Successful transcatheter retrieval of embolized Amplatz Canine Duct Occluders in two dogs

Current use of real-time three-dimensional transthoracic echocardiography in animals

This review includes 36 studies of transthoracic real-time three-dimensional echocardiography (RT3DE) in animals. Most of these studies concern cardiac chamber quantification of the left atrium and left ventricle, in dogs. Comparisons of RT3DE and different two-dimensional echocardiographic (2DE) methods have been reported in dogs with myxomatous mitral valve disease (MMVD), dilated cardiomyopathy, and in healthy control dogs. Comparisons of RT3DE and standard reference methods have been reported in healthy control dogs. In dogs with MMVD, volumetric RT3DE measurements of left atrium do not appear to provide superior prognostic value compared with 2DE methods using Simpson's method of discs in dogs with MMVD. The major advantages of RT3DE compared to 2DE include improvements in visualization of the complex morphology of the mitral valve, the estimation of mitral valve regurgitation, and improved visualization of complex congenital cardiac abnormalities.

Transjugular Patent Ductus Arteriosus Occlusion in Seven Dogs Using the Amplatzer Vascular Plug II

Simple Summary

This study outlines the authors’ experience using the Amplatzer Vascular Plug II device for occlusion of patent ductus arteriosus (PDA) in dogs through a right transjugular approach, never before described in veterinary medicine for this purpose. The obtained results demonstrate that the use of the Amplatzer Vascular Plug II via a transvenous right jugular approach is a feasible and effective method, even in small-sized patients. The authors’ experience is that the transvenous approach is a safe and effective method for PDA occlusion in dogs. Furthermore, the right jugular approach provides easier and faster vascular access than the femoral one. The authors affirm that this approach, together with the properties of the Amplatzer Vascular Plug II and its wide size selection, potentially provide a novel method that can complement the current available methods for transcatheter PDA occlusion.

Abstract

Although vascular plugs for the closure of patent ductus arteriosus (PDA) have been validated in dogs, studies are lacking on its use as a first-choice device with a transjugular approach. The present case series describes the transvenous right jugular embolization of PDA using an Amplatzer Vascular Plug II in seven dogs of different ages, breeds, and body weights. Complete closure of the PDA was demonstrated in all cases. All dogs showed significant hemodynamic reduction of pulmonary overcirculation and left heart size after the procedure and at following echocardiographic check-ups. Transjugular PDA occlusion using an Amplatzer Vascular Plug II can thus be considered as a safe alternative to the arterial or venous femoral approach using an Amplatzer canine ductal occluder (ACDO), particularly in puppies with small femoral vessels.

Case Report: Aortic Regurgitation of Postocclusion and Long-Term Outcome Following PDA Correction in an Adult Dog

A 9-year-old intact female Maltese dog was admitted for further evaluation of previously diagnosed patent ductus arteriosus (PDA). The dog showed severe coughing and exercise intolerance. On physical examination, a grade VI/VI continuous heart murmur was auscultated. Thoracic radiography demonstrated cardiomegaly, pulmonary overcirculation, and moderate bronchointerstitial pattern. Echocardiography revealed severe dilation of the left ventricle and atrium, decreased left ventricular contractility, and left-to-right PDA. On electrocardiography (ECG), R amplitude was increased. Computed tomographic angiography revealed type IIA PDA. The serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration was >10,000 pmol/L. Transarterial occlusion was performed and the Amplatz® Canine Duct Occluder was successfully deployed. On echocardiography 48 h after the procedure, aortic regurgitation (AR) and residual ductal flow were noted. Long-term follow-up on clinical signs, physical examination, radiography, echocardiography, ECG, and serum NT-proBNP were evaluated until 30 months after correction of PDA. The clinical indices of physical examination, thoracic radiography, echocardiography, ECG, and serum NT-proBNP concentration were improved, although the postocclusion AR and residual ductal flow persisted. The dog followed up without clinical signs for 41 months following the correction. To our knowledge, this is the first case report to demonstrate quite a long time of follow-up (41 months) in an older dog with transarterial occlusion of PDA with postocclusion AR and residual flow.

Transvenous embolization of moderate to large patent ductus arteriosus in dogs using the Amplatzer vascular plug II

BACKGROUND

Catheter-based occlusion of patent ductus arteriosus (PDA) can be performed using different devices. Transvenous embolization using the Amplatzer vascular plug II (AVP-II) has been studied in humans, but it has not been described in dogs.

OBJECTIVE

Evaluate the feasibility and success of transvenous embolization of PDA using the AVP-II in dogs.

ANIMALS

Nineteen client-owned dogs with left-to-right shunting PDA, with minimal ductal diameter >2.5 mm.

METHODS

Prospective observational study using AVP-II with transvenous access for PDA closure in dogs.

RESULTS

Angiography showed a conical ductus with a long (n = 17) or short (n = 2) ampulla. The minimal diameter of the duct was 4.34 ± 1.11 mm, and the maximal diameter of the ampulla was 13.18 ± 3.47 mm. Technical success was achieved in 18 of the 19 (94.7%) patients after the first intervention and in all 19 (100%) patients after the second intervention. Postrelease angiography documented complete occlusion of the PDA in 10 of 19 (52.6%) dogs. Mild flow acceleration or stenosis of the left pulmonary artery was found in 6 and 1 of the 17 analyzed cases, respectively, by Doppler examination. The closure rate 24 hours after intervention was 94.7% (18/19). The remaining dog had a moderate residual shunt, and delayed complete closure after 3 months led to a 100% closure rate.

CONCLUSION AND CLINICAL IMPORTANCE

The AVP-II is a safe and effective device for transvenous embolization in dogs with moderate to large PDA.

Low profile vascular plug for transarterial occlusion of patent ductus arteriosus in small dogs

Background

Minimally invasive transcatheter occlusion using Amplatz canine duct occluder (ACDO) is the treatment of choice for dogs with left‐to‐right shunting patent ductus arteriosus (PDA). However, in small dogs the femoral artery diameter is often too small to accommodate the guiding catheter required for ACDO deployment.

Objective

Describe the effectiveness of transarterial implantation of Amplatzer Vascular Plug 4 (AVP‐4), the only self‐expandable nitinol mesh occlusion device which can be implanted through a 4 French diagnostic catheter, in small dogs with left‐to‐right shunting PDA.

Animals

Seven client‐owned dogs.

Methods

Descriptive case series. Dogs with hemodynamically relevant left‐to‐right shunting PDA and a femoral artery diameter less than 2.0 mm measured preoperatively with ultrasonography were prospectively enrolled.

Results

Angiography after releasing the device showed complete immediate PDA closure in 5 dogs, where the manufacturers' recommendation were strictly followed (30%‐50% device oversizing of the ductal ampulla's diameter). Trivial residual flow on angiography in the 6th dog, whose device was slightly undersized, had resolved on echocardiography within 2 hours after placement. Marked device undersizing in the 7th dog resulted in severe residual shunting, which necessitated the addition of a coil. In this dog, the AVP‐4 embolized into the pulmonary artery within 2 weeks after placement.

Conclusions and Clinical Importance

Transarterial implantation of AVP‐4 is a safe, effective and technically easy procedure for PDA occlusion in small dogs and offers a valuable alternative to coil implantation. Accurate PDA measurement and device sizing is essential to prevent residual shunting, inadvertent device embolization, and protrusion of the device into the aorta.

Percutaneous transcatheter closure of an aorto-cardiac fistula in a six-year-old Warmblood mare with atrial fibrillation

This report describes a rare case of an aorto-cardiac fistula in a six-year-old French Warmblood mare presented with atrial fibrillation, decreased performance, ventral oedema, bounding arterial pulsation and pathological jugular venous pulse. A 2.7-cm-diameter fistula connected the right aortic sinus of Valsalva to the right atrium. Atrial fibrillation was likely due to volume overload of the right heart due to left-to-right shunting. The horse was treated by percutaneous transcatheter closure of the fistula delivered under general anaesthesia using a transarterial approach. The operation was initially successful, and clinical signs of congestive heart failure improved immediately. However, the device dislodged six days after procedure, and the general condition of the horse deteriorated quickly. A second closure attempt to deliver the occluder using a transvenous approach in the standing horse failed, and the horse was eventually euthanized. Procedural aspects and several possible risk factors for device dislodgement are discussed.