Ok what do you think............
5 year old picture of health, no history of TVD or heart issue in the pedigree of any kind.
No murmur, rubs, or noises on auscultation.
Echo revealed ALL anatomy was normal (R/L atria & ventricals, including valves), normal myocardial function/contractility as well, BUT "slight", "small leak" mitral regurg. was found. I repeat all normal anatomy, NO heart damage at all........ no right heart enlargement..... Failed echo..........
Are there others out there that have had this happen?
I am sick............

Some of these sorts of issues are later onset tvd type problems which have nothing to do with heredity as it were.

If it was a Mitral valve regurgitation, then it isn't TVD. Maybe it's not inherited and may not even be a problem. Some regurgitation is normal in the Tricuspid. May be the same in the Mitral and it can be subjective as to whether or not it is a fail on Echo.

Don't throw the baby out with that bathwater yet. Get a second opinion.

Oops sorry meant "small leak in the tricuspid valve".... So sorry, I am pretty upset.
how come there are NO set flow parameters to what is normal and not? It is all subjective. No valve closes 100%.

Please contact me privately and I will share my experience with a very similar situation.

Look at Conner on my website. As others have said, get a second opinion. Yes, the amount of regurgitation that is allowable is subjective.

Also, join the TVD in Labrador Retrievers in Facebook. Tons of great info there.

Sadly, I have heard that this happens a lot and know quite a few breeders who have been exactly in your shoes. This is why echo is considered the 'gold standard' for detecting TVD. That said, I would highly suggest a second opinion and would like to know (if you'll post it) who did the echo and under what conditions (in an office or at a mobile clinic). I have had great success at mobile clinics but I trust the vet 100% and she always takes great care to ensure she calibrates her ultrasound machine prior to starting the first dog.

Good luck. And I'm sorry you're going through this!

Thank you for being empathetic towards my situation. I am so frustrated with this.....
It doesn't seem right, especially in a 5 year old dog.

Just had this happen last winter in a 6 year old bitch. Had been bred 4 times and this pops up when I retired her.
I kept nothing out of her but there are several offspring and grand offspring out there still being bred right now.
Owners were warned but chose to ignore. Oh well

Dear LTBreeder:
so sorry for the bad news on your girl...absolutely... get a second opinion from a board certified cardiologist, preferably one doing an ARCH exam. I work in a referral clinic with several cardiologists and other specialists. The cardiologists in our practice consider the ARCH exam/echo to be the “gold standard” of cardiac certification which allows breeders to screen for disease and for the cardiologists to gather data about both congenital and adult onset heart disease in dogs.
Auscultation alone is an insufficient tool to use in such a deep/wide bodied breed as the Labrador. You said that there was a"slight, small leak" and mitral regurgitation. (later explaining that you meant tricuspid regurgitation). Arch cardiologists assimilate
measurements and other necessary data to establish parameters of the various levels of regurgitative flow.
You said that "how come there are NO set flow parameters to what is normal and not? It is all subjective". This is exactly why an Arch exam is so important. Arch cardiologists compile all there data, measurements, findings, etc into a central data bank to establish exactly what degree of regurgitation is considered to be "normal", "slight", and so on.
The terms "slight" and "small" are subjective descriptions which should have a quantifiable measurement. The OFA uses similar terminology in describing hip and elbow dysplasia, but most people accept these terms, so "small" and "slight" should not be considered that arbitrary, especially if a board certified cardiologist used these
descriptions when explaining findings to you.
You also mentioned no history of cardiac problems in your pedigree. Unless all the individuals in the pedigree had similar diagnostic evaluations using echocardiography, you really do not know. This includes all offspring, siblings and other close relatives, regardless of whether they are for breeding or placed in pet homes.
Echocardiography is a relatively new and hugely underused diagnostic tool in the world of dog breeding. As breeders, we should try to get thorough cardiac exams and clearances on all our breeding stock before they are bred.

Are there any TVD problems with any of these offspring or grand offspring?

I do not believe he did an ARCH exam.... Where do I find a cardiologist that does these......

The ACVIM website might help you. Good luck.

http://acvim.org/websites/acvim/index.php?p=113

She produced it, yes. It is in a pet home.
I do not believe any of the offspring or grand offspring being bred out there have echos.
My point is, these people are breeding offspring of a TVD affected dam. Regardless of whether they are affected, I do not believe they should be bred.
But that's me.
They will likely change their tune once they produce a TVD affected dog.
It's really not my problem. I can sleep at night.

Since you've been so open about your girl's diagnosis and let the owners of her get know, have you posted the results on OFA? It's a free listing and it would be a wonderful piece of information for people considering breeding to or buying a puppy from those grandget to know.

I realize a lot of TVD talk turns into a fingerpointing witch hunt, but if more people were more open about their affected dogs at least people could go into breedings with a full picture.

I have bred to two dogs who have produced TVD. Those dogs are echo cleared as are my girls and so far, so are their get. Its just one piece of the puzzle for me. If a dog is bred enough, he will produce EVERYTHING!

.

I have bred to two dogs who have produced TVD. Those dogs are echo cleared as are my girls and so far, so are their get. Its just one piece of the puzzle for me. If a dog is bred enough, he will produce EVERYTHING![/quote]

I don't think we will ever know what causes this and it very simply be just mother nature and NOT genetic... In my mind some regurg is NORMAL... If there is no malformation and heart damage then the heart is not affect.... as stated above, 2 echo clear dogs produced it... how are you ever going to stop it????

Normal structure with slight regurg? It's not TVD. TVD describes the malformation of the tricuspid valve, the actual tie down of the valve to the heart wall. Your dog has no malformation of the TV valve, therefore doesn't have TVD.

I think you got scared by the regurgitation that very well could be normal.

By all means get a second opinion.

I'm not a vet, and none of us (other than the OP) actually saw the examination. But by definition if there is regurgitation, the valves do not fully meet when/where they should. If the board certified cardiologist says the dog does not pass echo and has TVD, how can you come on a public forum and tell the OP the dog does not have TVD? Sure, there is normal regurgitation. But there is also abnormal regurgitation which IS classified as TVD.

I do agree with the last statement though. I would most certainly get a second opinion!

I hope it all works out for you. Please come back and post the results of the second opinion either way, if you will!

In the report, the vet said "in my opinion, blank has occult tvd."
The word occult means hidden........?
So if my dogs has hidden tvd, how will we ever know if it is hidden ? LoL
All anatomy was normal... I agree w the poster that said about the defected valve.

Think of the term occult blood when testing for colon cancer. You can't see it, but there's a test to know its there and then it leads the doctor to a diagnosis. That's exactly what this means in the vet's report. And actually, that's the point of an echo and is exactly why we have a problem with TVD in our breed. So many cases are hidden, but the next generation is not. The hidden TVD is not heard on auscultation, but is seen with color doppler.

The OP obviously thought it was important to get an echo on his/her dog. This is one of the reasons it is the gold standard-- it picks up on abnormalities that are seen but not heard.

OK that right there says there is no TVD. THE VALVES WERE NORMAL. TVD= Tricuspid VALVE Dysplasia.

Dysplasia: — n
abnormal development of an organ or part of the body, including congenital absence

[C20: New Latin, from dys- + -plasia, from Greek plasis a moulding]

The real question is not whether there is TVD, but what is normal regurgitation.

Rather than second guess and be arm chair quarterbacks, we should take the expert diagnosis as it stands from the cardiologist who performed the examination. The OP stated that vet said "occult" TVD. The amount of regurgitation seemed to be the basis for his DX. Anonymous posters' opinions have no credence nor validity. The anonymous posters are not trained in cardiology, did not witness the exam nor ask questions of the examiner and therefore, their posts should not be given any consideration.

Please get a second opinion from a board certified cardiologist and post again with the findings. Good luck.

Thank you for a sane response. And if I were the OP, I'd be testing offspring and sibs!

To Anon,

Here are some examples of the medical definition of "occult", just so you might understand a little better before you go off half-cocked with your "expert" diagnosis.

occult /oc·cult/ (ŏ-kult´) obscure or hidden from view.
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

oc·cult (-klt, klt)
adj.
1. Hidden; concealed.
2. Detectable only by microscopic examination or chemical analysis.
3. Not accompanied by readily detectable signs or symptoms.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

Occult
Not visible or easily detected.
Mentioned in: Fecal Occult Blood Test
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

occult
[əkult′]
Etymology: L, occultare, to hide
hidden or difficult to observe directly, such as occult prolapse of the umbilical cord or occult blood.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

occult [ŏ-kult´]
obscure or hidden from view.
occult blood test examination by microscope or chemical test of a specimen (such as feces, urine, or gastric juice) for presence of blood that is not otherwise detectable. Feces are tested when intestinal bleeding is suspected but there is no visible evidence of blood.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

occult
obscure or hidden from view.
occult blood test
examination, microscopically or by a chemical test, of a specimen of feces, urine, gastric juice, etc., to determine the presence of blood not otherwise detectable. Feces are tested when intestinal bleeding is suspected but there is no visible evidence of blood in the stools.
occult heartworm infection
infection by Dirofilaria immitis in which circulating microfilariae cannot be detected in the peripheral blood by the usual test methods.

occult virus
the virus or infectious agent cannot be isolated but there is strong circumstantial evidence that it is present, e.g. scrapie prion.
Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved

occult
adjective Not obvious, hidden, of unknown cause noun
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

"Not accompanied by readily detectable signs or symptoms."

EXACTLY!

http://mykentuckyheart.com/information/TricuspidRegurgitation.htm

"Mild Tricuspid regurgitation may be detected in over 90% of the normal population by color Doppler echocardiogram. This is usually a benign finding and does not require any follow up or treatment. Virtually all of the normal population will have a mild degree of leakage in one, two, or three of the heart valves by echocardiogram. We call this physiologic regurgitation and many cardiologists prefer not to mention it to parents, as they may become concerned about a common and benign echocardiogram finding."

SOOOO, if mild regurg without valvular deformation or heart damage is found to be normal and NOT genetic in 90% of the human population, why do we expect our dogs to be bionic?

Apparently just the studs need to be perfect. The girls are never at fault.

"SOOOO, if mild regurg without valvular deformation or heart damage is found to be normal and NOT genetic in 90% of the human population, why do we expect our dogs to be bionic?"


Apparently just the studs need to be perfect.

Actually, in our breed valvular deformation is found to be genetic and many of us echo our girls too. In my small breeding program its my girls who have the most influence as they are producing the puppies I keep and the puppies I sell to pet owners and donate to service dog organizations. While the stud dogs may have the potential to have the most influence in our gene pool, its the girls in my kennel that have the most direct influence to my next generation.

No dog is perfect or expected to be perfect. But if I have a bitch who has some normal regurgitation, I'd like to have the opportunity to know what the stud is bringing to the equation as well.
JMHO.

What did this have to do with anything in the conversation?

NOT TVD on the mitral valve.....dog I have also has tiniest of leak, diagnosed "uniquivocal"........7 years later NO CHANGE...............

not bred

Do you mean unequivocal? Meaning having no doubt?

To the OP......I am sorry for your diagnosis :( If you are unsure or confused about it, get a second opinion and use a Dr. that does the ARCH exam. Since this is such a scary diagnosis to get, you might ask a trusted friend to go with you and take notes while the the exam is taking place. You might also contact the Cardiologist that did the first exam and ask him/her if he/she took measurements and saved the data so that they can be compared. My favorite Cardiologist writes down all of the measurements she takes and gives you a copy of them along with the OFA form.
Let us know if you re-test and what the results are.

That is very good advice Sheila. OP, you did the right thing having a color echo dopplar done.

Every one of my Labs that had echo dopplars done by cardiologist had the ARCH exam at no additional fee. The only fee is to send it in to ARCH. I think that is $15.

A particular cardiologist I used a couple of times, gave the *trivial* amounts of leakage in number form I would think for ARCH. The highest number I distinctly recall was 0.08.

Sure, every dog with a normal heart, that doesn't have TVD has a *trivial* or *miniscule* amount of leakage with no regurgitation found.

That is not what the OP's vet that did the echo called her dog's. To quote it, OP said *"slight", "small leak" mitral regurg.was found.*

TVD can appear on an echo dopplar without a valve abnormality appearing, just by having too much regurgitation. We do need ARCH to come up with a maximum number. If we don't do echo dopplars or send it into ARCH, then it's up to each vet to determine how much is too much leakage. Regurgitation is more than trivial or miniscule leakage.

OP, go for a 2nd opinion. Make sure the vet does the ARCH exam also assuming this was done by a cardiologist, not a practitioner or internist. If you get a 2nd fail, then you know for sure there absolutely is a problem you don't want to breed. We do 2nd opinons for ourselves, why not for our dogs especially when it's in regard to their hearts.

On a last note, if I hear 1 more breeder say they don't do echo dopplars because they can't afford it I will hurl. If we can't afford to do all the clearances necessary, we don't belong breeding those particular dogs. And I don't mean auscultation as not all TVD dogs have murmurs that can be heard. I will not breed a bitch without an echo color dopplar or breed to a stud dog that doesn't have one. It's the only way we can partially avoid the disease until there is a test.

I hope the next cardiologist you possibly use will explain the difference between trivial and a small leak with mitral valve regurgitation. Perhaps you should speak to Meg Sleeper for an explanation too; faxing the report to her.

On my all passing reports; so far all; fortunately the word regurgitation never appears.

While there is still no consensus among board-certified cardiologists about how much regurgitation is too much, this is a quote from Dr. Meg Sleeper concerning how she measures regurgitation:

"Color labeling of the blood flow allows us to "see" the leak and an assessment is made based on how much of the right atrium is filled by the back flow. I tend to use the terms trivial or trace (a few pixels of color), mild (<1/3 of the right atrium filled), moderate (>1/3 but < 2/3 of the right atrium filled) and severe (>2/3 of the right atrium filled). If the valve appears normal, but there is a trace or trivial leak, I will clear the dog. I think generally most cardiologists will label a dog as equivocal, even if the valve appears normal, with mild TR." - Dr. Meg Sleeper, June 2010

There are some well-known board-certified cardiologists that will diagnosis any regurgitation as "affected". There are some that are more conservative with the males than with females, since males can have a greater impact on the gene pool than the females. Most will tell you that if a dog is diagnosed as "equivocal" or "affected" based on trivial or mild regurgitation alone, to retest in 6 mos - 1 year. If there have been no changes in the heart, or obvious dysplasia of the tricuspid valve, they will clear the dog.

I would also like to reiterate that TVD is dysplasia (malformation) of the tricuspid valve (right side of the heart). Any changes, regurgitation, or dysplasia of the mitral valve is, by definition, not TVD. While MVD is common in some breeds, like the Cavalier King Charles Spaniel, it is not common in Labs.

Susan,

I recall you said you would retest in a year after having a fail and then an equivocal after. Did you retest at that time for a 3rd echo? If so, do you want to share the results. Do you think it's worth it to test 3 times or go for a 2nd opinion only when there are differing ratings?

I heard of a bitch tested 5 times to finally get a vet to pass her so she could be sold in California.

I will be taking Conner in for a retest when I take Gage in for his echo. I plan to do that sometime this fall, but haven't planned a trip to Richmond yet. My sister and I had planned to go in Oct (her for shopping, me for canine echos), but personal issues forced that to the back burner.

And, yes, the results of the third echo will be posted on my website, OFA, and in LabraData - whatever they may be.

I think there is a difference in getting a second opinion to validate differing diagnoses and shopping for the result you want to hear. Conner is neutered and, since I have been open about his whole experience, there is nothing to gain by just shopping for a clear, even if I were so inclined. He is going back to the same cardiologist that did his second echo.

Participating as a normal control for a research study of chemotherapy treatment, my then 11-year-old bitch received two echos spaced about a year apart. Both echos showed no valve dysplasia and no heart damage but "minimal" regurgitation. Both cardiologists said that her level of cardiac function was similar to that of a fit and healthy one-year-old dog despite her age.

She had had 3 litters, died at 13 of an unrelated
cancer, and did not produce any puppies with TVD. To know the significance of minimal regurgitation, this is the kind of data we need.

Have you ever done any other echo dopplers besides that study dog's 2 Kate? Just curious.