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Prognostic Variables in Canine Mitral Valve Disease
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Introduction
Myxomatous mitral valve disease (MMVD) is by far the most common heart disease in dogs. Its presence is often suspected by the presence of a typical systolic heart murmur in the middle-aged to old small to medium sized dog, and the diagnosis is usually supported by ancillary examinations such as echocardiography. Although the disease has been described and investigated ever since it was first described more than a century ago, there are surprisingly many aspects of it we still do not know, and the most important question is still to be answered. Which is (are) the primary inciting mechanism(s) that causes a dog to develop MMVD ? This important question is also unknown in the human form of the disease (e.g. mitral prolapse syndrome). It is likely that the exact genetic abnormality causing MMVD will be elucidated in the future, because the disease has been shown to be inherited as an autosomal inherited polygenetic threshold trait in dogs. However, if, and when, a genetic test is available, the experiences from other canine disease, such as progressive retinal atrophy have shown that managing the disease is simply not a matter of identifying genetically abnormal individuals. There is still a need for correctly identifying the diseased phenotype, and this requires stringent diagnostic criteria and skilled examinators. Furthermore, correctly identified diseased individuals need to be managed. Because of the high prevalence of the disease and the mode of inheritance in certain affected breeds, this work is likely to be present even after the exact genetic background of MMVD has been elucidated and a genetic test is available.
Diagnosis and prognosis
The diagnosis of mitral regurgitation (MR) caused by MMVD is often not complicated because the clinical and echocardiographic findings are obvious and match. There are, however, situations where the diagnosis of MMVD may be less obvious. Especially early stages may be difficult. It may not be clinically important for managing the patient to correctly diagnose these early stages, because the effect of mild MR on the circulation is minimal, and so is the likelihood that the disease will cause clinical signs in the near future. However, it is of great importance for breeding that these dogs are correctly diagnosed as the currently employed breeding programs are founded on the principle to exclude dogs [...]
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