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Corda A, Corda F, Pentcheva P, Puci M, Mollica A, Gomez Ochoa P, Dabbagh T, Pinna Parpaglia ML. The echocardiographic pulmonary to left atrial ratio: A noninvasive variable for the hemodynamic classification of pulmonary hypertension in dogs. J Vet Intern Med 2024; 38:2064-2075. [PMID: 38715386 PMCID: PMC11256189 DOI: 10.1111/jvim.17097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/18/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Hemodynamic classification of pulmonary hypertension (PH) has important clinical implications. However, only a few echocardiographic variables have been used to hemodynamically classify PH in dogs. OBJECTIVE To evaluate the echocardiographic pulmonary to left atrial ratio index (ePLAR) in dogs with PH. ANIMALS Forty-six dogs with intermediate to high probability of PH. METHODS Cross-sectional study. Variables were compared between dogs with precapillary PH [PrePH (n = 24)] vs postcapillary PH [PostPH (n = 22)], and with combined PH [CombPH (n = 14)] vs isolated PH [IsoPH (n = 8)] using the t-, Mann-Whitney, Pearson's Chi, or Fisher's exact test. The receiver operating characteristic curve and Youden index were used to identify the optimal ePLAR cutoff value to differentiate among the groups, intraclass correlation coefficients (ICC) were used to determine the reliability of measurements. RESULTS The mean (SD) ePLAR of the PrePH was higher than that of the PostPH group [0.36 (0.13) vs 0.26 (0.09), respectively; P = .005]. The median (interquartile range) ePLAR of the CombPH was higher than that of the IsoPH subgroup [0.29 (0.24-0.38), vs 0.20 (0.16-0.23), respectively; P = .001]. The best cutoff value of ePLAR for identifying IsoPH was <0.245 [AUC at cutoff point = 0.86; sensitivity (95% confidence interval [CI]) = 0.71 (0.47-0.95); specificity (95% CI) = 1 (0.76-1)]. The ICC analysis indicated a high degree of reliability. CONCLUSIONS AND CLINICAL IMPORTANCE ePLAR can be considered a valid noninvasive variable to hemodynamically classify PH in dogs with an intermediate to high probability of PH. Assessment of ePLAR can be useful in the therapeutic management of PH in dogs.
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Affiliation(s)
- Andrea Corda
- Veterinary Teaching Hospital, Department of Veterinary MedicineUniversity of SassariSassariItaly
| | - Francesca Corda
- Veterinary Teaching Hospital, Department of Veterinary MedicineUniversity of SassariSassariItaly
| | - Plamena Pentcheva
- Veterinary Teaching Hospital, Department of Veterinary MedicineUniversity of SassariSassariItaly
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistic Unit, Department of Medicine, Surgery and PharmacyUniversity of SassariSassariItaly
| | - Alessandra Mollica
- Veterinary Teaching Hospital, Department of Veterinary MedicineUniversity of SassariSassariItaly
| | | | - Thouraya Dabbagh
- Veterinary Teaching Hospital, Department of Veterinary MedicineUniversity of SassariSassariItaly
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Ban K, Bini G, Herrold E, Stavri A, Winter R. Anaesthetic management of a dog with a bidirectionally shunting patent ductus arteriosus and concurrent pulmonary hypertension. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kaitlynn Ban
- Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USA
| | - Gianluca Bini
- Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USA
| | - Emily Herrold
- Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USA
| | - Alba Stavri
- Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USA
| | - Randolph Winter
- Department of Small Animal Clinical Sciences Auburn University College of Veterinary Medicine Auburn Alabama USA
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Hogan DF, Goldfeder GT. Transarterial correction of patent ductus arteriosus in small dogs with the Amplatz™ Vascular Plug 4: A pilot study. J Vet Cardiol 2021; 35:48-54. [PMID: 33813218 DOI: 10.1016/j.jvc.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Determine if the Amplatz™ Vascular Plug 4 (AVP4) can be used to occlude left-to-right shunting patent ductus arteriosus (PDA) in dogs with inadequate arterial vascular access for the Amplatz Canine Duct Occluder (ACDO). ANIMALS Six adolescent dogs with PDA whose femoral artery was too small for insertion of a 4 Fr vascular access sheath. MATERIALS AND METHODS Standard femoral arterial vascular access and a 4 Fr diagnostic catheter were used to deploy an appropriately sized AVP4 into the PDA of each dog. Successful occlusion was defined as no residual ductal flow and determined by color Doppler echocardiography and angiography. RESULTS The AVP4 was successfully deployed, and complete occlusion of the PDA was achieved in all dogs. There were no complications encountered in any of the dogs. CONCLUSIONS The AVP4 is a viable option for the correction of PDA in dogs with inadequate arterial vascular access for the ACDO and should be considered as one of the options available for PDA correction in this challenging animal population.
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Affiliation(s)
- D F Hogan
- Professor of Cardiology, Purdue University, College of Veterinary Medicine, Department of Veterinary Clinical Sciences-Lynn Hall, 625 Harrison Street, West Lafayette, IN, 47907-2026, USA.
| | - G T Goldfeder
- Clinical Director, Goldfeder & Dos Santos Cardiologia Veterinária, 121 Quitanduba Street, São Paulo, SP, 05516-030, Brazil
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Winter RL, Remaks JD, Newhard DK. Development of Spontaneous Echocardiographic Contrast After Transarterial Occlusion of a Patent Ductus Arteriosus in an Adult Dog With Concurrent Pulmonary Hypertension. Front Vet Sci 2020; 7:103. [PMID: 32175342 PMCID: PMC7054289 DOI: 10.3389/fvets.2020.00103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/11/2020] [Indexed: 11/23/2022] Open
Abstract
An 8-year-old intact female Chihuahua was presented for evaluation and possible occlusion of a previously diagnosed patent ductus arteriosus (PDA). Transthoracic echocardiography revealed left ventricular and left atrial enlargement, enlargement of the main pulmonary artery, and a PDA with bidirectional shunting. Tricuspid regurgitant velocities suggested moderate pulmonary hypertension. The PDA was occluded with an Amplatz® Canine Duct Occluder using a transarterial approach on the following day. No immediate complications were observed other than an acute decrease in left ventricular systolic function. One day after the PDA occlusion transthoracic echocardiography revealed no residual ductal flow, but there was spontaneous echocardiographic contrast in the left ventricle. The patient was discharged with sildenafil, pimobendan, and clopidogrel. Five weeks later when the patient was presented for a recheck examination, the previously documented spontaneous echocardiographic contrast was no longer present. Finding spontaneous echocardiographic contrast in the dog has not previously been reported in association with PDA occlusion.
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Affiliation(s)
- Randolph L Winter
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Julia D Remaks
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Auburn University, Auburn, AL, United States
| | - Daniel K Newhard
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Auburn University, Auburn, AL, United States
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Reinero C, Visser LC, Kellihan HB, Masseau I, Rozanski E, Clercx C, Williams K, Abbott J, Borgarelli M, Scansen BA. ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs. J Vet Intern Med 2020; 34:549-573. [PMID: 32065428 PMCID: PMC7097566 DOI: 10.1111/jvim.15725] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023] Open
Abstract
Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.
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Affiliation(s)
- Carol Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Heidi B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Medford, Massachusetts
| | - Cécile Clercx
- Department of Clinical Sciences of Companion Animals and Equine, University of Liège, Liège, Belgium
| | - Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Rodgers KC, Arnold AE, Newhard DK, Cline K, Winter RL. What Is Your Diagnosis? J Am Vet Med Assoc 2018; 252:649-652. [PMID: 29504862 DOI: 10.2460/javma.252.6.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abbott JA, Gentile-Solomon JM. Measurement Variation and Repeatability of Echocardiographic Variables Used to Estimate Pulmonary Artery Pressure in Dogs. J Vet Intern Med 2017; 31:1622-1628. [PMID: 29031025 PMCID: PMC5697183 DOI: 10.1111/jvim.14846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/09/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022] Open
Abstract
Background Pulmonary hypertension (PH) is an important clinical entity in dogs. Pulmonary hypertension is generally identified based on echocardiographic findings, but measurement variation of the variables most often used in this context has not been reported. Objective To define measurement variation of echocardiographic variables that are used to estimate pulmonary artery pressure. Animals Four dogs with subclinical tricuspid valve regurgitation were selected from a hospital population. Methods Prospective descriptive study ‐ dogs were subject to repeated echocardiographic examination by 2 operators. Each dog was echocardiographically examined 12 times, once by each operator during mornings and afternoons of 3 nonconsecutive days. Measurement variation was defined by coefficients of variation and by mean square errors (MSE) from ANOVA models. Repeatability coefficients (RC) were calculated from MSE. Results Of 50 within‐day, between‐day, and interoperator coefficients of variation (CVs), 37 were less than 10% and 46 were less than 15%. The range of peak velocity of tricuspid valve regurgitation (VTR) VTR was 1.87–3.34 m/s. Analysis of variance revealed a significant effect (P < 0.05) of operator for 7 of 10 measurements. Within‐operator/between‐day/within‐subject and between‐operator/between‐day/within‐subject RCs of VTR were, respectively, 0.3 and 0.6 m/s. Conclusions and Clinical Importance With regard to repeatability, VTR is superior to other methods used for echocardiographic estimation of systolic pulmonary artery pressure. When TR is absent, the acceleration time of pulmonary ejection and the acceleration‐to‐ejection time ratio are alternative measures. A change in VTR exceeding 0.3 m/s might be outside the range of expected within‐operator variation.
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Affiliation(s)
- J A Abbott
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA
| | - J M Gentile-Solomon
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA
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Boutet BG, Saunders AB, Gordon SG. Clinical Characteristics of Adult Dogs More Than 5 Years of Age at Presentation for Patent Ductus Arteriosus. J Vet Intern Med 2017; 31:685-690. [PMID: 28370380 PMCID: PMC5435065 DOI: 10.1111/jvim.14689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/01/2016] [Accepted: 02/14/2017] [Indexed: 12/02/2022] Open
Abstract
Background The median age at presentation for dogs with patent ductus arteriosus (PDA) is <6 months of age, and closure is associated with a decrease in heart size and increased survival time, which are not well described in older dogs. Objectives To describe the clinical characteristics of dogs with PDA ≥5 years of age at the time of presentation to a veterinary referral hospital. Animals 35 client‐owned dogs. Methods Retrospective case series. Results PDA was diagnosed at a median age of 7.4 years (range, 5.1–12.3 years). Females represented 23/35 (65.7%) of the patients. Concurrent heart disease included degenerative mitral valve disease (DMVD; 13), arrhythmias (11), pulmonary hypertension (7), and other congenital defects (2). Cardiomegaly was documented in the majority of dogs consisting of left ventricular enlargement (91%) and left atrial enlargement (86%). Median vertebral heart size in 24 dogs was 12.9 (range, 10.7–18.2). The PDA shunt direction was left‐to‐right in 33 and bidirectional in 2 dogs. Closure was performed in 26 dogs, including 4 with pulmonary hypertension. In 10 dogs receiving furosemide pre‐operatively for management of heart failure, furosemide was discontinued (8) or the dosage decreased (2) at the time of discharge. Conclusions and Clinical Importance Adult dogs can present with a left‐to‐right shunting PDA that results in cardiomegaly and clinical signs that can improve or resolve with PDA closure. This improvement is also apparent in dogs with PDA complicated by DMVD. Pulmonary hypertension that does not result in complete right‐to‐left shunting should not be considered a contraindication to closure.
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Affiliation(s)
- B G Boutet
- Department of Small Animal Clinical Sciences and the Michael E. DeBakey Institute for Comparative Cardiovascular Sciences and Biomedical Devices, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - A B Saunders
- Department of Small Animal Clinical Sciences and the Michael E. DeBakey Institute for Comparative Cardiovascular Sciences and Biomedical Devices, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - S G Gordon
- Department of Small Animal Clinical Sciences and the Michael E. DeBakey Institute for Comparative Cardiovascular Sciences and Biomedical Devices, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
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Hori Y, Kondo C, Matsui M, Yamagishi M, Okano S, Chikazawa S, Kanai K, Hoshi F, Itoh N. Effect of the phosphodiesterase type 5 inhibitor tadalafil on pulmonary hemodynamics in a canine model of pulmonary hypertension. Vet J 2014; 202:334-9. [DOI: 10.1016/j.tvjl.2014.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/08/2014] [Accepted: 08/09/2014] [Indexed: 10/24/2022]
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Novo-Matos J, Hurter K, Bektas R, Grest P, Glaus T. Patent ductus arteriosus in an adult cat with pulmonary hypertension and right-sided congestive heart failure: hemodynamic evaluation and clinical outcome following ductal closure. J Vet Cardiol 2014; 16:197-203. [PMID: 25108347 DOI: 10.1016/j.jvc.2014.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 03/09/2014] [Accepted: 06/24/2014] [Indexed: 11/25/2022]
Abstract
Right-sided congestive heart failure (CHF) developed secondary to severe pulmonary hypertension (PH) in an 8-year-old cat with a left-to-right shunting patent ductus arteriosus (PDA). Vascular reactivity was tested prior to shunt ligation by treatment with oxygen and sildenafil. This treatment was associated with a significant decrease in pulmonary artery pressure as assessed by echocardiography. Subsequently surgical shunt ligation was planned. During thoracotomy, digital occlusion of the PDA was performed for 10 min with simultaneous catheter measurement of right ventricular pressure, which did not increase. Permanent shunt ligation resulted in a complete and sustained clinical recovery. A lung biopsy sample obtained during thoracotomy demonstrated histopathological arterial changes typical of PH. Cats can develop clinically severe PH and right-sided CHF secondary to a left-to-right PDA even at an advanced age. Assuming there is evidence of pulmonary reactivity, PDA occlusion might be tolerated and can potentially produce long-term clinical benefits.
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Affiliation(s)
- José Novo-Matos
- Division of Cardiology, Vetsuisse Faculty, University of Zurich, Switzerland.
| | - Karin Hurter
- Division of Surgery, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Rima Bektas
- Division of Anesthesiology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Paula Grest
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Tony Glaus
- Division of Cardiology, Vetsuisse Faculty, University of Zurich, Switzerland
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Case example: Patent ductus arteriosus in a Shetland Sheepdog. IN PRACTICE 2012. [DOI: 10.1136/inp.f6021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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