ABSTRACT
BACKGROUND: Subaortic stenosis (SAS) is one of the most common congenital cardiac defects in dogs. Severe SAS frequently is treated with a beta adrenergic receptor blocker (beta blocker), but this approach largely is empirical. OBJECTIVE: To determine the influence of beta blocker treatment on survival time in dogs with severe SAS. METHODS: Retrospective review of medical records of dogs diagnosed with severe, uncomplicated SAS (pressure gradient [PG] ≥80 mmHg) between 1999 and 2011. RESULTS: Fifty dogs met the inclusion criteria. Twenty-seven dogs were treated with a beta blocker and 23 received no treatment. Median age at diagnosis was significantly greater in the untreated group (1.2 versus 0.6 years, respectively; P = .03). Median PG at diagnosis did not differ between the treated and untreated groups (127 versus 121 mmHg, respectively; P = .2). Cox proportional hazards regression was used to identify the influence of PG at diagnosis, age at diagnosis, and beta blocker treatment on survival. In the all-cause multivariate mortality analysis, only age at diagnosis (P = .02) and PG at diagnosis (P = .03) affected survival time. In the cardiac mortality analysis, only PG influenced survival time (P = .03). Treatment with a beta blocker did not influence survival time in either the all-cause (P = .93) or cardiac-cause (P = .97) mortality analyses. CONCLUSIONS: Beta blocker treatment did not influence survival in dogs with severe SAS in our study, and a higher PG at diagnosis was associated with increased risk of death.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Aortic Stenosis, Subvalvular/veterinary , Dog Diseases/drug therapy , Age Factors , Animals , Aortic Stenosis, Subvalvular/diagnostic imaging , Aortic Stenosis, Subvalvular/drug therapy , Aortic Stenosis, Subvalvular/mortality , Dog Diseases/diagnostic imaging , Dog Diseases/mortality , Dogs , Echocardiography, Doppler/veterinary , Female , Male , Proportional Hazards Models , Retrospective Studies , Survival AnalysisABSTRACT
Discrete membraneous subaortic stenosis is an uncommon cause of left ventricular outflow tract obstruction. Although its relationship to infective endocarditis is well defined, the expected site of vegetation is over the aortic valve. We report on a 46-year-old man who had a discrete membranous subaortic stenosis, complicated with infective endocarditis, in which the vegetation was over the subaortic membrane and the aortic valve was spared. To our knowledge, this is the first reported case of that entity.
Subject(s)
Aortic Stenosis, Subvalvular/complications , Aortitis/complications , Endocarditis/complications , Anti-Bacterial Agents/therapeutic use , Aortic Stenosis, Subvalvular/drug therapy , Aortitis/drug therapy , Endocarditis/drug therapy , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
OBJECTIVE: To determine survival times in dogs with severe subvalvular aortic stenosis (SAS) treated by means of balloon valvuloplasty or with atenolol, a beta-adrenoceptor blocking drug. DESIGN: Prospective study. ANIMALS: 38 dogs < 24 months old with severe SAS (peak systolic pressure gradient > or = 80 mm Hg). PROCEDURE: 10 dogs underwent balloon valvuloplasty and were reexamined 6 weeks later to determine the feasibility of the procedure. The remaining 28 dogs were randomly assigned to undergo balloon valvuloplasty (n = 15) or to be treated with atenolol long term (13) and were reexamined annually for 9 years or until the time of death. RESULTS: For the first 10 dogs, mean pressure gradient 6 weeks after balloon valvuloplasty (mean +/- SD, 119 +/- 32.6 mm Hg) was significantly decreased, compared with mean baseline pressure gradient (167 +/- 40.1 mm Hg). Median survival time for dogs that underwent balloon valvuloplasty (55 months) was not significantly different from median survival time for dogs treated with atenolol (56 months). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that balloon valvuloplasty can result in a significant decrease in the peak systolic pressure gradient in dogs with severe SAS, at least for the short term. No clear benefit in survival times was seen for dogs that underwent balloon valvuloplasty versus dogs that were treated with atenolol.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Aortic Stenosis, Subvalvular/veterinary , Atenolol/therapeutic use , Catheterization/veterinary , Dog Diseases/therapy , Animals , Aortic Stenosis, Subvalvular/drug therapy , Aortic Stenosis, Subvalvular/therapy , Blood Pressure/physiology , Catheterization/methods , Dog Diseases/drug therapy , Dogs , Female , Male , Prospective Studies , Survival AnalysisSubject(s)
Adrenergic beta-Antagonists/therapeutic use , Angina Pectoris/drug therapy , Aortic Stenosis, Subvalvular/drug therapy , Arrhythmias, Cardiac/drug therapy , Blood Pressure/drug effects , Catecholamines/antagonists & inhibitors , Coronary Disease/drug therapy , Humans , Intraocular Pressure/drug effects , Migraine Disorders/prevention & control , Pheochromocytoma/drug therapy , Propranolol/therapeutic use , United StatesSubject(s)
Aortic Stenosis, Subvalvular/drug therapy , Cardiomyopathy, Hypertrophic/drug therapy , Disopyramide/therapeutic use , Pyridines/therapeutic use , Administration, Oral , Adult , Aortic Stenosis, Subvalvular/physiopathology , Disopyramide/administration & dosage , Echocardiography , Female , Hemodynamics , Humans , Injections, Intravenous , Male , Middle AgedABSTRACT
The hemodynamic and clinical effects of verapamil administration were examined in patients with hypertrophic cardiomyopathy. Infusion of 0.021 mg/kg/min of verapamil decreased the basal left ventricular outflow tract gradient from 94 +/- 14 to 49 +/- 14 mm Hg, while cardiac index increased from 2.5 +/- 0.2 to 2.8 +/- 0.2 L/min/sq m. Orally administered, 80 or 120 mg four times daily (QID), increased exercise capacity relative to placebo by 26% (1.6 +/- 0.5 minute; p less than 0.005) and propranolol, 40 or 80 mg QID, increased it by 21 +/- 8% (1.3 +/- 0.5 minute, p less than 0.025). Nine patients considered their symptomatic status "best" while receiving verapamil, seven while receiving placebo, and only three while receiving propranolol. Seventy-three patients have been discharged from the hospital receiving long-term verapamil therapy, and 49 have reported continuing symptomatic benefit with many showing improved exercise capacity up to two years later. Thus, verapamil can improve exercise capacity and symptomatic status in certain patients with hypertrophic cardiomyopathy, thereby providing physicians with a new therapeutic agent for the treatment of this disorder.
Subject(s)
Aortic Stenosis, Subvalvular/drug therapy , Cardiomyopathy, Hypertrophic/drug therapy , Verapamil/therapeutic use , Adult , Aged , Blood Pressure , Cardiac Output , Cardiomyopathy, Hypertrophic/physiopathology , Clinical Trials as Topic , Double-Blind Method , Female , Heart Rate , Humans , Male , Middle Aged , Physical Exertion , Placebos , Verapamil/adverse effectsABSTRACT
The clinical and haemodynamic features of obstructive cardiomyopathy with hypertrophic subaortic stenosis in a 12-yr-old boy are examined. A cardiac souffle had been present for 10 yr and precordial pain, cardiopalmus and effort dyspnoea for 5-6 yr. Familial association, ischaemic and pseudonecrotic ECG changes, and signs of left ventricle hypertrophy were noted. Left catheterisation and ventriculography showed obstructive hypertrophy of the muscle, two chambers with filling at 160/10 and ejection at 120/10, and slight regurgitation into the left trium. Treatment with 0.2-0.5 mg/kg/day propranolol.
Subject(s)
Aortic Stenosis, Subvalvular/complications , Cardiomyopathy, Hypertrophic/complications , Propranolol/therapeutic use , Aortic Stenosis, Subvalvular/drug therapy , Cardiomyopathy, Hypertrophic/drug therapy , Child , Humans , MaleSubject(s)
Adrenergic beta-Antagonists/therapeutic use , Adrenergic beta-Antagonists/administration & dosage , Age Factors , Aortic Stenosis, Subvalvular/drug therapy , Arrhythmias, Cardiac/drug therapy , Child , Humans , Hypertension/drug therapy , Hyperthyroidism/drug therapy , Pheochromocytoma/drug therapyABSTRACT
Propranolol is a beta-adrenergic blocking drug with a wide spectrum of use and may diverse pharmacologic effects. This case report is an example of a parturient who was on a large dose of propranolol for idiopathic hypertrophic subaortic stenosis. The effects of this drug on pregnancy, labor, and above all, the fetus are discussed.
Subject(s)
Aortic Stenosis, Subvalvular/drug therapy , Cardiomyopathy, Hypertrophic/drug therapy , Pregnancy Complications, Cardiovascular/drug therapy , Propranolol/pharmacology , Adult , Anesthesia, Local , Anesthesia, Obstetrical , Cardiovascular System/drug effects , Female , Fetus/drug effects , Humans , Infant, Newborn , Labor, Obstetric/drug effects , Pregnancy , Propranolol/therapeutic useABSTRACT
A case is presented of a low birth weight infant born prematurely with depressed respiration, sinus bradycardia, and hypoglycemia associated with maternal propranolol therapy during pregnancy and up until labor and delivery. The need for caution in the casual use of propranolol during pregnancy in an asymptomatic patient with IHSS and the potential fetal complications are emphasized.
Subject(s)
Aortic Stenosis, Subvalvular/drug therapy , Cardiomyopathy, Hypertrophic/drug therapy , Fetus/drug effects , Pregnancy Complications, Cardiovascular/drug therapy , Propranolol/adverse effects , Adult , Female , Heart Rate/drug effects , Humans , Hypoglycemia/chemically induced , Infant, Low Birth Weight , Infant, Newborn , Male , Maternal-Fetal Exchange , Placenta/drug effects , Pregnancy , Propranolol/therapeutic use , Respiration/drug effectsABSTRACT
To determine the effectiveness of oral propranolol in children, we administered 0.5 to 4.0 mg/kg/day of the drug to 64 children (age one day to 20 years); 41 with cardiac dysrhythmias, six with isiopathic hypertrophic subaortic stenosis, and 17 with paroxysmal hypoxemic spells associated with right ventricular infundibular obstruction. A new liquid form of propranolol (10 mg/ml) was administered to 37 of the younger patients, and tablets were given to the other 27. Propranolol improved the dysrhythmia in 31 of 41 patients, being notably effective in supraventricular tachycardia and ventricular tachycardia associated with a prolonged QT interval. The drug also eliminated symptoms attributed to IHSS in six of six patients and abolished hypoxemic spells in 12 of 17. The liquid and tablets were equally effective; and the liquid had the advantage of allowing for accurate dose changes in younger children. We conclude that oral propranolol is an excellent drug for use in pediatric patients with certain types of cardiac disease.
Subject(s)
Propranolol/administration & dosage , Adolescent , Adult , Aortic Stenosis, Subvalvular/drug therapy , Arrhythmias, Cardiac/drug therapy , Child , Child, Preschool , Electrocardiography , Heart Ventricles , Humans , Hypoxia/drug therapy , Infant , Infant, Newborn , Propranolol/adverse effects , Propranolol/therapeutic use , Tablets , Tachycardia/drug therapySubject(s)
Aortic Stenosis, Subvalvular , Cardiomyopathy, Hypertrophic , Adrenergic beta-Antagonists/therapeutic use , Aortic Stenosis, Subvalvular/diagnosis , Aortic Stenosis, Subvalvular/drug therapy , Cardiomyopathy, Hypertrophic/drug therapy , Digitalis Glycosides/therapeutic use , Diuretics/therapeutic use , HumansABSTRACT
The coexistence of pregnancy and idiopathic hypertrophic subaortic stenosis is a potentially dangerous combination. We report a 23-year-old white woman with idiopathic hypertrophic subaortic stenosis and pregnancy who presented with severe symptoms (Class IV) and modest outflow obstruction associated with marked mitral regurgitation. After delivery, the evidence for significant mitral regurgitation regressed, while the outflow obstruction seemed unchanged. However, she returned to Functional Class II. We review the mechanisms by which pregnancy and labor may alter the hemodynamics of idiopathic hypertrophic subaortic stenosis and we discuss recommendations for the management of these patients during pregnancy, labor, and the immediate postpartum period. We conclude that despite increasing symptoms, most women with diopathic hypertrophic subaortic stenosis can tolerate pregnancy and a vaginal delivery.
