Coronary Arterial Compression Testing by Simultaneous Balloon Valvuloplasty and Coronary Angiography in an English Bulldog with Pulmonary Valve Stenosis

Abstract A 4-year-old male neutered English Bulldog presented for heart murmur evaluation. Echocardiography identified severe pulmonic stenosis (echocardiographic derived transpulmonary pressure gradient of 100 mmHg) and computed tomography confirmed the presence of an anomalous coronary artery with a prepulmonic course of the left coronary artery arising from the right coronary ostium. Prior to artificial pulmonic valve implantation, a coronary compression test was performed. Simultaneous aortic root angiogram and pulmonic balloon valvuloplasty revealed complete occlusion of the circumflex branch. Artificial valve implantation was aborted with concern for fatal coronary compression post-implantation. Coronary compression testing is a critical component of the evaluation prior to catheter-based implantation of conduits across the pulmonic valve.