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Paranjape VV, Henao-Guerrero N, Menciotti G, Saksena S. Performance of four cardiac output monitoring techniques vs. intermittent pulmonary artery thermodilution during a modified passive leg raise maneuver in isoflurane-anesthetized dogs. Front Vet Sci 2023; 10:1238549. [PMID: 37781276 PMCID: PMC10538972 DOI: 10.3389/fvets.2023.1238549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study investigated the performance among four cardiac output (CO) monitoring techniques in comparison with the reference method intermittent pulmonary artery thermodilution (iPATD) and their ability to diagnose fluid responsiveness (FR) during a modified passive leg raise (PLRM) maneuver in isoflurane-anesthetized dogs undergoing acute blood volume manipulations. The study also examined the simultaneous effect of performing the PLRM on dynamic variables such as stroke distance variation (SDV), peak velocity variation (PVV), and stroke volume variation (SVV). Study design Prospective, nonrandomized, crossover design. Study animals Six healthy male Beagle dogs. Methods The dogs were anesthetized with propofol and isoflurane and mechanically ventilated under neuromuscular blockade. After instrumentation, they underwent a series of sequential, nonrandomized steps: Step 1: baseline data collection; Step 2: removal of 33 mL kg-1 of circulating blood volume; Step 3: blood re-transfusion; and Step 4: infusion of 20 mL kg-1 colloid solution. Following a 10-min stabilization period after each step, CO measurements were recorded using esophageal Doppler (EDCO), transesophageal echocardiography (TEECO), arterial pressure waveform analysis (APWACO), and electrical cardiometry (ECCO). Additionally, SDV, PVV, and SVV were recorded. Intermittent pulmonary artery thermodilution (iPATDCO) measurements were also recorded before, during, and after the PLRM maneuver. A successful FR diagnosis made using a specific test indicated that CO increased by more than 15% during the PLRM maneuver. Statistical analysis was performed using one-way analysis of variance for repeated measures with post hoc Tukey test, linear regression, Lin's concordance correlation coefficient (ρc), and Bland-Altman analysis. Statistical significance was set at p < 0.05. Results All techniques detected a reduction in CO (p < 0.001) during hemorrhage and an increase in CO after blood re-transfusion and colloid infusion (p < 0.001) compared with baseline. During hemorrhage, CO increases with the PLRM maneuver were as follows: 33% for iPATD (p < 0.001), 19% for EC (p = 0.03), 7% for APWA (p = 0.97), 39% for TEE (p < 0.001), and 17% for ED (p = 0.02). Concurrently, decreases in SVV, SDV, and PVV values (p < 0.001) were also observed. The percentage error for TEE, ED, and EC was less than 30% but exceeded 55% for APWA. While TEECO and ECCO slightly underestimated iPATDCO values, EDCO and APWACO significantly overestimated iPATDCO values. TEE and EC exhibited good and acceptable agreement with iPATD. However, CO measurements using all four techniques and iPATD did not differ before, during, and after PLRM at baseline, blood re-transfusion, and colloid infusion. Conclusion and clinical relevance iPATD, EC, TEE, and ED effectively assessed FR in hypovolemic dogs during the PLRM maneuver, while the performance of APWA was unacceptable and not recommended. SVV, SDV, and PVV could be used to monitor CO changes during PLRM and acute blood volume manipulations, suggesting their potential clinical utility.
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Affiliation(s)
- Vaidehi V. Paranjape
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Natalia Henao-Guerrero
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Giulio Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Siddharth Saksena
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
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Stoner CH, Saunders AB. Evaluation of two probes for transesophageal echocardiography in small dogs: imaging capabilities, image quality, and usability. J Vet Cardiol 2023; 45:41-49. [PMID: 36696791 DOI: 10.1016/j.jvc.2022.12.005] [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: 01/19/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTIONS Patient size is a limiting factor for transesophageal echocardiography (TEE) in small dogs. The objective of this study was to describe imaging capabilities of two probes for TEE in small dogs. ANIMALS, MATERIALS, AND METHODS Prospective study in 10 client-owned dogs weighing <4 kg with congenital heart disease (CHD). Dogs had TEE performed with a microprobe (10T-D, GE Medical) and intracardiac echocardiography (ICE) catheter-based probe (AcuNav™, Biosense Webster) in the esophagus in alternating order. Ease of placement, ability to acquire images of the CHD, image quality, and probe limitations were recorded. RESULTS Median weight was 2.4 kg (range, 1.0-3.2). Congenital abnormalities included patent ductus arteriosus (n = 9) and pulmonary valve stenosis (n = 1). The 10T-D microprobe was easy to place (n = 8) or achievable with gentle manipulation (n = 2), and image quality of the CHD was optimal (n = 8), adequate (n = 1), or poor (n = 1). The ICE probe was difficult to place in the esophagus even with an external support system (n = 9) or could not be placed (n = 1), and image quality of the CHD was optimal (n = 2), adequate (n = 3), or poor (n = 5). Both probes provided images in a 1.0-kg dog. Probe limitations included lack of lateral motion (microprobe), the need for an external support system (ICE probe) and inability to consistently maintain contact with the esophagus (ICE probe). CONCLUSION The 10T-D microprobe provided high-quality TEE images more consistently than the ICE probe in the majority of dogs in this study; however, the lack of lateral motion can diminish its utility in some dogs.
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Affiliation(s)
- C H Stoner
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
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Wieser M, Ringer SK, Baron Toaldo M. Pericardial tamponade during balloon pulmonary valvuloplasty in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Manuela Wieser
- Department of Clinical Diagnostics and Services Section of Anaesthesiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Simone Katja Ringer
- Department of Clinical Diagnostics and Services Section of Anaesthesiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Marco Baron Toaldo
- Clinic for Small Animal Internal Medicine Division of Cardiology Vetsuisse Faculty University of Zurich Zurich Switzerland
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Stoner CH, Saunders AB, Heseltine JC, Cook AK, Lidbury JA. Prospective evaluation of complications associated with transesophageal echocardiography in dogs with congenital heart disease. J Vet Intern Med 2022; 36:406-416. [PMID: 34997940 PMCID: PMC8965207 DOI: 10.1111/jvim.16356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Transesophageal echocardiography (TEE) is useful in the assessment and procedural monitoring of congenital heart disease (CHD) with a relatively low complication rate in humans. Objectives To evaluate the safety of TEE and report complications in dogs. Animals Forty client‐owned dogs with CHD. Methods Prospective observational study including gastroesophagoscopy before and after TEE imaging. TEE was planned with a GE 6VT‐D adult probe in dogs weighing ≥4 kg and a GE 10T‐D microprobe alternating with an intracardiac echocardiography probe placed in the esophagus in dogs <4 kg. Difficulties with probe placement, probe interference and TEE probe imaging times were recorded. Dogs were monitored in the recovery period after TEE using an established nausea scoring system. Results New gastroesophageal abnormalities were identified after TEE in 4 dogs including 4 areas of mucosal damage involving <25% of the lower esophageal sphincter (n = 4) and 1 lesion at the heart base (n = 1) and were not attributed to longer imaging times or a specific probe. Lesions identified before TEE in 4 dogs remained unchanged after TEE. The 6VT‐D probe could not be placed in 1 dog with enlarged tonsils, and it obstructed fluoroscopic views in 3 dogs. The probes did not compress any structures in dogs in which fluoroscopy was performed (n = 20). Four dogs had evidence to suggest nausea after the procedure. Conclusions and Clinical Importance While major complications remain possible, complications in this study were mild and few in number. Dog size and probe characteristics are factors to consider when performing TEE.
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Affiliation(s)
- Caitlin H Stoner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Johanna C Heseltine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Audrey K Cook
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Jonathan A Lidbury
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Saunders AB. Key considerations in the approach to congenital heart disease in dogs and cats. J Small Anim Pract 2021; 62:613-623. [PMID: 34180062 DOI: 10.1111/jsap.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/12/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
Congenital heart disease is an important subset of all cardiovascular disease in dogs and cats that is present at birth and most often detected in young animals but can be diagnosed in adulthood. The range of abnormalities that can occur during development of the heart is vast incorporating simple and complex defects, varying degrees of severity and clinical presentations that include heart failure and cyanosis. While some defects do not result in morbidity in an individual animal, others cause severe clinical signs and death at a young age. Advances in imaging and expanding treatment options offer increasingly more possibilities in the diagnosis and management of congenital heart disease which is the focus of this review. The objective is to provide a broad overview of current practice and highlight key aspects to guide practitioners in their approach to congenital heart disease diagnosis and knowledge of available treatment options.
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Affiliation(s)
- A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Mizuno T, Chen A, Mamada K, Takahashi A, Uchida S, Uechi M. Analysis of mitral valve morphology in dogs undergoing mitral valve repair with three-dimensional transesophageal echocardiography. J Vet Cardiol 2021; 34:64-72. [PMID: 33592560 DOI: 10.1016/j.jvc.2021.01.004] [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: 04/21/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Information about real-time three-dimensional (3D) transesophageal echocardiography (TEE) for the evaluation of canine mitral valve morphology is lacking in veterinary medicine. OBJECTIVES To evaluate the feasibility of 3D TEE for the evaluation of canine mitral valves and whether there was a difference in mitral valve morphology between American College of Veterinary Internal Medicine (ACVIM) stages. ANIMALS Thirty-one dogs were evaluated, including nine dogs classified as ACVIM stage B2, 15 as stage C, and seven as stage D. MATERIALS AND METHODS Three-dimensional TEE was performed after anesthetic induction for mitral valve surgery, and the 3D geometry of the mitral valve apparatus was measured. RESULTS The intraclass correlation coefficient was good in both inter- and intraobserver analyses of the 3D measurements of mitral valve annulus geometry and excellent in both inter- and intraobserver analyses in the 3D measurements of mitral valve annular and leaflet sizes. Annulus height to commissural width ratio of stage D dogs showed significantly lower values than B2 dogs (B2: 14.2% [9.1-20.5%]; C: 10.6% [6.5-24.1%]; D: 9.5% [4.7-13.8%]). The aortic-mitral angle of stages C and D were significantly flatter than stage B2 (B2: 122.32 ± 9.39; C: 133.66 ± 8.43; D: 140.70 ± 10.70). CONCLUSIONS Real-time 3D echocardiography using TEE is a feasible method to evaluate the morphology of the mitral valve in dogs. The saddle shape of the mitral annulus and aortic-mitral angle were flatter in stage D. Further studies are required to understand the pathology of mitral valve disease in dogs.
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Affiliation(s)
- T Mizuno
- JASMINE Veterinary Cardiovascular Medical Center, 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa, 224-0001, Japan.
| | - A Chen
- JASMINE Veterinary Cardiovascular Medical Center, 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa, 224-0001, Japan
| | - K Mamada
- JASMINE Veterinary Cardiovascular Medical Center, 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa, 224-0001, Japan
| | - A Takahashi
- JASMINE Veterinary Cardiovascular Medical Center, 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa, 224-0001, Japan
| | - S Uchida
- JASMINE Veterinary Cardiovascular Medical Center, 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa, 224-0001, Japan
| | - M Uechi
- JASMINE Veterinary Cardiovascular Medical Center, 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa, 224-0001, Japan
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Fries RC, Clark-Price SC, Kadotani S, Stack JP, Schaeffer DJ, Lascola KM. Quantitative assessment of left ventricular volume and function by transthoracic and transesophageal echocardiography, ultrasound velocity dilution, and gated magnetic resonance imaging in healthy foals. Am J Vet Res 2020; 81:930-939. [PMID: 33251841 DOI: 10.2460/ajvr.81.12.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare measurements of left ventricular volume and function derived from 2-D transthoracic echocardiography (2DE), transesophageal echocardiography (TEE), and the ultrasound velocity dilution cardiac output method (UDCO) with those derived from cardiac MRI (cMRI) in healthy neonatal foals. ANIMALS 6 healthy 1-week-old Standardbred foals. PROCEDURES Foals were anesthetized and underwent 2DE, TEE, and cMRI; UDCO was performed simultaneously with 2DE. Images acquired by 2DE included the right parasternal 4-chamber (R4CH), left apical 4- and 2-chamber (biplane), and right parasternal short-axis M-mode (M-mode) views. The longitudinal 4-chamber view was obtained by TEE. Measurements assessed included left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), ejection fraction, stroke volume (LVSV), cardiac output (CO), and cardiac index (CI). Bland-Altman analyses were used to compare measurements derived from biplane, R4CH, and M-mode images and UDCO with cMRI-derived measurements. Repeatability of measurements calculated by 3 independent reviewers was assessed by the intraclass correlation coefficient. RESULTS Compared with cMRI, all 2DE and TEE modalities underestimated LVEDV and LVESV and overestimated ejection fraction, CO, and CI. The LVSV was underestimated by the biplane, R4CH, and TEE modalities and overestimated by UDCO and M-mode methods. However, the R4CH-derived LVSV, CO, and CI were clinically comparable to cMRI-derived measures. Repeatability was good to excellent for measures derived from the biplane, R4CH, M-mode, UDCO, and cMRI methods and poor for TEE-derived measures. CONCLUSIONS AND CLINICAL RELEVANCE All assessed modalities yielded clinically acceptable measurements of LVEDV, LVESV, and function, but those measurements should not be used interchangeably when monitoring patient progress.
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Sugimoto K, Mochizuki Y, Kanda T, Ohnishi A, Miyabe M, Wada Y, Kochi M, Aoki T. Atrial septal defect closure in a midget toy poodle. Open Vet J 2020; 10:11-15. [PMID: 32426251 PMCID: PMC7193879 DOI: 10.4314/ovj.v10i1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background Atrial septal defect (ASD) is a rare congenital cardiac disease, and there have been no reports about the treatment of ASD in midget breed dogs. Case Description A 7-month-old female toy poodle weighing 1.4 kg presented with cardiac enlargement. Echocardiography revealed a secundum-type ASD, right ventricular and atrial enlargement, and pulmonary hypertension. Blood flow through the ASD exhibited left-to-right shunting. The dog underwent ASD closure through a hybrid approach, in conjunction with catheter techniques and thoracotomy. Ten months after treatment, cardiac enlargement and pulmonary hypertension were improved. Conclusion Even in midget dog breeds, ASD can be corrected through a hybrid approach.
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Affiliation(s)
- Keisuke Sugimoto
- Department of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
| | - Yohei Mochizuki
- Department of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
| | - Teppei Kanda
- Department of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
| | - Akihiro Ohnishi
- Department of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
| | - Masahiro Miyabe
- Department of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
| | - Yuko Wada
- Department of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
| | - Masaki Kochi
- Division of Cardiology, Matsubara Animal Hospital, Matsubara, Osaka 580-0044, Japan
| | - Takuma Aoki
- Department of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa 252-5201, Japan
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Castagna P, Romito G, Baron Toaldo M. Cor triatriatum sinister in a dog. J Vet Cardiol 2019; 25:25-31. [PMID: 31446292 DOI: 10.1016/j.jvc.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022]
Abstract
This report describes the transthoracic and transesophageal echocardiographic features of cor triatriatum sinister in an asymptomatic 6-year-old male French bulldog. Although cor triatriatum sinister represents a well-known and widely described cardiac malformation in humans, its description in the canine population is rare. In this clinical case, non-invasive echocardiographic techniques were helpful in visualizing and characterizing the lesion, allowing a valuable assessment of the malformation, and its hemodynamic consequences.
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Affiliation(s)
- P Castagna
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - G Romito
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - M Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy.
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Mantovani MM, Fantoni DT, Gimenes AM, de Castro JR, Flor PB, Ida KK, Schwartz DS. Clinical monitoring of cardiac output assessed by transoesophageal echocardiography in anaesthetised dogs: a comparison with the thermodilution technique. BMC Vet Res 2017; 13:325. [PMID: 29121915 PMCID: PMC5679384 DOI: 10.1186/s12917-017-1227-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 10/25/2017] [Indexed: 12/26/2022] Open
Abstract
Background Cardiac output (CO) is an important haemodynamic parameter to monitor in patients during surgery. However, the majority of the techniques for measuring CO have a limited application in veterinary practice due to their invasive approach and associated complexity and risks. Transoesophageal echocardiography (TEE) is a technique used to monitor cardiac function in human patients during surgical procedures and allows CO to be measured non-invasively. This prospective clinical study aimed to compare the transoesophageal echocardiography using a transgastric view of the left ventricular outflow tract (LVOT) and the thermodilution (TD) technique for the assessment of CO during mean arterial pressure of 65–80 mmHg (normotension) and <65 mmHg (hypotension) in dogs undergoing elective surgery. Eight dogs were pre-medicated with acepromazine (0.05 mg/kg, IM), tramadol (4 mg/kg, IM) and atropine (0.03 mg/kg, IM), followed by anaesthetic induction with propofol (3–5 mg/kg IV) and maintenance with isoflurane associated with a continuous infusion rate of fentanyl (bolus of 3 μg/kg followed by 0.3 μg/kg/min). The CO was measured by TEE (COTEE) and TD (COTD) at the end of expiration during normotension and hypotension (induced by isoflurane). Results There was a strong positive correlation between COTEE and COTD (r = 0.925; P < 0.0001). The bias between COTD and COTEE was 0.14 ± 0.29 L/min (limits of agreement, −0.44 to 0.72 L/min). The percentage error of CO measured by the two methods was 12.32%. In addition, a strong positive correlation was found between COTEE and COTD during normotension (r = 0.995; P < 0.0001) and hypotension (r = 0.78; P = 0.0223). Conclusions The results of this study indicated that the transgastric view of the LVOT by TEE was a minimally invasive alternative to clinically monitoring CO in dogs during anaesthesia. However, during hypotension, the CO obtained by TEE was less reliable, although still acceptable.
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Affiliation(s)
- Matheus M Mantovani
- Departamento de Clínica Médica, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil.
| | - Denise T Fantoni
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil. .,Faculdade de Medicina Veterinária e Zootecnia da Universidade Federal de São Paulo, Av. Prof Dr Orlando Marques de Paiva 87, São Paulo, SP, 05508-270, Brazil.
| | - André M Gimenes
- Departamento de Clínica Médica, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Jacqueline R de Castro
- Departamento de Clínica Médica, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Patrícia B Flor
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Keila K Ida
- Laboratório de Investigação Médica 8, Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Denise S Schwartz
- Departamento de Clínica Médica, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
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Borgarelli M, Lanz O, Pavlisko N, Abbott JA, Menciotti G, Aherne M, Lahmers SM, Lahmers KK, Gammie JS. Mitral valve repair in dogs using an ePTFE chordal implantation device: a pilot study. J Vet Cardiol 2017; 19:256-267. [PMID: 28576476 DOI: 10.1016/j.jvc.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/07/2017] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mitral valve (MV) regurgitation due to degenerative MV disease is the leading cause of cardiac death in dogs. We carried out preliminary experiments to determine the feasibility and short-term effects of beating-heart MV repair using an expanded polytetrafluorethylene (ePTFE) chordal implantation device (Harpoon TSD-5) in dogs. ANIMALS This study involved six healthy purpose-bred Beagles (weight range 8.9-11.4 kg). MATERIAL AND METHODS Following a mini-thoracotomy performed under general anesthesia, the TSD-5 was used to place 1 or 2 artificial ePTFE cords on the anterior MV leaflet or the posterior MV leaflet via a left-ventricular transapical approach. The procedure was guided and monitored by transesophageal echocardiography. Postoperative antithrombotic treatment consisted of clopidogrel or a combination of clopidogrel and apixaban. Dogs were serially evaluated by transthoracic echocardiography at day 1, 7, 14, 21, and 30. The hearts were then examined for evaluation of tissues reactions and to detect signs of endothelialization. RESULTS One or two chords were successfully implanted in five dogs. Four dogs completed the 30 days follow-up. One dog died intra-operatively because of aortic perforation. One dog died early post-operatively from a hemorrhagic pleural effusion attributed to overly aggressive antithrombotic treatment. One dog developed a thrombus surrounding both the knot and the synthetic cord. Postmortem exam confirmed secure placement of ePTFE knots in the mitral leaflets in all dogs and the presence of endothelialization of the knots and chords. CONCLUSIONS These preliminary results demonstrate the feasibility of artificial chordal placement using an ePTFE cordal implantation device in dogs.
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Affiliation(s)
- M Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA.
| | - O Lanz
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - N Pavlisko
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - G Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - M Aherne
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - S M Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - K K Lahmers
- Department of Biomedical Sciences & Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, 205 Duck Pond Dr., VA 24061, USA
| | - J S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S. Paca St., MD 21201, USA
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Guglielmini C, Baron Toaldo M, Quinci M, Romito G, Luciani A, Cipone M, Drigo M, Diana A. Sensitivity, specificity, and interobserver variability of survey thoracic radiography for the detection of heart base masses in dogs. J Am Vet Med Assoc 2017; 248:1391-8. [PMID: 27270062 DOI: 10.2460/javma.248.12.1391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the sensitivity, specificity, and interobserver variability of survey thoracic radiography (STR) for the detection of heart base masses (HBMs) in dogs. DESIGN Retrospective case-control study. ANIMALS 30 dogs with an HBM and 120 breed-matched control dogs (60 healthy dogs and 60 dogs with heart disease and no HBM). PROCEDURES In a blinded manner, 2 observers (designated as A and B) evaluated STR views from each dog for a mass-like opacity cranial to the heart, tracheal deviation, cardiomegaly, findings suggestive of pericardial effusion or right-sided congestive heart failure, and soft tissue opacities suggestive of pulmonary metastases. Investigators subsequently provided a final interpretation of each dog's HBM status (definitely affected, equivocal, or definitely not affected). RESULTS Considering equivocal interpretation as negative or positive for an HBM, the sensitivity of STR for diagnosis of an HBM was 40.0% (95% confidence interval [CI], 22.5% to 57.5%) and 56.7% (95% CI, 38.9% to 74.4%), respectively, for observer A and 63% (95% CI, 46.1% to 80.6%) and 80.0% (95% CI, 65.7% to 94.3%), respectively, for observer B. The corresponding specificity was 96.7% (95% CI, 93.5% to 99.9%) and 92.5% (95% CI, 87.8% to 97.2%), respectively, for observer A and 99.2% (95% CI, 97.5% to 100%) and 92.5% (95% CI, 87.8% to 97.2%), respectively, for observer B. The presence of a mass-like opacity cranial to the heart or tracheal deviation, or both, was significantly associated with a true diagnosis of HBM. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that STR is a highly specific but not a highly sensitive predictor of HBM in dogs.
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Cavaliere L, Romito G, Domenech O, Venco L. Heartworm Removal Guided by Transesophageal Echocardiography in a Dog with Naturally Acquired Caval Syndrome. J Am Anim Hosp Assoc 2017; 53:96-100. [DOI: 10.5326/jaaha-ms-6424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
A 14 mo old shih tzu was referred for dyspnea, hemoptysis, and hematuria. Heartworm disease with caval syndrome was diagnosed by laboratory tests, thoracic radiography, and transthoracic echocardiography. The minimally invasive heartworm removal procedure was performed using flexible alligator forceps guided by transesophageal echocardiography. The procedure was successfully performed removing over 94% of heartworms displayed echocardiographically without any intraoperative complication.
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Affiliation(s)
- Leonardo Cavaliere
- From the Dipartimento di Medicina Veterinaria, Università degli Studi di Bari “Aldo Moro,” Valenzano, Italy (L.C.); Istituto Veterinario di Novara, Granozzo con Monticello, Italy (G.R., O.D.); and Ospedale Veterinario Citta' di Pavia, Pavia, Italy (L.V.)
| | - Giovanni Romito
- G. Romito's present affiliation is Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- From the Dipartimento di Medicina Veterinaria, Università degli Studi di Bari “Aldo Moro,” Valenzano, Italy (L.C.); Istituto Veterinario di Novara, Granozzo con Monticello, Italy (G.R., O.D.); and Ospedale Veterinario Citta' di Pavia, Pavia, Italy (L.V.)
| | - Oriol Domenech
- From the Dipartimento di Medicina Veterinaria, Università degli Studi di Bari “Aldo Moro,” Valenzano, Italy (L.C.); Istituto Veterinario di Novara, Granozzo con Monticello, Italy (G.R., O.D.); and Ospedale Veterinario Citta' di Pavia, Pavia, Italy (L.V.)
| | - Luigi Venco
- From the Dipartimento di Medicina Veterinaria, Università degli Studi di Bari “Aldo Moro,” Valenzano, Italy (L.C.); Istituto Veterinario di Novara, Granozzo con Monticello, Italy (G.R., O.D.); and Ospedale Veterinario Citta' di Pavia, Pavia, Italy (L.V.)
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Goya S, Wada T, Shimada K, Hirao D, Fukushima R, Yamagishi N, Shimizu M, Tanaka R. Effects of postural change on transesophageal echocardiography views and parameters in healthy dogs. J Vet Med Sci 2017; 79:380-386. [PMID: 27980234 PMCID: PMC5326945 DOI: 10.1292/jvms.16-0323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The purpose of the present study is to investigate the effect of postural change on
transesophageal echocardiography (TEE) views and parameters of interest anesthesia
monitoring in healthy dogs. Twelve Beagle dogs were anesthetized and randomly positioned
in one of four postures: right lateral-recumbency, left lateral-recumbency, supine
position and prone position. After examinations in one posture, the same examination was
demonstrated in another posture and repeated in all postures. In each posture, several
standard TEE views were demonstrated: longitudinal cranial-esophageal aorta
long-axis-view, transverse middle-esophageal mitral valve long-axis-view and transgastric
middle short-axis-view. Additionally, echocardiographic parameters were attempted to
measure, and direct blood pressure monitoring was performed in each view. As a result,
oriented views, except for transgastric middle short-axis-view, could be obtained in all
postures. Stroke volume and peak early diastolic velocity of mitral inflow were lower in
supine position compared with those in right and left lateral-recumbency. Heart rate (HR)
and systemic vascular resistance were higher in supine position compared with those in
right and left lateral-recumbency. Left ventricular pre-ejection period/left ventricular
ejection time corrected and uncorrected by HR were higher in supine position compared with
those in right and left lateral-recumbency. In conclusion, longitudinal cranial-esophageal
aorta long-axis-view and transverse middle-esophageal mitral valve long-axis-view provide
useful information of interest anesthesia monitoring, because of their views enable to
certainly obtain TEE parameters in various postures. Furthermore, TEE parameters allow to
detect the changes of preload, afterload and HR that occur in supine position dogs.
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Affiliation(s)
- Seijirow Goya
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-0052, Japan
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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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