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Liz Bode

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  • Liz Bode
    Keymaster

    Hi Svetlana,

    I don’t really like looking for a PDA from the right parasternal view as it is very difficult to distinguish it from the LPA as you say. If we do see one it is mainly through having continuous flow on colour Doppler and then being able to demonstrate a continuous flow on spectral Doppler. That being said, it is always at an angle for me so I prefer to move to the left cranial view!

    Pulmonary insufficiency should look like a jet of red originating from the pulmonic valve, not from near the branch of the PA, so should be very different. You would also hear a characteristic continuous murmur. If there is bidirectional or R-L flow then you have more of a difficult time seeing a PDa on 2D and colour – you would need to find evidence for pulmonary hypertension and then a rule out, using contrast study, would be a R-L shunt in a young animal.

    If you have a PDA and PS then this can be tricky, you should still have a continuous murmur. When you interrogate the PA you should still see flow that occurs in diastole and systole – this is where moving frame by frame with an ECG is really important.

    Hope that helps!

    Liz

    Liz Bode
    Keymaster

    Replying to Janet Lewis 07/01/2026 - 20:43

    Hi Janet,

    How interesting! I think it is most likely to be a neoplasm if it is mainly associated with the wall and in a dog with that history – myxomas tend to occur in the LA/LV but not beyond possibility that it could be that. I have also seen RA chemodectomas and other weird and wonderful things. A would think a clot and endocarditis are less likely but you do right I think to provide multi-modal therapy. Also worth evaluating urine UPC? If we think it could be a clot.

    Let me know how you get on with it!

    Liz

    Liz Bode
    Keymaster

    Replying to Annet Krabbenborg 09/01/2026 - 14:57

    Hi Annet,

    Sadly not. June Boon’s book on echocardiography has tables of some of them in, otherwise you end up searching for them separately. I then print them out and have them in a folder in my room. The breeds we most commonly see are:

    English springer spaniels
    Whippets/ other sight hounds
    Doberman
    Boxer
    Lab
    Great Dane

    Most of the giant breeds have papers. Sorry that isn’t much help for you.

    Liz

    Liz Bode
    Keymaster

    Replying to Janet Lewis 06/01/2026 - 15:39

    Hi Janet,

    this could be a number of things. I have never seen endocarditis of the pulmonic valve in a dog/ cat, but that doesn’t mean it can’t happen!

    A few questions:
    – what is the signalment?
    – what is the clinical history, is it compatible with endocarditis?
    – Is the mass attached to the leaflets and mobile?

    This could be a neoplastic lesion/ thrombus (sterile)/ infectious from that image – it looks pretty big and I guess clopidogrel wouldn’t go amiss just in case!!

    Looking forward to your reply, it is an interesting one!

    Liz

    Liz Bode
    Keymaster

    Replying to Roland R. 05/01/2026 - 11:01

    Hi Roland,

    I don’t have one I am afraid, but let’s see if Sid does. He finished his residency at Liverpool not so many years ago and I am pretty sure they had a sheet there with some reference ranges on etc. We will get back to you πŸ™‚

    Liz

    Liz Bode
    Keymaster

    Hi Scott,

    Some cardiologists are using this product, and I have seen one or two UK cardiologists talk about it on forums. The experience over here will be limited due to the financial implications, I have not used it. However, it has some very positive data in people and I think it could be beneficial in dogs. Would be interested to hear how your case goes!

    Liz

    Liz Bode
    Keymaster

    Replying to Annet Krabbenborg 27/12/2025 - 15:01

    Hi Annet,

    I will do my best to answer the questions so that you can visualise what I mean:

    – measuring ivs i know you said leading edge to trailing edge.. ? Do you measure the full ivs (? I assume there’s a left and right side?) or if you can see the divide just the left side of the ivs? Maybe this is not a thing but am sure i’ve heard something re this before)
    Yes, there is often a difference in echo texture between the right and left side of the septumn However, there is no consensus on where to measure and as we don’t see this divide on all patients we measure the whole of the septum, leading edge to trailing edge on 2D.

    – mapse& tapse ? What are normal measurements for cats?

    Here is Illaria’s paper on MAPSE and TAPSE in cats (open access) it has all the measurements in there including ref ranges.
    https://onlinelibrary.wiley.com/doi/10.1111/jvim.14697

    – i often struggle to get a really nice la/ao view in a cat ( i often get it more like on a dog echo so la more on left side of the screen in stead of underneath the ao) ? Any tips to improve this?

    I think cats atria often do look the same as dogs? Perhaps as they get bigger then they become more ‘underneath’ the aorta. As long as you are seeing a symmetrical looking aorta with the 3 cusps and the body and auricle of the LA in entirety then I think you are doing a good job πŸ™‚

    – how do you get the left crannview for the measurement of the lau velocity?
    This is tricky in cats with normal left atria, it is much easier when the atria is dilated. You start at the left cranial view with the aorta running horizontally across the screen and then angle your probe slightly caudally so it’s pointing towards the spine near where the last rib inserts. This should bring the auricle to the top oof the screen. In cats with normal LA you will struggle to get it. In those cases I don’t measure it, just LA fractional shortening.

    Happy New Year πŸ™‚

    Liz

    Liz Bode
    Keymaster

    Replying to Caroline T. 24/12/2025 - 16:27

    Hi Caroline,

    This is a good question, what we mean by ‘normal’ velocity is the velocity we would expect to be generated by the right or left ventricle. Trivial MR or TR, in isolation (without valve changes) could be normal but if you are able to interrogate MR and TR and get a good profile then you probably have more than trivial regurgitation and that isn’t ‘normal’.

    The RV is a low pressure system normally, so you would anticipate velocity of TR to reflect that, so a normal value for this is <3.0m/s. It is elevated in Pulmonic stenosis and pulmonary hypertension, amongst other more weird congenital abnormalities.

    The LV is a high pressure system, so at normal blood pressure you would expect to see an MR velocity of 5-6m/s, reflecting a blood pressure of 100-120mmHg. MR velocity will be higher than this if there is aortic stenosis or systemic hypertension. It will be lower than this if there is increased left atrial pressure/ poor systolic function. However, in order to interpret the velocity of any jet accurately you must be critical of the profiles on Doppler you get, if you don't get a full profile then you can't interpret the image accordingly.

    Hope that makes sense.

    Liz

    Liz Bode
    Keymaster

    Replying to Caroline T. 24/12/2025 - 16:27

    Hi Caroline,

    This is a good question, what we mean by ‘normal’ velocity is the velocity we would expect to be generated by the right or left ventricle. Trivial MR or TR, in isolation (without valve changes) could be normal but if you are able to interrogate MR and TR and get a good profile then you probably have more than trivial regurgitation and that isn’t ‘normal’.

    The RV is a low pressure system normally, so you would anticipate velocity of TR to reflect that, so a normal value for this is <3.0m/s. It is elevated in Pulmonic stenosis and pulmonary hypertension, amongst other more weird congenital abnormalities.

    The LV is a high pressure system, so at normal blood pressure you would expect to see an MR velocity of 5-6m/s, reflecting a blood pressure of 100-120mmHg. MR velocity will be higher than this if there is aortic stenosis or systemic hypertension. It will be lower than this if there is increased left atrial pressure/ poor systolic function. However, in order to interpret the velocity of any jet accurately you must be critical of the profiles on Doppler you get, if you don't get a full profile then you can't interpret the image accordingly.

    Hope that makes sense.

    Liz

    Liz Bode
    Keymaster

    Replying to Annet Krabbenborg 14/12/2025 - 13:01

    Hmmm, the noise around the baseline is possibly your wall filter? So you might want to increase that slightly to hide some of the noise.

    Liz Bode
    Keymaster

    Replying to Svetlana D. 12/12/2025 - 14:06

    Hi Svetlana,

    That looks good to me. You want to measure at the end of diastole, so the start of the QRS. Then leading edge to leading edge, so that is the top of the endocardium on the RV side of the septum and the top of the endocardium on the LV side of the septum and so on through the free wall, looks like your cursors are good here. Systole is the same but the smallest LV size, which is usually and of the T wave.

    Liz

    Liz Bode
    Keymaster

    Replying to Svetlana D. 12/12/2025 - 14:06

    Hi Svetlana,

    That looks good to me. You want to measure at the end of diastole, so the start of the QRS. Then leading edge to leading edge, so that is the top of the endocardium on the RV side of the septum and the top of the endocardium on the LV side of the septum and so on through the free wall, looks like your cursors are good here. Systole is the same but the smallest LV size, which is usually and of the T wave.

    Liz

    Liz Bode
    Keymaster

    Replying to Caroline T. 11/12/2025 - 08:22

    Amazing! Welcome Caroline πŸ™‚

    Liz Bode
    Keymaster

    Answers to the above questions:

    QUESTION 1 β€” Aortic Stenosis (Peak Gradient)
    Doppler peak velocity across the aortic valve is 4.0 m/s. Calculate the peak pressure gradient between the left ventricle and the aorta.

    Solution
    Ξ”P=4v^2= 4(4.0)^2= 4(16)= 64mmHg

    QUESTION 2 β€” Tricuspid Regurgitation (Estimating PA systolic pressure)

    You measure TR jet velocity = 3.2 m/s. Right atrial pressure (estimated from CaVC) = 10 mmHg.

    Calculate the pulmonary artery systolic pressure (PASP).

    Solution
    RV–RA gradient:
    Ξ”P=4(3.2)^2=4(10.24)=40.96β‰ˆ 41 mmHg

    Add RA pressure to estimate PASP:
    PASP=41+10= 51 mmHg

    QUESTION 3 β€” Pulmonic Stenosis
    The peak velocity across the pulmonary valve is 2.8 m/s. Find the peak systolic gradient.

    Solution
    Ξ”P=4(2.8)^2=4(7.84)= 31.36 mmHg

    QUESTION 4 β€” Ventricular Septal Defect Gradient
    You measure VSD jet velocity = 5.0 m/s. Calculate the pressure gradient between LV and RV.

    Solution
    Ξ”P=4(5.0)^2=4(25)= 100 mmHg

    QUESTION 5 β€” A step further: Estimating RV Systolic pressure from VSD velocity
    If systemic systolic BP = 100 mmHg and VSD jet velocity = 4.0 m/s, what is the RV systolic pressure?

    Solution
    Gradient:
    Ξ”P=4(4.0)^2= 64 mmHg
    RVSP=SBP-Ξ”P=100-64= 36 mmHg

    Liz Bode
    Keymaster

    Replying to Annet Krabbenborg 03/12/2025 - 19:45

    Hi Annet,

    Thanks for the questions, tissue Doppler is a little tricky! In terms of the annulus, yes this is where the valve attaches to the wall of the heart, it is also called the hinge point.

    When setting up tissue Doppler, I narrow the sector width, then put the colour on to cover the whole window (you might also need to adjust the depth to get the frames per second above 200), you will also need to adjust the Nyquist limit so you don’t get any brown colour. Then I place the sample volume of the pulse wave Doppler (which is how I set it up on my machine, but it could be different on other machines) on the annulus. The sample volume is usually 2-3mm.

    Hope that helps!

    Liz

Viewing 15 posts - 16 through 30 (of 299 total)