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Eisenmenger's complex

icanis
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Introduction

  • Very little clinical data exists relating to Eisenmenger's COMPLEX in the dog.
  • All of the clinical material in this text relates to Eisenmenger's Syndrome/physiology Eisenmenger's syndrome.
  • Cause: rare congenital heart defect characterised by:
    • Ventricular septal defect (VSD) Ventricular septal defect.
    • Right ventricular hypertrophy.
    • Over-riding aorta.
    • Pulmonary hypertension present from birth.
  • It is more commonly found in large animal species, eg cattle and pigs.
  • Signs: include dyspnea, exercise intolerance, collapse, seizures, stunted growth, cyanosis, polycythemia Polycythemia: secondary and heart murmurs.
  • Treatment: palliative.
  • Prognosis: typically very poor.

Pathogenesis

Pathophysiology

  • Embryological developmental abnormality → VSD, conotruncal abnormality → over-riding (dextroposed) aorta and retention of high resistance pulmonary foetal vasculature with compensatory right ventricular hypertrophy.
  • Eisenmenger's complex has many similiarities with tetralogy of fallot Tetralogy of fallot but the difference is that in Eisenmenger's the RV outflow is not obstructed.
  • In tetralogy there are varying degrees of pulmonary stenosis and in one study both defects were found in the same family of Keeshounds, therefore they are probably related in terms of pathogenisis in the dog.
  • Left-to-right shunt from aorta to pulmonary artery (PDA) or left-to-right shunt across interventricular septal defect (VSD) → increased blood flow through pulmonary vasculature.
  • Increased pulmonary arterial and arteriolar pressure → stimulates progressive myointimal proliferation, endothelial degeneration, intimal fibrosis and hyalinzation → occlusion of pulmonary vessels ("pruning").
  • Right ventricular pressure exceeds left ventricular/systemic pressure → right-to-left shunting.
  • Deoxygenated blood is pumped into systemic circulation → cyanosis → hypoxia → stimulate erythropoietin release in kidneys → increased red blood cell production → polycythemia.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Ware W A & Bonagura J D (1988) Multiple congenital cardiac anomalies and Eisenmenger's syndrome in a dog. Comp Cont Ed Pract Vet 10 (8), 932-949 VetMedResource.
  • Noden D M & DeLahunta A (1985) The Embryology of Domestic Animals - Developmental Mechanisms and Malformations. The embryology of domestic animals. Developmental mechanisms and malformations pp.xvi + 367pp VetMedResource.
  • Feldman E C, Nimmo-Wilkie J S & Pharr J W (1981) Eisenmenger's syndrome in the dog - case reports. JAAHA 17 (3), 477-483 VetMedResource.
  • Nimmo-Wilkie J S & Feldman E C (1981) Pulmonary vascular lesions associated with congenital heart defects in three dogs. JAAHA 17 (3), 485-490 VetMedResource.
  • Van Mierop L H, Patterson D F & Schnarr W E (1977) Hereditary conotruncal septal defects in Keeshound dogs. Am J Cardiol 40 (6), 936-950 PubMed.

Other sources of information

  • Ettinger S J & Feldman E C (1995)Congenital heart disease.In:Textbook of Veterinary Internal Medicine. 4th edn. pp 892-943.

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