Ever heard of double-inlet left ventricle? Here is a case report

Multimodal Imaging of Congenital Double-Inlet Left Ventricle with Hypoplastic Right Ventricle and Ventricular Septal Defect in a Young Cat

O. Peterson, M. Pabon Torres, R. White, E. Manson, M. Tropf, J.L. Ward

Background
Double-inlet left ventricle (DILV) is a rare congenital cardiac abnormality, classified as a form of univentricular disease, in which both atrioventricular valves open into a single ventricular chamber. While DILV has been reported in humans and large animals, it has not been previously documented in small animals. This case report describes the diagnosis and characterization of DILV, accompanied by a hypoplastic right ventricle and a ventricular septal defect (VSD), in a young cat.

Methods
A one-year-old male domestic shorthair cat was referred for evaluation of a grade V/VI heart murmur and intermittent signs of exercise intolerance. The diagnostic approach included echocardiography, fluoroscopy with non-selective angiography, and computed tomography with angiography. These modalities were used to assess cardiac structure, blood flow dynamics, and great vessel orientation.

Results
Imaging confirmed DILV with both atria emptying into a common left ventricle. A hypoplastic right ventricle was identified, receiving blood through a restrictive muscular VSD with left-to-right shunting. The great arteries displayed normal orientation, consistent with Type I (Holmes classification) DILV in humans. The cat exhibited stable clinical signs with no evidence of polycythemia or congestive heart failure at diagnosis. Over a 2.5-year follow-up period, the cat remained clinically stable with mild exercise intolerance.

Limitations
This is a single-case report, and long-term prognosis for DILV in cats remains uncertain. While multimodal imaging allowed comprehensive characterization, the absence of invasive hemodynamic measurements limits the assessment of pressure gradients and cardiac output.

Conclusions
This case represents the first documented diagnosis of DILV in a small animal. The use of multimodal imaging enabled detailed structural and functional characterization. Despite the congenital defect, the cat remained stable without the need for medical or surgical intervention. Further studies are needed to explore the clinical progression and management of DILV in feline patients.

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