High-output cardiac failure in a dog secondary to hepatic vascular malformation

A 2-month-old, 8.5 kg (18.7 lb), entire, female Chesapeake Bay retriever presented for increased respiratory effort. Physical exam revealed a V/VI left basilar systolic heart murmur, mild dyspnoea and hepatomegaly. An echocardiogram revealed left-sided volume overload, evidence of moderate pulmonary hypertension, markedly distended hepatic veins and caudal vena cava, and increased aortic and pulmonary flow velocities in the absence of overt structural heart disease, which was suspicious for high-output cardiac failure. Thoracic radiographs revealed pulmonary oedema. An abdominal ultrasound revealed a hepatic vascular malformation. Medical management with furosemide was elected. A computed tomography was not pursued. The dog has done well over 9-month follow-up, with only one escalation in dose. Treatment of high-output cardiac failure in a dog secondary to a hepatic vascular malformation has not been previously reported. Intervention to attenuate flow through the hepatic vascular malformation or portocaval shunt could be considered; however, short-term treatment goals are controlling congestion.