FRANK J. MILNE STATE-OF-THE-ART LECTURE


Table 1. Prognostic Guidelines for Performance of Horses with Mitral Regurgitation, Aortic Regurgitation, and Ventricular Septal Defect§* Mitral Regurgitation


Arterial pulses Valve lesion


LA enlargement LA shape


Interatrial septum LV volume overload LV systolic function


Pulmonary vein enlargement PA enlargement MR jet**


AF, APCs Ventricular arrhythmias Aortic Regurgitation Arterial pulses


Arterial blood pressure Valve lesion


Aortic root


LV volume overload LV systolic function AR jet**


LA enlargement Concurrent MR PA enlargement


Ventricular arrhythmias AF


Age at onset Ventricular Septal Defect


Arterial pulses Size of VSD**** Shunt velocity Volume overload


LV systolic function


Aortic valve bulges into VSD Concurrent AR


Pulmonary artery enlargement Right ventricular hypertrophy


Concurrent MR AF


Complex congenital heart disease


Adapted from the Joint ACVIM/EVEIM Consensus statement “Recommendations for Management of Equine Athletes with Cardiovascular Abnormalities.”39 *Combined assessments are essential in accurately formulating a prognosis for life and performance and should include lesions detected, size of cardiac chambers, myocardial function, color Doppler assessment of jet, Doppler (CW)/hemodynamic estimates, age at onset, and intended use of horse. **Jet includes both the width of the regurgitant flow at the valve orifice (at the vena contracta) and the jet area relative to the receiving chamber area, in which case the “jet” likely includes entrained red blood cells. Width of the jet at the valve orifice is difficult to measure accurately due to dynamic, nonuniform, 3D structure at the vena contracta. Jet area is highly dependent on technical factors including ultrasound beam angle, transducer distance from the region of interest, transducer frequency, 2D and color gain and filter settings, pulse-repetition frequency, and image plane. ***Pressure half-time cannot be accurately measured unless the interrogating beam is maintained at a constant angle with the regurgitant jet. ****VSD diameter is for average 450–500 kg horse. VSD can change in size, be covered by aortic valve or tricuspid valve, is 3-dimensionally difficult to characterize and the edges may not be easy to measure. LA, left atrial; LV, left ventricular; PA, pulmonary artery; MR, mitral regurgitation; AF, atrial fibrillation; MVP, mitral valve prolapse; AVP, aortic valve prolapse; RCT, ruptured chorda tendinea; RA, right atrium; APCs, atrial premature complexes; AR, aortic regurgitation; VPCs, ventricular premature complexes; VT, ventricular tachycardia; VSD, ventricular septal defect.


§ AAEP PROCEEDINGS  Vol. 64  2018 95


Excellent Normal 2.5 cm 4.5 m/s Mild


Normal


Absent or small Absent or mild


Absent or mild, systolic only


Absent Absent Absent Absent


Fair or Uncertain Normal


2.5–3.5 cm 3.0–4.5 m/s Moderate


Hyperdynamic


Medium and restricting flow Moderate


Moderate, systolic only Absent, mild


Mild Absent Absent or mild


Guarded to Poor Bounding or weak 3.5 cm 3.0 m/s Severe


Hyperdynamic or decreased Severe Severe


Severe, systolic, and diastolic Present


Moderate to severe Present Present


Excellent Normal Normal


None, parallel fibrous band, mild AVP


Normal


Absent or mild Normal


One or two small and narrow jets


Long pressure half- time***


Absent Absent Absent Absent Absent Older


Fair Normal or slightly bounding


Nodular thickening, moderate AVP-suspected fenestration


Normal or mild enlargement; mild decrease in diastolic diameter


Mild to moderate Hyperdynamic


One or more medium sized jets


Moderate pressure half- time***


Absent or mild


Absent or preexisting Absent Absent


Preexisting Middle age


Guarded to Poor Bounding or weak


Pulse pressure 60 mmHg


Severe thickening or AVP, flail leaflet, endocarditis, congenital malformation


Mild to severe enlargement; moderate or severe decrease in diastolic diameter


Moderate to severe Hyperdynamic or decreased


Large single or large multiple jets Short pressure half-time*** Mild to severe


Secondary to AR Present


VPCs, VT may be present Secondary Young


Excellent Normal


None, mild MVP


Absent or mild Normal Normal Absent Normal


Absent Absent


One or multiple small & narrow jets


Absent Absent


Fair Normal


Mild thickening, moderate MVP, mild to moderate dysplasia


Mild to moderate


Normal or slightly rounded Normal Mild


Normal Absent


Absent


One or more medium sized jets Preexisting


Absent


Guarded to Poor Weak


Severe thickening, severe MVP, RCT, flail leaflet, endocarditis, severe dysplasia


Moderate to severe or progressive Might appear round and turgid Might be bulging towards RA Moderate to severe


Hyperdynamic, normal (less than expected) or decreased


Usually present Present or developing


Large single or large multiple jets Secondary


VPCs may be present


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