Puppy with subaortic stenosis

[M Hinderaker]

This is my first post, as I am a new member. My family has picked out a beautiful male fawn puppy, and we have been waiting to bring him home for several weeks. His first day in our home (at 8 weeks) we took him for a wellness exam with our vet, and they detected a heart murmur. I spoke with the breeder and she told me that we could keep the puppy and she would pay for the test with the cardiologist, or she could take the puppy back and have the test done. Because I have twin daughters that are 4 I asked the breeder to take the puppy back so if the results were such that we would not keep the puppy my girls would not become more attached than what they already were.

Well, after a doppler test at the cardiologist it was determined that Ty had subaortic stenosis. His flow meter was a 1.7. The cardiologist said that it was a very mild case, and he would probably live a normal life. Now, my family has to decide if we want to take this puppy that we have fallen in love with even though he has SAS.

My concern is that if the condition worsens he would have high maintenance medical needs. Does anyone have a dog that was diagnosed with SAS at this young of an age. And, what are the chances that the condition can worsen. Please help.....I am torn on what to do. We already love Ty and know that someone needs to give this sweet puppy a home, but I do not want to disappoint my girls a few months or years down the road if Ty becomes very sick. Thanks.

 

[JulieM]

1.7 is considered a normal flow rate....there are other factors invovled in diagnosing AS (for example, if the vet saw a narrowing of the aorta, or if the mmHg was very high), but flow rate is generally used as a determining factor for breeding. Murmurs are very common in puppies and I'm surprised the Doppler was even suggested, unless it was a very strong murmur (?) - they usually outgrow them.

As for progression, generally it is accepted that at 12 months the degree of AS is where it is going to be for the life of the dog - although I have heard from some who feel it progresses (or that certain types of it do). I would guess that if it does progress, as a mild case it would not progress far enough to affect the life of the dog (but, that is only a guess!!). I know of 2 puppies that were diagnosed with AS at that young of an age (different litters) - both were considered severe cases, with murmurs graded at 4-5/6. One succumbed at almost 2 years old - the other is now two and still here, although she has recently been fainting more often (which her owner and I happen to think is more due to the medication she's on than the actual AS). Dogs with mild AS are usually not affected by the condition at all, and live normal lives. Dogs with moderate AS usually live the same as dogs with mild AS. Dogs with severe AS are at the greatest risk of sudden death, and generally severe is characterized as velocities greater than 5 and mmHg of 90+.

Good luck, whatever you decide

 

[Molly's Mom]

Heart Murmurs

Molly had a dizzy spell at about four months of age and was evaluated by a vet cardiologist. She has a grade 2 murmur, is 2.5 yrs old and doing fine. The cardiologist said the only precaution should be give her antibiotics before dental work.
Of course, I am ever vigilant as losing her would be my undoing. I got her when I was on sick leave receiving cancer treatments and bonded with her almost too much so am particularly anxious when she even looks at me wrong.

 

[M Hinderaker]

The doppler was performed because I wanted to know exactly what was causing the murmur before we committed to the puppy. Otherwise, they would have waited to see if he outgrew it. I spoke with the cardiologist today and she told me that the grade was 1.7 and that there were no signs of thickening of the heart, nor any changes in the chambers. She stated that it was a very mild case, and her experience would suggest that the condition was finished, and that there would be no further progression. Obviously, she could not guarantee this. My vet's cardiologist is going to review the test results tomorrow and give a second opinion.

At this point we are leaning towards taking the puppy. We will bring him home, unless the second cardiologist tells us something that we do not already know. We were not planning on showing or breeding the puppy, and know that someone needs to give this puppy a good home. We have already fallen in love with him, therefore we believe we are going to take the risks involved and love and spoil him. Thanks for you input.

 

[Matt S]

First of all, Welcome to BoxerWorld & good luck with your decision.
Here is an article on Subaortic Stenosis in Boxers that I have that may also be of some interest to you, even though from your posts I can clearly see that you have a fair idea of what you are dealing with & have already been given some very good information.

http://members.aol.com/Usabox/sas.html

 

[JulieM]

I spoke with the cardiologist today and she told me that the grade was 1.7 and that there were no signs of thickening of the heart, nor any changes in the chambers.

So what was she basing the diagnosis of AS on?

I would be interested in hearing what the second opinion is. I'm assuming these are board-certified cardiologists, and I had thought the guidelines as to normal flow rate were quite clear so I'm wondering if there's something else there....if not I'm quite puzzled!!

 

[Marimat]

Hello and welcome to M Hinderaker.

Firstly I'm going to say that I am pleased to hear of a vet that will run the ultrasound over and doppler puppies at a young age - it's something I have been preaching for a long time and is a totally acceptable course to take. What is surprising is that they went for it with what I would guess is a mild murmur, supported by the fact the flow rate is only 1.7m/s.

The findings, as reported, don't seem to be adequate to support a definitive diagnosis of SAS - but that's not to say they didn't see more happening when they did the ultrasound.

Do we know if they visualised the aortic valve and saw abnormality? Or if they measured the lumen of the aorta to look for narrowing in the aorta itself? There has to be a reason to give SAS as a differential diagnosis and I'm just wondering what that reason is because as Julie says 1.7m/s is considered normal?

Did they get the Doppler reading via a substernal (up under the ribs) approach or just by shaving and going through the chest wall (innacurate - has a large margin for error). I'm guessing that they went transcostally (through the side) and this is why they are giving this diagnosis as you can add on anywhere between 0.1 to 1.0 m/s to this is they go sub sternally.

"there were no signs of thickening of the heart, nor any changes in the chambers."

You wouldn't expect there to be in an 8 week old puppy, it hasn't been around long enough for these changes to occur so this would not be a good diagnostic observation.

Anyway, despite this I think you have to go with the differential diagnosis of AS until a definitive diagnosis is reached.

Does the puppy show signs and symptoms of severe heart disease? Like collapsing, getting tired easily, not thriving, runty looking etc - if it doesn't I wouldn't worry about it at this stage.

Take heart from my old Lissa, shes now 11 years old, has and always has had a grade 3 murmur with a flow rate between 2.3 and 2.8 m/s and is the healthiest of my oldies. Doesn't sound like this puppy is anywhere near as badly affected - if at all

MC

 

[Alisha Mobley]

Just to compare...

Tyson was diagnosed w/ mild AS about a month ago (he'll be 4 in July). He has a grade 3 heart murmur and his aortic velocity was 2.33 m/s. He shows no signs of the disease and so far is just as healthy and active as my other 3. According to the cardiologist the condition will not worsen and should live a normal life being unaffected by the disease.

Good luck on what you decide.

 

[M Hinderaker]

Thank you for the feedback. We have decided to keep the puppy. He came back home on Friday, and boy is he keeping us busy!!!!

Yes, both of the specialist are board certified cardiologist. The first Dr. said that she was basing the SAS diagnosis on the 1.7 flow and that she saw a small leak in the aorta valve when looking at the color doppler. The second Dr. said that a 1.7 flow meter does not support a SAS diagnosis. He said that it may be an innocent murmur, however, he would have to run his own tests to confirm.

We are taking Ty up to the Veterinary Ultrasound Institute in Atlanta on Sunday. It is a learning facility specific to ultrasounds. They are having a large conference this weekend, and will do an ultrasound and offer a diagnosis for free. Since they will be using Ty's case as a learning tool there is no fee, and the diagnosis is an accumulation of students and specialist. I am excited about this opportunity, and anxious to see what they say. They were excited about Ty coming up to the facility as the differing diagnosis interested them. I will let you know what they say. Thanks again.

 

[Matt S]

I'm so glad you're keeping Ty. :D
It certainly sounds like a great opportunity for you & Ty this weekend.
I hope everything goes well & your worries can be put behind you & you can get on with enjoying life with a boxer.