One of my girls was recently echo'd and came back with a diagnosis of "equivocal". I have no idea what that really means and if I can breed her? She's got OFA Excellent hips/clear elbows, and eyes done, so I'd like to be able to breed her if possible.

TIA

That is very disturbing, I thought the whole point of doing an echo is to have a definative anwser. That result leaves one scratching their head. Useless wording for you ! Call the Vet that did the procedure and demand they get off the fence and give you a specific result !

You cannot "demand" that an examining cardiologist give you a pass or fail upon an equivocal finding. That is what "equivocal" means - there is no clear answer based upon the results of that exam.

An equivocal exam means that cardiac disease, whether congenital or acquired, cannot be definitively ruled-out (excluded) based on the results of testing. This term has caused considerable frustration for breeders, veterinarians, and veterinary cardiologists alike. An animal with an equivocal exam should not be bred since the available information cannot exclude the animal of potentially hereditary disease.

http://amccc.com/test/VSSF/cardiology_articles_cardio_clearance.html

Equivocal means that it is not clear as to whether the findings indicate heart disease. Did the cardiologist give you a diagnosis measurement sheet with the flow data through the valves? Was it a structural finding that caused the diagnosis? Or was it simply more flow than that vet considered normal? Did the heart have other structural deficiencies ie larger or size differences between the two sides? All of these are important to know as you make a decision on your girl.

Until there is a definitive test for TVD, the echo is the only means of finding out what is really going on in our dog's hearts. And, until that definitive test is available, we will have to negotiate a battlefield of land mines with labels of "equivocals", "clear", and "affected", or "cleared by auscultation" - which is not a clearance at all.

In the meantime, don't throw the baby out with the bath water. Equivocal just means that something - any number of things - is occurring in your girl's heart that is outside the currently accepted norms. That could mean that she has a higher than accepted level of regurgitation, a murmur, or a number of other conditions that would lead to an "equivocal" rating. The vet that did your girl's test should have given you some printouts showing pictures of the heart showing the flow, size of the heart, and other views, as well as printouts showing the actual flow rates, percentages of oxygenated blood vs non-oxygenated blood, and other statistics. He/she should also have provided a written document of his/her findings.

Here's where it gets tricky and I'm sure there are plenty that will disagree - so flame on, folks. IF there is no sign of cardiac disease (no stenosis, right heart is normal size) and there is no sign of valve abnormalities, then there is no reason to believe your bitch is at risk for TVD - depending on her age when she was echo'd. Since you said she was an OFA excellent, I'm assuming she was over 2 years old. At 2+ years old, she would be showing signs of cardiac disease. The heart is a miraculous organ, but its efforts to compensate for the failure of the TV to operate properly will show up - in murmurs, thickening of the ventricular walls, enlargement of the right heart, and other evident effects of the disease.

At this point, even the experts disagree - or have not calibrated - what is a 'normal and acceptable' level of regurgitation. To quote Lori Seimens, DVM, DACVIM, from her article, "Tricuspid Dysplasia :
A Cardiologist's Perspective":

"At this time, we are still trying to come to a consensus as to how much leakage is normal for a dog's tricuspid valve. With the advent of better ultrasound technology, we can detect even minute amounts of valvular regurgitation. two facts indicate that the presence of very mild amounts of regurgitation is a normal variation, ESPECIALLY IF THE VALVE ITSELF APPEARS NORMAL (emphasis added). The first is that we humans (one study found as many as 50% of the population) have small tricuspid leaks that are considered normal. Secondly, other breeds of dogs that are not predisposed to TVD have individuals with detectable amounts of tricuspid regurgitation. the major difficulty occurs when attempting to differentiate Labs with subtle TVD from those normal variations in valve anatomy and tricuspid regurgitation. Medicine has many "gray zones" and this issue is certainly one of them. For dogs that fall into this gray area, we give them a grading of "Equivocal" . . . The equivocal grade frustrates many breeders who desire a "yes or no" answer. Even human cardiologists experience the same dilemnas and are always reassessing what normal really is as newer technologies become available. The good news is that we are still advising that dogs with equivocal grades be bred, especially if they have cleared their other screening tests."

If you know your lines, and you know exactly what the cardiologist that performed the test found, then you take that information and make a determination about whether to breed your bitch or not. If you have a mentor you trust - listen to him/her - then make your own decision.

Years ago, there were lots of folks that screamed and yelled that any dog found to be Optigen B should NEVER be bred. Others that weren't so sure, listened to the naysayers and, as a result, there were a lot of good dogs that are now not part of the gene pool because of a faulty test. I'm not saying that an equivocal rating is like the Optigen B scare, but I am saying we don't know the whole answer yet. And I'm saying that, while the echo is the closest we can come to a definitive test for hearts at this time, it is not the end all/be all that it is frequently made out to be. While TVD is a very serious congenital defect, the screening for it is still just that - a tool to give you information to make the best decision for your dog and the for the breed.

Hopefully, one day soon, we will have a final and definitive test for TVD. Until then, we make the best decisions we can given the information we have.

Do dogs who have TVD have physical symptoms?
After reading this last post and how the heart is affected I was wondering if these dogs show any outward symptoms, do they have a shorter life expectancy. etc?
Thank you for any additional insight.

Yes, though the effects can range widely, depending on the severity of the regurgitation present. In severe cases, the puppy may never see his/her first birthday.

To learn more about this congenital defect, please go here: http://www.labbies.com/tvd.htm. The experts can do a far better job of describing the eventual effects than I can.

Okay, I read thru it..I had no idea that TVD affected dogs have life expectancy of 1-3 years. This gives me a better understanding of this disease-very sad.
Thank you for directing me here.

Actually a cardiac clearance by auscultation IS a clearance. You may not like it, or think it is worthless, but it IS a clearance. It is certainly better than not even checking the heart at all.

but no one who really wants to know the status of their dog(s) in their breeding program or to studs they care to use, will take anything less than an echo with color doppler. It is the golden standard if you 'really' want to know.

Okay - here's another question - would you breed to a stud dog with an equivocal rating? Can a dog get an OFA heart number with an equivocal diagnosis?

Well, then why is it accepted by the OFA to do a ausculation for the heart? I think your wrong, I know dogs that have the echo and color doppler and they have produced TVD. It's just a matter of opinion and until they have a genetic test for this, it is only a "opinion". So, don't say; "no one", that is just your opinion, not everyone's opinion.

Yes, a dog can get an OFA rating of normal with an equivocal rating -- I did it so know first hand.

also, why then do they still offer auscultation at the clinics if they are useless?

There are approx 150 board certified cardiologits in the USA. Call up any one of them and CAREFULLY ask the question properly.....

"is an Auscultation alone a 100% guarantee the dog being tested does not have TVD (or another heart issue). The answer will be NO 100% of the time.

Then ask.... "if you want a 100% guarantee the dog being tested is clear of these heart problems should an echo-doppler be done. 100% of the time the answer will be yes.

I am not speaking about who throws it or how it's passed. Im only speaking about any given dog being tested by auscultation vs echo/doppler

I have personally spoken to way too many cardiologists who say flat out not one cardiologist would ever say an Auscultation is enough. Every single one of them said it's the way the client is presenting the question, the way it's asked.

As far as why these tests are accepted... no different then human medicine. We have testing that is accepted but is no longer the golden standard.

From my understanding very few that pass auscultation done by a board certified cardiologist fail on echos. I have heard any where from 5% to 10%. Which really is a very small amount. In my opinion having an auscultation done by a cardiologist is better then breeding without an heart clearance at all. I would not trust a regular vet to do a heart clearance. I don't think they have enough experience. Very few vets have a total understanding of how to check for TVD in Labradors. Its very scary all the stud dogs standing at stud without any heart clearances done or just an auscultation done by a regular vet.

Until more people get serious about checking Hearts, then TVD is going to be more widespread. Over the years breeder have cut down on Hip and Elbow problems by checking breeding stock.

Yes, two echo clear parents can and still do produce heart problems. But if their parents, grandparents, etc were not checked there is a good chance someone back in the pedigree was affected. So until more breeders start testing, we will not know for sure exactly how many Labradors are truly affected by TVD. Some of the mild TVD cases will go undetected.

I was speaking about an Auscultation alone that some mild cases of TVD can be missed. I can't say for sure how many of these cases are missed by Cardiologist for sure. I am sure there are more cases missed by regular vets then by Board Certified Cardiologist.

Agree however, let's not forget to mention even with echo the cardiologist performing the study better know what he is looking at and how to use the machine. I have worked in Human Ultrasound, both general US for abd. pelvis pregnancy, vascular etc to echos....you would be amazed at how different radiologists "interpret" images. I am not making an argument against echo's by an means, but be careful when you start giving 100% guarantees.

That's an excellent point because they are several regular vets that are now doing Echos that have very little training. I do know the quality of the machine plays a big part in getting a quailty screening too. I wouldn't feel comfortable using just anyone to do an echo. I would want them to be board certified or be a specialist doing it for many, many years.

I was also told by a Cardiologist Echos aren't truly a 100% you could have an echo done at 2 yrs old and not have any heart disease but done the road have a heart problem with that same dog. Now my thinking is TVD should have been seen at 2 yrs on a echo because they say its congenital.

TVD can be diagnosed in newborn puppies that have died if and when a necropsy is done. The Cardiologists that I deal with it agree that via echo, TVD can be diagnosed in young puppies. They either have it or they don't. Other heart conditions may present themselves with age, but TVD is there from birth

While there are other heart conditions that are acquired with age and may not be detectable at an early age, TVD is not one of them. Sheila is correct in that TVD can be detected in a newborn through necropsy. The only benefit to waiting for a clearance until a dog is older is because of the whole "equivocal, clear, affected" issue. A rating of equivocal can only be ascertained as a safe breeding prospect if there is no abnormality to the valve itself and no accompanying signs of compensation by the heart - no stenosis, no enlargement of the right heart, no thickening of the ventricular walls, etc. These changes will only be seen at a later age. I would prefer to wait until at least 18 months, but later is better. Any of those changes would indicate that the tricuspid valve is indeed compromised and resulting heart disease is inevitable eventually. If there is no indication of heart disease, then the regurgitation that usually invokes an equivocal rating may be normal. Even the experts have not agreed on a definitive normal range at this time.

That is very true TVD is there at birth and from my understanding normally gets worse with age, enlarged heart, loud murmurs, etc. There is a gray area and no one seems to know how much leakage is normal when the valve is normal and no right side enlargement. So the big question is, how many of these dogs with a little bit of leakage is normal or not?? Every breed has some leakage. But no one seems to know what is truly normal and what is not normal. What one Cardiologist says is normal another one might say Equivocal. Its kind of like OFA and hip and elbow readings. Readings can vary from day to day. So I would think this could be the case with leakage. Seeing if the valve and there is no signs of enlargement of the heart.

Very sticky subject until they can develop a gene test or some type of for sure standard on the gray areas. It would be interesting to know how many labs have passed auscultation by a Broad Certified Cardiologist but failed on Echo.

I spoke in length with a Human Cardiologist at a top 10 hospital in the country who also has co publish with Vet. Cardiologist in the Journal of Veterinary Cardiology. I ask him about auscultation vs echo in help decreasing TVD in the breed, Since no genetic test is available. The problem he has with Echo right now is there is no standard to when it should be done. As above you may have a dog at 10 months be cleared but still have it. A standard needs to be set on when they are done as with OFA. The breed as a whole would more benefit from everyone doing auscultation, since way more would be picked up than missed and more likely everyone would do it. And any test is only as good as the person giving it.

In the 15th years I have been doing this I have run across so called Board Certified specialist, that have miss diagnosis way more than what my regular vet. Crap, I had an Ortho Board Certified Vet tell one of my puppy people their puppy had HD, second opinion with my regular vet and xrays to OFA come back OFA Excellent. This is veterinary medicine 101!
Just because they are a specialist does not make them any better at what they do.

He did say there is a blood test out there, only 2 labs across the country do it that can detect heart disease in dogs and gives a picture of their heart condition 5 or 10 years out. Good question to run across your Cardiologist, surely they would know about it, he does.

I am hoping for a genetic test, myself. Hopefully soon.

My cardiologist is very experienced. He said there is a cardiology panel that's trying to come up with a "standard". He said he's glad he's not on the panel.It's not black and white.