Mild Pulmonary Stenosis with Severe Pulmonary Insufficiency

Amara Estrada, DVM, DACVIM (Cardiology) University of Florida

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A combination of systolic and diastolic murmurs (auscultated over the left heart base) is heard in this heart sound, following a balloon valvuloplasty for severe pulmonary valve dysplasia. 

The combination of a systolic ejection murmur with a diastolic decrescendo murmur is described as a to-and-fro murmur. The ejection component tapers in late systole, allowing recognition of S2 and differentiation from a continuous murmur. 

This dog had mild outflow tract obstruction with severe pulmonary insufficiency following the balloon valvuloplasty, resulting in systolic and diastolic murmurs with almost equal intensity (both grade 3/6).

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