case_images: PMC6005283_01
case_images: Thoracic radiograph: left lateral thoracic view of the skeletally immature alpaca cria demonstrating mild loss of the cranial waist, distention of the caudal vena cava, and a mild diffuse unstructured interstitial pattern in the lungs warranting cardiac evaluation. A reduced cervical tracheal diameter is also evident.
case_images: CRIVEM2016-4609126.001.jpg
case_images: PMC6005283_01_CRIVEM2016-4609126.001.jpg
case_images: fig1
case_images: Standard lateral thoracic radiographs (evaluated by a board certified veterinary radiologist) revealed slight loss of cranial cardiac waist, distention of the caudal vena cava, and a mild diffuse interstitial lung pattern (Figure 1) without significant evidence of pulmonary venous congestion or overcirculation.
case_images: Two-dimensional echocardiographic images. (a) Right parasternal long axis view. Note the truncus arteriosus overriding the ventricular septal defect (star). (b) Right parasternal short axis view at the level of the heart base. Note the ventricular septal defect (star), atrial septal defect (asterisk), and lack of an obvious right ventricular outflow tract. LA, left atrium; RA, right atrium; RV, right ventricle; TA, truncus arteriosus.
case_images: CRIVEM2016-4609126.002.jpg
case_images: PMC6005283_01_CRIVEM2016-4609126.002.jpg
case_images: fig2
case_images: At the base of the IVS a large ventricular septal defect (VSD) was detected (Figure 2(a)). Additionally, a patent foramen ovale (PFO) was noted in the atrial septum (Figure 2(b)) and a single large artery overriding the VSD was also identified.
case_images: Two-dimensional echocardiographic images of agitated saline contrast study. Two-dimensional echocardiographic right parasternal image of an agitated saline contrast study demonstrating primarily right to left flow of bubbles across the large ventricular septal defect. LV, left ventricle; RV, right ventricle; TA, truncus arteriosus.
case_images: CRIVEM2016-4609126.003.jpg
case_images: PMC6005283_01_CRIVEM2016-4609126.003.jpg
case_images: fig3
case_images: Presence of bubbles from the right heart crossing the VSD into the left heart and main artery during systole confirmed the presence of a right to left shunting VSD (Figure 3; Supplementary Information: Video 1 and Video 2 in Supplementary Material available online at http://dx.doi.org/10.1155/2016/4609126).