hello and welcome to this first opinion veter ultrasound case I'm Dr Camila Edwards this was a King Charles Cavalier Spaniel who was 10 years old female intire she had a history of moderate systolic heart murmur with a point of maximum intensity on the left and it was also audible on the right hand side so here we have the long AIS view of um the heart we can see the left ventricle here uh the right ventricle here tricuspid valve here right atrium left atrium and mitro valves here and we can see the mitro valves appear a bit thickened here slightly better um where we've got a longer left fench Co um here so this is a better right parasal long AIS View and we can see the mitro valves opening and closing and that they're a bit thickened so we can apply Color flow mapping um at this angle where we're expecting flow to go from the left atrium to the left ventricle and we're looking for a regurgitation back into the left atrium it's not the best angle because we're at a right angle to the sound waves and really color flow mapping is looking at any flow towards or away from the probe so difficult to see a regurgitation on this view now rotated the probe slightly so we still got a right parisal long AIS view but this is a five chamber view so we've still got the left atrium here the mitro valves opening and closing left ventricle here and then the right side of the heart up here but we've also got the aortic outflow tract so we've got the aortic valves opening and closing here then we're rotating further to get the short AIS view so here we're looking um at the left ventricle in cross-section in short axis and when we tilt up we can get to the Lao view where we've got the A and the left atrium and the left Oracle here so on a moving image we can see the aortic valves opening and closing and we can see that left atrium here we can take a measurement to assess um how many a Alters we can fit into the left atrium and here it is under the 1.6 which would indicate an enlarged left atrium again looking at that short AIS view of the LA AO moving on to the left sided views of the heart we have the right side of the heart over here with a tricuspid valve there this is our left atrium with our mitro valves opening and closing and our left ventricle up here sometimes the aort is just popping into view here also so again we can see the mitro valves are are a little bit thickened this is a much better angle to place color flow mapping on to assess for regurgitation because we would expect normal flow to go from the left atrium into the left ventrical and if there is a vitation it will happen here away from the pro probe so what we expect is to see flow towards the probe so it should be red flow moving into the left ventricle and if we have a regurgitation it will be blue or turbulent flow into the left atrium and that's what we're seeing here we're seeing that regurgitation so the red flow is correct and then we're getting that blue and turbulent flow back into the left atrium so here we've got this regurgitation into the left atrium so in this case there was a mild regurgitation of the mital valve which was also thickened there was no obvious cardiac remodeling the left ventrical size and the left atrial size were within normal limits so we staged this as stage B1 mital valve degenerative valve disease and we recommend Ed a recheck of echocardiography in one year's time
