Sunghoon Jeon, Gahyun Lee, Dahee Han, Jin-Kyung Kim, Namsoon Lee, Dongwoo Chang
Background
Pulmonary coarctation (PC) is a rare congenital anomaly in cats and humans, characterized by narrowing of the pulmonary arteries and resulting in right ventricular pressure overload. Pulmonary artery interruption (PAI), also uncommon, is defined by discontinuity of a pulmonary artery branch. Cases of co-occurring PC and PAI are particularly rare, with limited veterinary documentation. This report describes the clinical findings, imaging features, treatment, and long-term outcome of a feline patient diagnosed with right PC and left PAI.
Methods
A 4-month-old British Shorthair kitten with a grade IV/VI systolic murmur underwent diagnostic evaluation including thoracic radiography, echocardiography, and computed tomography (CT). Severe right PC with concurrent left PAI was diagnosed. A percutaneous transvenous balloon angioplasty using a high-pressure balloon was performed under general anesthesia. Follow-up assessments were conducted by echocardiography and thoracic radiography up to 33 months post-diagnosis.
Results
Balloon angioplasty reduced systolic flow velocity across the stenotic lesion from 6.15 m/sec to 2.79 m/sec and significantly lowered the pressure gradient. Right atrial enlargement and right ventricular hypertrophy improved post-procedure. Although transient hypotension and desaturation occurred during balloon insertion, the cat recovered uneventfully. At one year, echocardiography confirmed sustained improvement, while radiographs showed collapse of the left lung and compensatory hyperinflation of the right lung. Despite these changes, the cat remained asymptomatic and continued to thrive without clinical signs for nearly three years.
Limitations
This case represents a single patient, limiting generalizability. Pulmonary artery pressures were not directly measured during the procedure, and additional respiratory evaluations such as bronchoalveolar lavage were not performed. Long-term risks of recurrent respiratory disease or restenosis remain uncertain.
Conclusions
This report demonstrates that balloon angioplasty can successfully relieve right pulmonary coarctation in cats with concurrent left PAI, improving right heart remodeling and maintaining long-term clinical stability. However, the persistence of contralateral PAI may predispose to progressive lung changes, highlighting the importance of ongoing long-term monitoring.
Thoracic radiography images at initial presentation (A, B) and transthoracic echocardiography images one month after
initial presentation (C, D, E). Lateral (A) and ventrodorsal (B) thoracic radiographs reveal mild cardiomegaly with mild
right atrial enlargement and a slight leftward shift of the cardiac axis. Right parasternal short-axis echocardiogram (C, D)
shows a focal narrowing between the main pulmonary artery (MPA) and right pulmonary artery (RPA) (arrowhead), with
evidence of right ventricular hypertrophy (white arrows), dilation of the MPA, a stenotic RPA, and post-stenotic dilation.
Color Doppler imaging demonstrates turbulent flow within the RPA, while the left pulmonary artery (LPA) is not visualized.
(E) The maximum velocity through the stenotic region was 6.15 m/sec, corresponding to a pressure gradient (PG) of 151.42
mmHg. RVOT: right ventricular outflow tract, MPA: main pulmonary artery, Ao: aorta, RPA: right pulmonic artery.
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