Canada (English)
Myxomatous mitral valve disease and heartworm infection
Identification and history
- Name: Miko
- Report and medical history: canine, Poodle, male, entire, 11 years old.
An 11-year-old intact male Poodle was referred for evaluation of a persistent, chronic cough that showed no improvement despite ongoing management. The patient tested positive for canine heartworm in February 2025 and has undergone the slow-kill treatment protocol since then. On auscultation, a grade IV/VI systolic heart murmur was detected.
Diagnostics
M-Mode measurements revealed left ventricular enlargement, as evidenced by an increased LVIDDn (1.8) value exceeding the normal reference range (<1.7).
Echocardiographic measurements demonstrated left atrial enlargement, supported by an elevated LA/Ao ratio of 1.88, which is above the normal limit (<1.6). This is consistent with chronic volume overload and the potential progression of underlying cardiac disease.
Color Doppler echocardiography revealed a mild-to-moderate mitral regurgitation jet, which was attributed to thickened mitral valve leaflets, suggesting degenerative changes consistent with myxomatous mitral valve disease. The recorded MR velocity was 1.5 m/s.
On the right parasternal long-axis 5-chamber view, these echogenic parallel lines within the dilated pulmonary artery are highly suggestive of the presence of adult Dirofilaria immitis.
On the right parasternal short axis view at the heart base, echogenic parallel lines suggestive of adult Dirofilaria immitis are seen within the main pulmonary artery and right ventricular outflow tract.
Pulmonary hypertension is suspected to be developing, as evidenced by a pulmonary regurgitation jet velocity of 2.88 m/s, generating a calculated pressure gradient of 33.3 mmHg, which falls within the range consistent with mild pulmonary hypertension.
Images were acquired with MyLab™Heron.
Conclusions and treatment
This case is consistent with Stage C myxomatous mitral valve disease concurrent with canine heartworm infection, with evidence suggestive of mild, developing pulmonary hypertension.
Management includes pimobendan, benazepril, and furosemide. The slow-kill protocol for heartworm disease is being maintained due to the unavailability of melarsomine in the country, which limits options for adulticidal therapy.
Paul A. Cardenio DVM, MS, DPCCP, DPCVS-CA, Medical Director, PetLandia Veterinary Clinic, City of Malolos, Bulacan, Philippines
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