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Wang G, Wu Y, Pan Z, Wu C, Li Y, Li H, Wang Q, Liu B, Dai J. Transesophageal echocardiography-guided percutaneous patent ductus arteriosus closure without fluoroscopy. J Cardiothorac Surg 2023; 18:142. [PMID: 37060014 PMCID: PMC10105385 DOI: 10.1186/s13019-023-02248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/02/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVES A retrospective study was performed to summarize the experience of transcatheter closure of patent ductus arteriosus (PDA) through the right femoral vein under the guidance of transesophageal echocardiography (TEE). METHODS From January 2019 to September 2021, 75 children who underwent PDA closure through the right femoral vein under the guidance of TEE were included. The guide wire and delivery sheath were inserted through the ductus arteriosus into the descending aorta via the right femoral vein, and the occluder was subsequently deployed. After discharge, all patients were required for outpatient follow-ups at 1, 3, 6 and 12 months. RESULTS In this group, patients were older than 10 months of age and body weight greater than 8 kg. Among 75 cases with PDA, 63 were tubular type and 12 were conical type. The mean operative time was 40.2 ± 7.3 min. The size of PDA occluder ranged from 4-6 to 12-14 mm. The mean hospital stay was 5.5 ± 0.5 days. One month after discharge, there were 4 cases with a mild residual shunt. Eventually, the residual shunt was not observed during 3, 6, and 12 months of follow-up. CONCLUSIONS PDA closure under the guidance of TEE can be performed through the right femoral vein successfully and effectively. This procedure has no contrast agent usage, radiation exposure, or open incisions.
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Affiliation(s)
- Gang Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Quan Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Bo Liu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
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Transvenous detachable coiling of patent ductus arteriosus in small dogs. J Vet Cardiol 2022; 42:65-73. [DOI: 10.1016/j.jvc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
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Porciello F, Marchesi MC, Birettoni F, Spina F, Knafelz P, Bufalari A, Rishniw M, Moise NS, Caivano D. Transthoracic echo-guided pacemaker implantation reduces fluoroscopic use in dogs. Vet J 2021; 277:105762. [PMID: 34655788 DOI: 10.1016/j.tvjl.2021.105762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
Echocardiographic guidance provides an alternative method when fluoroscopy is unavailable, equipment or power failure of fluoroscopic equipment during a procedure occurs or to decrease radiation risk. Recently, transthoracic (TTE) and transesophageal echocardiography were reported as an alternative method to guide interventional procedures in dogs. Therefore, we hypothesized that TTE could be used as an alternative method to visualize endocardial leads during pacemaker implantation in dogs, largely avoiding the use of fluoroscopy. A prospective consecutive case series of pacemaker implantation was performed using TTE guidance. The endocardial lead was imaged by TTE during its intracardiac advancement until the lead tip was positioned at the right ventricular apex. Echocardiographic right parasternal views, optimized to visualize the pacing lead, were used, starting with a short axis image of the right atrium and ending with a long axis view of the right ventricle (RV) optimized to image the RV apex. Proper lead placement was confirmed by both capture threshold, impedance and fluoroscopy. Twenty-one pacemaker implantation procedures by TTE monitoring were successfully performed. The TTE guidance provided images of a quality sufficient to clearly monitor implantation in real-time and allowed for immediate corrections to pacing lead malpositioning or excessive looping. Fluoroscopy was used to confirm the correct placement of the lead that was guided echocardiographically in the initial three procedures, after which a single radiographic image (no cine-mode) was used to identify lead placement and redundancy in the remaining eighteen cases. Static imaging (radiography using the fluoroscope) was used to assess the proper lead redundancy in all procedures because this cannot be evaluated echocardiographically. Pacemaker leads were successfully implanted in the RV of dogs using TTE monitoring. A larger cases series is needed for validation of safety and effectiveness of TTE during this interventional procedure in dogs.
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Affiliation(s)
- F Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy.
| | - M C Marchesi
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Birettoni
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Spina
- Veterinary Hospital 'Etiopia', Viale Etiopia 16, Rome, 00199 Italy
| | - P Knafelz
- Veterinary Hospital 'GregorioVII', Piazza di Villa Carpegna 52, Rome, 00165 Italy
| | - A Bufalari
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - M Rishniw
- Veterinary Information Network, Davis, CA 95616, USA; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - N S Moise
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
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Wesselowski S, Saunders AB, Gordon SG. Anatomy, baseline characteristics, and procedural outcome of patent ductus arteriosus in German Shepherd dogs. J Vet Intern Med 2018; 33:471-477. [PMID: 30556180 PMCID: PMC6430865 DOI: 10.1111/jvim.15401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022] Open
Abstract
Background German Shepherd dogs (GSD) are predisposed to developing patent ductus arteriosus (PDA) and are reportedly prone to type III (tubular) PDA anatomy. Dogs with type III anatomy are not considered favorable candidates for device‐based intervention. Objective To describe the PDA anatomy, baseline characteristics, and procedural outcome of GSD with PDA. Animals Twenty‐eight client‐owned GSD. Methods Retrospective review of medical records of 28 GSD diagnosed with PDA that underwent surgical ligation or transcatheter device closure between 2007 and 2017. Results German Shepherd dogs with PDA often presented with clinical signs (50%), concurrent congenital heart disease (35.7%), and arrhythmias (29%). Dogs were typically mature at presentation (median age, 12.1 months) and evenly distributed by sex (57% female). The PDA anatomy was classified in 24 of 28 GSD, with type II anatomy being most common (21/24). Three dogs had unusual anatomy (type IV in 1, type V in 2). Median minimal ductal diameter (MDD) in this population was larger than previously reported in a mixed population and ranged between 4.4 and 4.9 mm depending upon imaging modality. Successful closure was achieved using an Amplatz canine duct occluder (ACDO) in 22 dogs or by surgical ligation in 6 dogs. No cases of type III anatomy were confirmed. Conclusions and Clinical Importance The majority of GSD in this population had type II PDA anatomy that was amenable to ACDO deployment. Predisposition for large MDD and occasional, unusual PDA anatomy suggests that transesophageal echocardiography may be beneficial for optimal procedural planning in this breed.
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Affiliation(s)
- Sonya Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
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A pictorial view of the three-dimensional representation and comparative two-dimensional image orientation derived from computed tomography angiography in a dog with a patent ductus arteriosus. J Vet Cardiol 2018; 21:34-40. [PMID: 30797443 DOI: 10.1016/j.jvc.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/23/2022]
Abstract
Patent ductus arteriosus (PDA) occlusion is one of the more common cardiovascular procedures performed in dogs. Two-dimensional imaging has been the primary method of visualizing the PDA and is the basis of its morphologic description. Transesophageal echocardiographic imaging has further characterized the three-dimensional (3D) variation in ductal morphology and shape (circle, oval). An accurate assessment of the shape and dimensions of a PDA in an individual dog is important when making decisions about definitive closure. Ductal measurements from angiography and echocardiography have not been found to be interchangeable, likely related in part to the static two-dimensional measurement of a 3D structure. We describe the use of computed tomography angiography (CTA) images imported into three software programs as a tool to provide 3D information about PDA anatomy including a comparison to images obtained from classic two-dimensional imaging modalities. These images provide an example of thorax and heart position related to transducer position and the orientation of image acquisition to demonstrate why measurements do not always compare. Additionally, 3D images are useful as a training tool and in the development of devices and training opportunities. Multidimensional imaging provides a unique representation of the 3D anatomical structure of the ductus arteriosus as displayed in these images from a dog with a PDA.
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Doocy KR, Saunders AB, Gordon SG, Jeffery N. Comparative, multidimensional imaging of patent ductus arteriosus and a proposed update to the morphology classification system for dogs. J Vet Intern Med 2018; 32:648-657. [PMID: 29460426 PMCID: PMC5866990 DOI: 10.1111/jvim.15068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/08/2017] [Accepted: 01/18/2018] [Indexed: 11/26/2022] Open
Abstract
Background Accurately assessing the morphology and shape of the patent ductus arteriosus (PDA) and obtaining measurements are important to avoid procedural complications. Objectives To characterize and compare PDA morphology, shape, and dimensions with angiography and echocardiography. Animals 25 client‐owned dogs with echocardiographically confirmed PDA. Methods Prospective case series. Imaging consisted of single plane angiography, transthoracic echocardiography from the right (TTE‐R) and left (TTE‐L), and two‐dimensional, biplane, and three‐dimensional transesophageal echocardiography (TEE‐2D and TEE‐3D). Measurements included angiographic minimal ductal diameter (MDD), echocardiographic pulmonary ostium in a single dimension (TTE‐R, TTE‐L, and TEE‐2D) and in perpendicular dimensions (TEE‐3D) with similar measurements of the ampulla 3 mm above the MDD or pulmonary ostium. The morphology and shape of the PDA were characterized. Results Catheter‐based occlusion (N = 20) and surgical ligation (N = 5) were performed without complication. Angiographic morphology was classified as type II (N = 19), type III (N = 1), and other (N = 1). Angiographic MDD and TEE‐2D pulmonary ostium measurements were significantly (P = .008) but weakly correlated (r = .56); similar relationships were found for ampulla diameter measurements (P < .0001; r = .75). In general, TEE‐2D did not correlate with other imaging modalities measurements. Based on TEE‐3D measurements, the majority of pulmonary ostium (17/24; 71%) and ampulla (19/24; 79%) were oval. Conclusions and Clinical Importance Measurements using different imaging modalities are not interchangeable. TEE‐3D provided an en face view of the PDA that cannot be replicated with other echocardiographic techniques and demonstrated an oval shape in the majority of dogs. We propose an update to the current classification system to include additional PDA morphologies.
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Affiliation(s)
- Kelley R Doocy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Nicholas Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Reis A, Aptekmann K, Egert L, Andrade-Júnior P. Parâmetros ecocardiográficos em cães saudáveis tratados com acepromazina, meperidina e sua associação. ARQ BRAS MED VET ZOO 2017. [DOI: 10.1590/1678-4162-8979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivou-se avaliar os efeitos da tranquilização com meperidina, acepromazina e de sua associação sobre os parâmetros ecocardiográficos em cães. Foram utilizados 12 cães adultos, da raça Rottweiler, submetidos ao exame ecocardiográfico sem utilização de sedação (controle - TC) e a três protocolos de tratamento, utilizando-se meperidina (TM), acepromazina (TA) e a associação dos medicamentos (TMA). As variáveis foram analisadas pelo teste de Tukey (P<0,05). Observou-se que as médias obtidas na onda A do fluxo mitral em TA e TMA diminuíram significativamente com relação ao TM, que não diferiu do TC. Houve uma diminuição significativa no valor de movimento anular mitral (MAM) e excursão sistólica do plano anular tricúspide (ESPAT) no TA. Não houve diferença significativa para os valores de fração de encurtamento (FE) entre TA e os demais tratamentos. Entretanto, observou-se que 57,3% dos cães apresentaram valores de FE abaixo da normalidade. As alterações encontradas podem ser decorrentes dos efeitos hipotensores da acepromazina utilizada de forma isolada. Conclui-se que a meperidina ou sua associação com acepromazina não alteram os parâmetros ecocardiográficos em cães saudáveis e que a acepromazina, utilizada isoladamente, causa alteração nos parâmetros de função sistólica dos cães, não sendo recomendada para a contenção química dos cães submetidos ao ecocardiograma, o que poderia levar à má interpretação do exame.
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Affiliation(s)
- A.C. Reis
- Universidade Federal do Espírito Santo, Brazil
| | | | - L. Egert
- Universidade Federal do Espírito Santo, Brazil
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Wesselowski S, Saunders AB, Gordon SG. Relationship between Device Size and Body Weight in Dogs with Patent Ductus Arteriosus Undergoing Amplatz Canine Duct Occluder Deployment. J Vet Intern Med 2017; 31:1388-1391. [PMID: 28782853 PMCID: PMC5598890 DOI: 10.1111/jvim.14797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/10/2017] [Accepted: 06/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Deployment of the Amplatz Canine Duct Occluder (ACDO) is the preferred method for minimally invasive occlusion of patent ductus arteriosus (PDA) in dogs, with appropriate device sizing crucial to successful closure. Dogs of any body weight can be affected by PDA. Objectives To describe the range of ACDO sizes deployed in dogs of various body weights for improved procedural planning and inventory selection and to investigate for correlation between minimal ductal diameter (MDD) and body weight. Animals A total of 152 dogs undergoing ACDO deployment between 2008 and 2016. Methods Body weight, age, breed, sex, and MDD obtained by angiography (MDD‐A), MDD obtained by transesophageal echocardiography (MDD‐TEE), and ACDO size deployed were retrospectively evaluated. Results Correlation between body weight and ACDO size, MDD‐A and MDD‐TEE was poor, with R‐squared values of 0.4, 0.36, and 0.3, respectively. Femoral artery diameter in the smallest population of dogs placed inherent limitations on the use of larger device sizes, with no limitations on the wide range of device sizes required as patient size increased. The most commonly used ACDO devices were size 3 through 6, representing 57% of the devices deployed within the entire study population. Conclusions and Clinical Importance Patent ductus arteriosus anatomy varies on an individual basis, with poor correlation between MDD and body weight. Weight‐based assumptions about expected ACDO device size for a given patient are not recommended.
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Affiliation(s)
- S Wesselowski
- College of Veterinary Medicine, Texas A&M University, College Station, TX
| | - A B Saunders
- College of Veterinary Medicine, Texas A&M University, College Station, TX
| | - S G Gordon
- College of Veterinary Medicine, Texas A&M University, College Station, TX
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De Monte V, Staffieri F, Caivano D, Nannarone S, Birettoni F, Porciello F, Di Meo A, Bufalari A. Heart rate and blood pressure variations after transvascular patent ductus arteriosus occlusion in dogs. Res Vet Sci 2017; 113:73-78. [DOI: 10.1016/j.rvsc.2017.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/02/2017] [Accepted: 09/03/2017] [Indexed: 11/26/2022]
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Incidence of postoperative implant-related bacterial endocarditis in dogs that underwent trans-catheter embolization of a patent ductus arteriosus without intra- and post-procedural prophylactic antibiotics. Vet Microbiol 2017; 207:25-28. [DOI: 10.1016/j.vetmic.2017.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/26/2017] [Accepted: 05/28/2017] [Indexed: 11/18/2022]
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Birettoni F, Caivano D, Bufalari A, Giorgi M, Miglio A, Paradies P, Porciello F. Transthoracic ultrasound guided balloon dilation of cor triatriatum dexter in 2 Rottweiler puppies. J Vet Cardiol 2016; 18:385-390. [DOI: 10.1016/j.jvc.2016.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/06/2016] [Accepted: 06/20/2016] [Indexed: 11/15/2022]
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Landsman TL, Bush RL, Glowczwski A, Horn J, Jessen SL, Ungchusri E, Diguette K, Smith HR, Hasan SM, Nash D, Clubb FJ, Maitland DJ. Design and verification of a shape memory polymer peripheral occlusion device. J Mech Behav Biomed Mater 2016; 63:195-206. [PMID: 27419615 PMCID: PMC5508979 DOI: 10.1016/j.jmbbm.2016.06.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
Shape memory polymer foams have been previously investigated for their safety and efficacy in treating a porcine aneurysm model. Their biocompatibility, rapid thrombus formation, and ability for endovascular catheter-based delivery to a variety of vascular beds makes these foams ideal candidates for use in numerous embolic applications, particularly within the peripheral vasculature. This study sought to investigate the material properties, safety, and efficacy of a shape memory polymer peripheral embolization device in vitro. The material characteristics of the device were analyzed to show tunability of the glass transition temperature (Tg) and the expansion rate of the polymer to ensure adequate time to deliver the device through a catheter prior to excessive foam expansion. Mechanical analysis and flow migration studies were performed to ensure minimal risk of vessel perforation and undesired thromboembolism upon device deployment. The efficacy of the device was verified by performing blood flow studies that established affinity for thrombus formation and blood penetration throughout the foam and by delivery of the device in an ultrasound phantom that demonstrated flow stagnation and diversion of flow to collateral pathways.
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Affiliation(s)
- Todd L Landsman
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Ruth L Bush
- College of Medicine, Texas A&M University Health Science Center, MS 1359, 8447 State Highway 47, HPEB 3060, Bryan, TX 77807-3260, USA
| | - Alan Glowczwski
- Texas A&M Institute for Preclinical Studies, Texas A&M University, MS 4478, College Station, TX 77845-4478, USA
| | - John Horn
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Staci L Jessen
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Ethan Ungchusri
- College of Medicine, Texas A&M University Health Science Center, MS 1359, 8447 State Highway 47, HPEB 3060, Bryan, TX 77807-3260, USA
| | - Katelin Diguette
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Harrison R Smith
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Sayyeda M Hasan
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Daniel Nash
- Maverick Regional Anesthesia Education, LLC, 10592 County Road 175, Iola, TX 77861, USA
| | - Fred J Clubb
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA; Department of Veterinary Pathobiology, Cardiovascular Pathology Laboratory, College of Veterinary Medicine, Texas A&M University, MS 4467, College Station, TX 77843-4467, USA
| | - Duncan J Maitland
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA.
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Szatmári V. Chitosan hemostatic dressing for control of hemorrhage from femoral arterial puncture site in dogs. J Vet Sci 2016; 16:517-23. [PMID: 26119165 PMCID: PMC4701745 DOI: 10.4142/jvs.2015.16.4.517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/15/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022] Open
Abstract
Removal of an introducer-sheath from a femoral artery after completing transarterial embolization of a patent ductus arteriosus can cause life-threatening hemorrhage in dogs. In the present study, the effectiveness of chitosan acetate dressing in 10 experimental dogs was tested. Under general anesthesia, an introducer-sheath was placed into the femoral artery with percutaneous puncture using Seldinger's technique. The outer diameter of the introducer-sheaths varied from 3.0 to 4.0 mm with an introducer/artery ratio of 80 to 123%. The artery's diameter was measured using ultrasonography. Following removal of the introducer-sheath, a chitosan acetate dressing was applied to the wound and held in place with manual compression for 10 min. Successful hemostasis was reached on 12 arteries. However, on two arteries, hemorrhage was uncontrollable and led to a hypovolemic shock during 10 min of manual compression. Possible causes of the negative outcome in two dogs were their old age and an introducer-sheath with a too large diameter. The chitosan acetate dressing was easy to use and the artery remained patent. Dogs could walk directly after recovery from anesthesia and their femoral arteries were saved. In conclusion, the outer diameter of the introducer-sheath should not exceed 3 mm or the inner diameter of the artery.
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Affiliation(s)
- Viktor Szatmári
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
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Porciello F, Caivano D, Giorgi ME, Knafelz P, Rishniw M, Moise NS, Bufalari A, Fruganti A, Birettoni F. Transesophageal echocardiography as the sole guidance for occlusion of patent ductus arteriosus using a canine ductal occluder in dogs. J Vet Intern Med 2014; 28:1504-12. [PMID: 25041218 PMCID: PMC4895578 DOI: 10.1111/jvim.12401] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 04/14/2014] [Accepted: 05/29/2014] [Indexed: 11/29/2022] Open
Abstract
Background Transcatheter occlusion of patent ductus arteriosus (PDA) is usually performed by fluoroscopy alone or together with transesophageal echocardiography (TEE). Transthoracic echocardiography (TTE) guidance has been used for deployment of Amplatz Canine Ductal Occluder (ACDO), but sometimes is limited by suboptimal acoustic windows. Transesophageal echocardiography can overcome such issues and provides higher image resolution at the level of the great vessels. Objectives To determine if TEE without fluoroscopy could be used to successfully perform ductal occlusion for the treatment of PDA in dogs. Animals Twenty client‐owned dogs with PDA. Methods A prospective consecutive case series of PDA occlusion was performed using only TEE guidance. Dogs were positioned in right lateral recumbency and the TEE probe was positioned to visualize the descending aorta, PDA, and pulmonary artery. The guide wire, long introducer sheath, and ACDO were imaged by TEE to direct deployment. Results Ductal occlusion was performed successfully without need for fluoroscopy and without complications in 19 dogs. One dog required a second larger ACDO because of embolization of the first device 18 hours after positioning. Conclusions and Clinical Importance We have demonstrated that TEE monitoring without concurrent fluoroscopy can guide each step of transcatheter ACDO embolization thereby providing an alternate method of visualization for this procedure. Use of TEE alone can reduce radiation exposure or is an option when fluoroscopy is not available, and, therefore, should be evaluated in a larger case series to better assess procedural failure rates.
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Affiliation(s)
- F Porciello
- Department of Veterinary Medicine, University of Perugia, Perugia, Italy
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15
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Using technology to find the secret places of the heart. Vet J 2014; 200:216-7. [DOI: 10.1016/j.tvjl.2014.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 11/19/2022]
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16
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Hou CJ, Zhang DZ, Wang QG, Cui CS, Kuang L, Chen B, Wang Y. Promotion of artery occlusion in dogs by percutaneous rotational atherectomy. Ann Vasc Surg 2014; 28:1306-11. [PMID: 24560823 DOI: 10.1016/j.avsg.2014.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aims to offer experimental data and indirect evidences for the application of percutaneous rotational atherectomy to treat patent ductus arteriosus (PDA). METHODS Eleven dogs (6 male dogs and 5 female dogs; aged 14-20 months, with an average of 16.7±3.2 months; weight 20-25 kg, with an average of 22.7±2.5 kg) were enrolled in this study. The diameters of the left and right arteries ranged from 3.2 to 4.8 mm (average 3.9±0.6 mm) on percutaneous angiography. Percutaneous rotational atherectomy with proper rotablator (the size was 1-1.5 mm larger than the artery diameter) was performed in the arterial intima. After 4 weeks from percutaneous rotational atherectomy, arteriography was conducted to observe the changes in artery diameter. Then all dogs were sacrificed and the pathologic examination was conducted on the left and right axillary arteries. RESULTS There were obvious changes with different degrees in 22 arteries, including 8 arteries with complete occlusion and 12 arteries with stenosis (≥2/3, 1/2, and 1/3 stenosis in 4, 4, and 4 arteries, respectively). The occlusion rate was 36.4% and the total effective rate was 90.9%. It was considered failure in other 2 arteries with <1/3 of stenosis. CONCLUSIONS Percutaneous rotational atherectomy of arterial intima can promote the occlusion of arteries. This has provided a new choice for the treatment of PDA.
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Affiliation(s)
- Chuan-Ju Hou
- Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang, China.
| | - Duan-Zhen Zhang
- Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang, China
| | - Qi-Guang Wang
- Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang, China
| | - Chun-Sheng Cui
- Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang, China
| | - Li Kuang
- Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang, China
| | - Bing Chen
- Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang, China
| | - Yang Wang
- Department of Congenital Heart Disease, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Command, Shenyang, China
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17
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Silva J, Domenech O, Mavropoulou A, Oliveira P, Locatelli C, Bussadori C. Transesophageal Echocardiography Guided Patent Ductus Arteriosus Occlusion with a Duct Occluder. J Vet Intern Med 2013; 27:1463-70. [DOI: 10.1111/jvim.12201] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/10/2013] [Accepted: 08/21/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- J. Silva
- Department of Cardiology; Clinica Veterinaria Gran Sasso; Milan Italy
| | - O. Domenech
- Istituto Veterinario di Novara; Granozzo con Monticello Italy
| | - A. Mavropoulou
- Department of Cardiology; Clinica Veterinaria Gran Sasso; Milan Italy
| | - P. Oliveira
- Davies Veterinary Specialists; Higham Gobion UK
| | - C. Locatelli
- Dipartimento di Scienze Veterinarie e Sanità Pubblica; Facoltà di Medicina Veterinaria; Università degli studi di Milano; Milan Italy
| | - C. Bussadori
- Department of Cardiology; Clinica Veterinaria Gran Sasso; Milan Italy
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18
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Transoesophageal echocardiography in the dog. Vet J 2013; 198:329-38. [PMID: 24183715 DOI: 10.1016/j.tvjl.2013.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/21/2013] [Accepted: 08/10/2013] [Indexed: 11/22/2022]
Abstract
Transoesophageal echocardiography (TEE) allows imaging of the heart through the oesophagus using a special transducer mounted on a modified endoscope. The proximity to the heart and minimal intervening structures enables the acquisition of high-resolution images that are consistently superior to routine transthoracic echocardiography and optimal imaging of the heart base anatomy and related structures. TEE provides high-quality real-time imaging free of ionizing radiation, making it an ideal instrument not only for diagnostic purposes, but also for monitoring surgical or minimally invasive cardiac procedures, non-cardiac procedures and critical cases in the intensive care unit. In human medicine, TEE is routinely used in these settings. In veterinary medicine, TEE is increasingly used in referral centres, especially for perioperative assessment and guidance of catheter-based cardiovascular procedures, such as patent ductus arteriosus, balloon valvuloplasty, and atrial and ventricular septal defect occlusion with vascular devices. TEE can also aid in heartworm retrieval procedures. The purpose of this paper is to review the current uses of TEE in veterinary medicine, focusing on technique, indications and complications.
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