A one-year-old French Bulldog was referred for the management of a severe form of pulmonary valve stenosis (PS) complicated by right-sided congestive heart failure.

Echocardiography showed severe valvular PS with right ventricular concentric hypertrophy, dilatation and severe right atrial enlargement. A pulmonary balloon valvuloplasty (PBV) was performed with a balloon-to-pulmonary annulus ratio of 1.36. Echocardiography immediately after PBV showed a significant reduction in right atrial and ventricular size, improved opening and mobility of the pulmonary valve leaflets, and a 75% reduction in the pulmonary pressure gradient from 158 mmHg pre-operative to 40 mmHg post-operative. The dog recovered well from anesthesia, but 2 h later, it suddenly showed severe respiratory distress. Focus cardiac ultrasound showed increased left cardiac size with echocardiographic signs of high left ventricular filling pressure. Bedside lung ultrasound showed diffuse numerous-to-confluent B lines, compatible with a severe alveolar-interstitial syndrome. The dog was treated with furosemide, helmet continuous positive airway pressure, and then mechanical ventilation but without success.

At post-mortem evaluation, histological examination of the lung showed diffuse, severe broncho-alveolar edema with mixed leukocyte, fibrin, and red blood cell infiltrate. Moreover, severe congestion and multifocal alveolar hemorrhages were evident. All findings were compatible with fatal acute lung injury after PBV secondary to pulmonary reperfusion-ischemia injury and increased pulmonary capillary hydrostatic pressure. Based on the present case, acute lung injury should be considered as a rare but serious complication of PBV.

一只一岁大的法国斗牛犬被转诊用于治疗并发右侧充血性心力衰竭的严重肺动脉瓣狭窄 (PS)。

超声心动图显示重度瓣膜 PS 伴右心室向心性肥大、扩张和重度右心房扩大。进行肺球囊瓣膜成形术 (PBV)，球囊与肺环的比率为 1.36。PBV 后立即进行的超声心动图显示右心房和心室大小显着减小，肺动脉瓣叶的开放性和活动性得到改善，肺压梯度从术前的 158 mmHg 降低到术后 40 mmHg 的 75%。这只狗从麻醉中恢复得很好，但2小时后，它突然出现了严重的呼吸窘迫。焦点心脏超声显示左心大小增加，超声心动图显示左心室充盈压高。床边肺部超声显示弥漫性多至汇合的 B 线，符合严重的肺泡间质综合征。狗用呋塞米治疗，头盔持续气道正压通气，然后机械通气，但没有成功。

在死后评估中，肺部组织学检查显示弥漫性严重的支气管肺泡水肿，伴有混合的白细胞、纤维蛋白和红细胞浸润。此外，严重的充血和多灶性肺泡出血很明显。所有发现都与继发于肺再灌注缺血损伤和肺毛细血管静水压增加的 PBV 后致命的急性肺损伤相符。基于目前的病例，急性肺损伤应被视为PBV罕见但严重的并发症。