and its limitations in the diagnosis of congenital supernumerary aortic valve in a Thoroughbred.
Abstract: Aortic valve malformation is a common congenital abnormality reported in human medicine. The malformation is characterised by an increased or decreased number of cusps. Anatomical variations of the aortic valve that have been documented in humans include unicuspid, bicuspid, quadricuspid and quinticuspid valves. Two reports described a quadricuspid aortic valve in horses associated with either a ventricular septal defect (VSD) or tetralogy of Fallot. In this case report we describe the clinical and echocardiographic findings of a horse with a quadricuspid aortic valve as single congenital abnormality, referred with history of exercise intolerance and an episode of paroxysmal atrial fibrillation. Limitations and risks of misdiagnosis that can be encountered with transthoracic echocardiography are also discussed. The reported case highlights the importance of echocardiographic screening in asymptomatic patients as congenital heart disease can be present without obvious cardiac signs. As advanced imaging on the equine thorax is still far from future possibilities for adult horses, this report may help to reach an accurate diagnosis with similar cases.
© 2021 The Authors. Veterinary Medicine and Science Published by John Wiley & Sons Ltd.
Publication Date: 2021-03-13 PubMed ID: 33713550PubMed Central: PMC10029896DOI: 10.1002/vms3.472Google Scholar: Lookup
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Summary
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This research discusses a case of a Thoroughbred horse with a rare congenital heart defect, specifically, a quadricuspid aortic valve, and highlights the potential limitations and risks of misdiagnosis when using transthoracic echocardiography as a diagnostic tool in such cases.
The case description
- This paper presents the case of a Thoroughbred horse diagnosed with a congenital quadricuspid aortic valve. This particular heart defect is characterized by having an abnormal number of cusps in the aortic valve. Normally, aortic valves have three cusps, but in this anomalous condition, the aortic valve develops four cusps.
- The subject horse was brought in with a history of exercise intolerance and an episode of paroxysmal atrial fibrillation, which are irregular and often high heart rates that can cause poor blood flow to the body.
Echocardiographic findings and limitations
- While echocardiographic screening was used for the diagnostic process in this case, the researchers discuss its limitations and the risks of misdiagnosis, particularly for this kind of congenital abnormality in the heart. Echo images can vary based on different factors such as the animal’s positioning or the sonographer’s level of experience, which increases the chance for diagnosis error.
- The paper also emphasizes the importance of echocardiographic screening in asymptomatic patients because congenital heart disease may be present without any apparent cardiac signs.
Implications of the case report
- This case is significant because it is one of the few documented instances of a horse with a quadricuspid aortic valve without other associated defects, such as ventricular septal defect (VSD) or tetralogy of Fallot, which are common in quadricuspid cases in humans.
- Gaining knowledge and better understanding of such rare congenital heart conditions can inform and improve future diagnostic and therapeutic procedures, aiding in the accurate diagnosis of similar anomalies in horses and potentially other animals.
The future of imaging in equine medicine
- Despite these diagnostic challenges, the article acknowledges that advancements in imaging technology for the equine thorax are still relatively far off, especially for adult horses due to their size and unique anatomy.
- This case report can be beneficial for equine practitioners, as it can offer valuable insights that can assist in reaching an accurate diagnosis in similar future cases, till advancements in imaging technology are leveraged.
Cite This Article
APA
Vitale V, Laurberg M, van Galen G.
(2021).
Transthoracic echocardiography and its limitations in the diagnosis of congenital supernumerary aortic valve in a Thoroughbred.
Vet Med Sci, 9(2), 712-716.
https://doi.org/10.1002/vms3.472 Publication
Researcher Affiliations
- University Teaching Hospital, Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia.
- University Teaching Hospital, Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia.
- University Teaching Hospital, Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia.
MeSH Terms
- Humans
- Animals
- Horses
- Aortic Valve / diagnostic imaging
- Aortic Valve / abnormalities
- Aortic Valve / surgery
- Quadricuspid Aortic Valve / veterinary
- Echocardiography / veterinary
- Heart Defects, Congenital / diagnostic imaging
- Heart Defects, Congenital / veterinary
- Thorax
- Horse Diseases / diagnostic imaging
Conflict of Interest Statement
The authors have no conflicting interest to declare.
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Citations
This article has been cited 1 times.- Vitale V, Laurberg M, van Galen G, van Loon G. Limitations of transthoracic echocardiography in equine patients. Vet Med Sci 2023 Jul;9(4):1618-1620.
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