* Common

 How is congenital heart disease detected?

 Murmur location.

 Pulse - hyperdynamic, normal, or attenuated?

 Innocent murmurs.

 "What if we don't do any tests?" Follow-up if client declines cardiac evaluation.

 Prognosis - identifying the problem and quantifying severity.

Treatment Options

PDA (common, left-to-right)^1–3

 Thoracotomy and ligation^1,2 (A)

 Any closure (thoracotomy and ligation, coils, plug, or occluder)³ (A)

Pulmonic stenosis^4–7

 Balloon valvuloplasty^4–6 (B)*

 Thoracotomy and direct surgical correction^4,7 (E)*

Subaortic stenosis⁸

 Surgical resection of stenotic tissue (open-heart)⁹ (E)

 Closed-heart surgical repair¹⁰ (D)

 Cutting balloon high-pressure dilation¹¹ (C)

 Balloon dilation¹² (C)

 Beta-blockers^13,14 (D)

Atrial septal defect, ventricular septal defect, AV canal

 Open surgical correction^15,16 (D)

 Pulmonary artery banding¹⁷ (C)

Cor triatriatum, Budd-Chiari syndrome¹⁸

 Thoracotomy and direct surgical correction^19–22 (C)

 Balloon dilation^23,24 (C)

Tetralogy of Fallot²⁵

 Open surgical correction^25,26 (C)

 Beta-blockers²⁷ (C)

Tricuspid or mitral dysplasia or stenosis

 Balloon dilation²⁸ (C)

 Open surgical correction (valve repair/replacement)²⁹ (C)

Vascular ring anomaly^30,31

 Surgical correction^30,31 (A)

Peritoneopericardial diaphragmatic hernia³² (PPDH)

 Surgical repair^32,33 (B)

Reversed (right-to-left) PDA

 Phlebotomy³⁴ (C)

 Anti-erythropoietic drugs³⁵ (C)

KEY

A.  Shown to increase longevity versus medical management or no treatment (large or multiple case series). "Clearly helps."

B.  Suspected to help clinical signs +/- longevity but unproven at this time (small case series or several case reports). "Looks like it clearly helps."

C.  Palliation of clinical signs noted after intervention, but small case series, no control subjects. "Helped in a few cases."

D.  No demonstrable effect on longevity; unclear benefit over no treatment (case reports, no controls, or conflicting evidence). "Can't tell if it helps."

E.  To date, shown to be inferior to other treatment or to no treatment. "Does not seem to help."

*  Only if stenosis due to fused valvular leaflets; excludes severe valve dysplasia, aberrant coronary artery.

References

1.  Eyster GE, Eyster JT, Cords GB, Johnston J. Patent ductus arteriosus in the dog: characteristics of occurrence and results of surgery in one hundred consecutive cases. J Am Vet Med Assoc. 1976;168:435–438.

2.  Birchard SJ, Bonagura JD, Fingland RB. Results of ligation of patent ductus arteriosus in dogs: 201 cases (1969–1988). J Am Vet Med Assoc. 1990;196:2011–2013.

3.  Saunders AB, Gordon SG, Boggess MM, Miller MW. Long-term outcome in dogs with patent ductus arteriosus: 520 cases (1994–2009). J Vet Intern Med. 2014;28:401–410.

4.  Ewey DM, Pion PD, Hird DW. Survival in treated and untreated dogs with congenital pulmonic stenosis. In: Proceedings from the 10th Annual Veterinary Medical Forum; May 28–31, 1992; San Diego, CA: 114. Abstract.

5.  Johnson MS, Martin M, Edwards D, French A, Henley W. Pulmonic stenosis in dogs: balloon dilation improves clinical outcome. J Vet Intern Med. 2004;18:656–662.

6.  Locatelli C, Spalla I, Domenech O, Sala E, Brambilla PG, Bussadori C. Pulmonic stenosis in dogs: survival and risk factors in a retrospective cohort of patients. J Small Anim Pract. 2013;54:445–452.

7.  Fingland RB, Bonagura JD, Myer CW. Pulmonic stenosis in the dog: 29 cases (1975–1984). J Am Vet Med Assoc. 1986;189:218–226.

8.  Kienle RD, Thomas WP, Pion PD. The natural clinical history of canine congenital subaortic stenosis. J Vet Intern Med. 1994;8:423–431.

9.  Orton EC, Herndon GS, Boon JA, Gaynor JS, Hackett TB, Monnet E. Influence of open surgical correction on intermediate-term outcome in dogs with subvalvular aortic stenosis: 44 cases (1991–1998). J Am Vet Med Assoc. 2000;216:364–367.

10. Dhokarikar P, Caywood DD, Ogburn PN, et al. Closed aortic valvotomy: a retrospective study in 15 dogs. J Am Animal Hosp Assoc. 1995;31:402–410.

11. Kleman ME, Estrada AH, Maisenbacher HW 3rd, Prošek R, Pogue B, Shih A, Paolillo JA. How to perform combined cutting balloon and high pressure balloon valvuloplasty for dogs with subaortic stenosis. J Vet Cardiol. 2012;14:351–361.

12. DeLellis L, Thomas WP, Pion PD. Balloon dilation of congenital subaortic stenosis in the dog. J Vet Intern Med. 1993;7:153–162.

13. Meurs KM, Lehmkuhl LB, Bonagura JD. Survival times in dogs with severe subvalvular aortic stenosis treated with balloon valvuloplasty or atenolol. J Am Vet Med Assoc. 2005;227:420–424.

14. Eason BD, Fine DM, Leeder D, Stauthammer C, Lamb K, Tobias AH. Influence of beta blockers on survival in dogs with severe subaortic stenosis. J Vet Intern Med. 2014;28:857–862.

15. Monnet E, Orton EC, Gaynor J, Boon J, Peterson D, Guadagnoli M. Diagnosis and surgical repair of partial atrioventricular septal defects in two dogs. J Am Vet Med Assoc. 1997;211:569–572.

16. Braden TD, Appleford MA, Hartsfield SM, et al. Correction of a ventricular septal defect in a dog. J Am Vet Med Assoc. 1972;161:507–512.

17. Eyster GE, Whipple RD, Anderson LK, et al. Pulmonary artery banding for ventricular septal defect in dogs and cats. J Am Vet Med Assoc. 1977;170:434–438.

18. Duncan RB, Freeman LE, Jones J, Moon M. Cor triatriatum dexter in an English bulldog puppy: case report and literature review. J Vet Diagn Invest. 1999;11:361–365.

19. Kaufman AC, Swalec KM, Mahaffey MB. Surgical correction of cor triatriatum dexter in a puppy. J Am Animal Hosp Assoc. 1994;30:157–161.

20. Wander KW, Monnet E, Orton EC. Surgical correction of cor triatriatum sinister in a kitten. J Am Animal Hosp Assoc. 1998;34:383–386.

21. Tobias AH, Thomas WP, Kittleson MD, Komtebedde J. Cor triatriatum dexter in two dogs. J Am Vet Med Assoc. 1993;202:285–290.

22. Malik R, Hunt GB, Chard RB, Allan G. Congenital obstruction of the caudal vena cava in a dog. J Am Vet Med Assoc. 1990;197:880–882.

23. Adin DB, Thomas WP. Balloon dilation of cor triatriatum dexter in a dog. J Vet Intern Med. 1999;13:617–619.

24. Atkins CE, DeFrancesco T. Regarding balloon dilation of cor triatriatum dexter in a dog (letter). J Vet Intern Med. 2000;14:471–472.

25. Ringwald RJ, Bonagura JD. Tetralogy of Fallot in the dog: clinical findings in 13 cases. J Am Animal Hosp Assoc. 1988;24:33–43.

26. Lew LJ, Fowler JD, McKay R, Egger CM, Rosin MW. Open-heart correction of tetralogy of Fallot in an acyanotic dog. J Am Vet Med Assoc. 1998;213:652–657.

27. Eyster GE, Anderson LK, Sawyer DC, Chaffee A, Steinfeldt B. Beta adrenergic blockade for management of tetralogy of Fallot in a dog. J Am Vet Med Assoc. 1976;169:637–639.

28. Brown WA, Thomas WP. Balloon valvuloplasty of tricuspid stenosis in a Labrador retriever. J Vet Intern Med. 1995;9:419–424.

29. White RN, Stepien RL, Hammond RA, et al. Mitral valve replacement for the treatment of congenital mitral dysplasia in a bull terrier. J Small Anim Pract. 1995;36:407–410.

30. Muldoon MM, Birchard SJ, Ellison GW. Long-term results of surgical correction of persistent right aortic arch in dogs: 25 cases (1980–1995). J Am Vet Med Assoc. 1997;210:1761–1763.

31. Shires PK, Liu W. Persistent right aortic arch in dogs: a long-term follow-up after surgical correction. J Am Anim Hosp Assoc. 1981;17:773–776.

32. Punch PI, Slatter DH. Diaphragmatic hernias. In: Slatter DH, ed. Textbook of Small Animal Surgery. Philadelphia, PA: WB Saunders; 1985:869–885.

33. Bellah JR, Whitton DL, Ellison GW, Phillips L. Surgical correction of concomitant cranioventral abdominal wall, caudal sternal, diaphragmatic, and pericardial defects in young dogs. J Am Vet Med Assoc. 1989;195:1722–1726.

34. Côté E, Ettinger SJ. Long-term clinical management of right-to-left ("reversed") patent ductus arteriosus in three dogs. J Vet Intern Med. 2001;15(1):39–42.

35. Moore KW, Stepien RL. Hydroxyurea for treatment of polycythemia secondary to right-to-left shunting patent ductus arteriosus in 4 dogs. J Vet Intern Med. 2001;15:418–421.