Severe pulmonic stenosis in dogs: when to do valvuloplasty?
6-month-old asymptomatic Beagle with a grade 4/6 systolic murmur at the left base. Echocardiography: thin but fused pulmonic valve leaflets forming a dome (type A), post-stenotic dilation of the pulmonary trunk and right ventricular hypertrophy. Peak transpulmonary velocity: 5.5 m/s (gradient ≈ 120 mmHg). Normal coronary anatomy.
What is the most appropriate management?
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A. Pulmonary balloon valvuloplasty, ideally with prior beta-blocker treatment
Correct. With a gradient > 80 mmHg, balloon valvuloplasty is indicated even if the dog is asymptomatic. Type A valves (thin and fused) respond best. A beta-blocker reduces the dynamic infundibular obstruction that may remain after dilation.
B. Open-heart surgery as the first option
Surgical techniques (patch graft, valvulectomy) are more invasive and reserved for cases that fail balloon dilation or have unfavourable anatomy. They are not first choice.
C. Lifelong furosemide and pimobendan
There is no congestion to treat, and no drug reduces the valvular obstruction. Diuretics are only indicated if congestive heart failure develops.
D. Wait until signs of right-sided heart failure appear before intervening
By the time ascites or syncope appear, right ventricular hypertrophy and fibrosis are advanced and the risk of sudden death is higher. Severe stenosis is treated before signs appear.
lightbulb Key takeaway
Pulmonic stenosis is one of the most common congenital heart defects in dogs (English and French Bulldogs, Boxers, Beagles, Chihuahuas, Miniature Schnauzers, West Highland Terriers). With a gradient > 80 mmHg, balloon valvuloplasty lowers the gradient, improves signs and is associated with longer survival. In brachycephalics, rule out the anomalous coronary first.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.