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Maffei A, Pariaut R, Perego M, Santilli RA. Use of combined cutting balloon and high-pressure balloon technique for the treatment of double-chambered right ventricle or primary infundibular stenosis: a case series. J Vet Cardiol 2024; 53:6-12. [PMID: 38555707 DOI: 10.1016/j.jvc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 04/02/2024]
Abstract
Five dogs and two cats with a diagnosis of double-chambered right ventricle or primary infundibular stenosis were referred to undergo a combined cutting balloon and high-pressure balloon technique. At admission five cases were asymptomatic, one had a history of syncope and one had signs of right-sided congestive heart failure. Each patient underwent a complete transthoracic echocardiogram, thoracic radiographs, an angiogram and the combined interventional procedure. Median diameter of the right mid-ventricular stenosis was 4 mm (range 2-8.7 mm) in dogs, and it measured 1.9 and 2 mm in cats. Under general anesthesia initial dilation with an 8-mm × 2-cm cutting balloon was performed from a left external jugular vein approach followed by dilation with a high-pressure balloon (1.5:1 balloon diameter-right outflow tract diameter ratio). In one dog and the two cats the procedure was not completed due to technical issues. In the other four dogs the median intracavitary proximal chamber pressure decreased from 100 mmHg (range 70-150 mmHg) before the procedure to 57 mmHg (range 45-70 mmHg) post-dilation. Long-term follow-up (from six months to two years) showed complete or partial reverse remodeling of the proximal chamber with a median residual pressure gradient below 80 mmHg (range 46-75 mmHg) for all four dogs. This case series shows that this procedure should be considered in dogs with right ventricular outflow tract obstruction. In cats, the procedure might be feasible, if additional guidewire inventory were available.
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Affiliation(s)
- A Maffei
- Clinica Veterinaria Malpensa, AniCura, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | - R Pariaut
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, 14853, Ithaca, NY, USA
| | - M Perego
- Clinica Veterinaria Malpensa, AniCura, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | - R A Santilli
- Clinica Veterinaria Malpensa, AniCura, Viale Marconi 27, 21017 Samarate, Varese, Italy; Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, 14853, Ithaca, NY, USA.
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2
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Malone RJ, Henderson ER, Wilson ZR, McMullan MR, Skelton TN, Campbell WF, McMullan MR. Double-Chambered Right Ventricle in Adulthood: A Case Series. CASE (PHILADELPHIA, PA.) 2024; 8:202-209. [PMID: 38524987 PMCID: PMC10954581 DOI: 10.1016/j.case.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•DCRV is a rare cardiac anomaly leading to subvalvular RVOT obstruction. •DCRV is most frequently found in children but can occur in adults. •Adults with DCRV are often initially misdiagnosed. •Echocardiography is the first-line imaging modality to visualize this anomaly. •Providers should be aware of this condition and the associated image findings.
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Affiliation(s)
| | | | - Zachary Ryan Wilson
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Matthew R. McMullan
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Thomas N. Skelton
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, Mississippi
| | - William F. Campbell
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael R. McMullan
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, Mississippi
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3
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Halder V, Ghosh S, Thingnam SKS, Singh H, Mishra AK, Mahajan S, Kumar R, Aggarwal P, Dutta ARS, Mishra A. Early and mid-term outcomes of double-chambered right ventricle repair: An 8-year experience. Cardiol Young 2024; 34:268-271. [PMID: 37318004 DOI: 10.1017/s1047951123001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND/AIM Double-chambered right ventricle is a rare and progressive condition that is characterised by obstruction of the right ventricular tract. Double-chambered right ventricle is usually associated with ventricular septal defect. Early surgical intervention is recommended in patients with these defects. Based on this background, the present study aimed to review early and midterm outcomes of primary repair after double-chambered right ventricle. METHODS Between January 2014 and June 2021, 64 patients with a mean age of 13.42 ± 12.31 years underwent surgical repair for double-chambered right ventricle. The clinical outcomes of these patients were reviewed and assessed retrospectively. RESULTS An associated ventricular septal defect was present in all the recruited patients; 48 (75%) patients of sub-arterial type, 15 (23.4%) of perimembranous, and 1 (1.6%) patient of muscular type. The patients were followed up for a mean period of 46.73 ± 27.37 months. During their follow-up, a significant decrease in the mean pressure gradient from 62.33 ± 5.52 mmHg preoperatively to 15.73 ± 2.94 mmHg postoperatively was observed (p < 0.001). Notably, there were no hospital deaths. CONCLUSIONS The development of double-chambered right ventricle in association with ventricular septal defect results in an increased pressure gradient within the right ventricle. The defect needs correction in a timely manner. In our experience, the surgical correction of double-chambered right ventricle is safe and shows excellent early and mid-term results.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amit Mishra
- Department of CTVS, UNMICRC, Ahmedabad, India
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4
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Schrope D. Acquired infundibular pulmonary stenosis associated with a congenital membranous ventricular septal defect (Gasul phenomenon) in a dog and discussion regarding causes of infundibular stenosis. J Vet Cardiol 2023; 47:64-69. [PMID: 37247530 DOI: 10.1016/j.jvc.2023.05.001] [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: 12/13/2022] [Revised: 04/23/2023] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
An aclinical Havanese dog was diagnosed with a membranous restrictive ventricular septal defect. The patient was represented later in their natural history due to the development of syncope. At that time the patient was diagnosed with acquired pulmonary infundibular stenosis. Balloon dilation of the stenosis was performed successfully twice over the patient's lifetime. The patient died suddenly approximately 14 months after the second balloon dilation. A discussion regarding primary infundibular pulmonary stenosis versus causes of acquired infundibular pulmonary stenosis including anomalous muscle bundles (double chamber right ventricle), tetralogy of Fallot, and infundibular stenosis is presented.
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Affiliation(s)
- D Schrope
- Oradell Animal Hospital, Paramus, NJ, USA.
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Narula J, Bansal P, Rajput N. Indispensable Role of Transesophageal Echocardiography in Double-Chamber Right Ventricle Repair Surgery. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00120-9. [PMID: 36990803 DOI: 10.1053/j.jvca.2023.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
Abstract
Double-chamber right ventricle repair surgery requires the excision of anomalous obstructive muscular or fibromuscular bundles in the right ventricular outflow tract. Because of the close proximity of key structures in the right ventricular outflow tract, the surgery is extremely challenging and requires precise resection. Underresection of the muscle bands can lead to significant residual gradients in the postoperative period, whereas overenthusiastic resection can cause iatrogenic injury to surrounding structures. Various techniques like Hegar sizing by the surgeons, direct chamber pressure measurement, transesophageal echocardiography, and epicardial echocardiography can guide the surgeons about the adequacy of repair. Transesophageal echocardiography is crucial at each step, as it can precisely determine the exact site of obstruction in the preoperative period. Postoperatively, it helps determine the adequacy of surgical repair and identification of inadvertent iatrogenic complications.
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Affiliation(s)
- Jitin Narula
- Department of Anesthesia, Narayana Super Specialty Hospital, Gurugram, Haryana, India; Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences, Faridabad, Haryana, India.
| | - Piyush Bansal
- Department of Anesthesia, Narayana Super Specialty Hospital, Gurugram, Haryana, India
| | - Nitin Rajput
- Department of Cardio Thoracic and Vascular Surgery, Narayana Super Specialty Hospital, Gurugram, Haryana, India
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6
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Dynamic cardiac computed tomography characteristics of double-chambered right ventricle. Sci Rep 2022; 12:20607. [PMID: 36446892 PMCID: PMC9708647 DOI: 10.1038/s41598-022-25230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
To introduce image characteristics of double-chambered right ventricle on cardiac computed tomography and set a diagnostic criterion for the diagnosis. We retrospectively collected and measured the right ventricular constrictive ratio on computed tomography images in children who had simple ventricular septal defects in the past 10 years, because double-chambered right ventricle is often associated with ventricular septal defects. The right ventricular constrictive ratio was defined as the subinfundibular cross-sectional intraluminal area during end-systole divided by the area during end-diastole in the same patient. We compared the right ventricular constrictive ratio between subjects with concomitant double-chambered right ventricle and those without. 52 children were included, and 23 (44.2%) of them have concomitant double-chambered right ventricle. In most cases (n = 21; 91.3%), the hypertrophied muscular bundles occur just inferior to the level of the supraventricular crest in the right ventricle. Mean right ventricular constrictive ratio in patients with double-chambered right ventricle (15%) was significantly smaller than that without (29%). A cut-off value of a right ventricular constrictive ratio less than 20.1% was established to diagnose double-chambered right ventricle with an 89.7% sensitivity and 78. 3% specificity. Right ventricular constrictive ratio can be a valuable asset for the preoperative diagnosis of double-chambered right ventricle with cardiac computed tomography.
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7
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Double-chambered right ventricle in adults: Invasive and noninvasive hemodynamic considerations. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Garg A, Agrawal D, Sharma GL. Isolated Double-Chambered Right Ventricle - A Rare Entity. J Cardiovasc Echogr 2020; 30:162-164. [PMID: 33447507 PMCID: PMC7799069 DOI: 10.4103/jcecho.jcecho_36_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/30/2020] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
A double-chambered right ventricle (DCRV) is a rare congenital heart disease and an uncommon cause of congestive heart failure. An anomalous muscle band divides the right ventricle into two cavities: the proximal high-pressure chamber and the distal low-pressure chamber. Most cases are diagnosed and treated during childhood. Furthermore, there is a tendency for progression, if not treated early. Echocardiography is considered useful for the diagnosis of this ailment. Most of the patients have associated congenital anomalies, such as ventricular septal defect, pulmonary stenosis, and subaortic stenosis. Isolated DCRV is a rare entity. Hence, we report a case of an isolated DCRV in an adult patient.
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Affiliation(s)
- Ashok Garg
- Department of Preventive and Noninvasive Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
| | - Deepak Agrawal
- Department of Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
| | - G L Sharma
- Department of Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
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9
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Patibandla S, Trehan S, Kyaw H, Tsai K, Reddy S. Adult Double-Chambered Right Ventricle Associated With Ventricular Tachycardia and New-Onset Heart Failure. Cureus 2020; 12:e8122. [PMID: 32542173 PMCID: PMC7292684 DOI: 10.7759/cureus.8122] [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] [Indexed: 11/05/2022] Open
Abstract
A double-chambered right ventricle is an uncommon form of congenital heart disease that is characterized by the division of the right ventricle into a proximal high-pressure chamber and a distal low-pressure chamber. A 70-year-old male presented to the emergency room from his outpatient doctor's office with unstable wide complex ventricular tachycardia with right axis deviation. His ventricular tachycardia was terminated using external cardioversion and intravenous amiodarone. He was subsequently found to have new-onset heart failure with a reduced ejection fraction and a right ventricular tract outflow obstruction on transthoracic echocardiography. A diagnosis of the double-chambered right ventricle was made. The patient was offered surgery to fix the anomalous tissue but he refused. He did agree to subcutaneous implantable cardioverter-defibrillator placement and was then discharged home.
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Affiliation(s)
| | | | - Htoo Kyaw
- Cardiology, Brooklyn Hospital Center/Mount Sinai Heart, Brooklyn, USA
| | - Kevin Tsai
- Cardiology, Brooklyn Hospital Center/Mount Sinai Heart, Brooklyn, USA
| | - Sarath Reddy
- Cardiology, Brooklyn Hospital Center/Mount Sinai Heart, Brooklyn, USA
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10
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Bhambi NS, Shah A, Sarte P, Laughrun DR. Bacterial endocarditis presenting in an adult patient with undiagnosed double-chambered right ventricle. Clin Case Rep 2019; 7:893-897. [PMID: 31110710 PMCID: PMC6510006 DOI: 10.1002/ccr3.2107] [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: 01/10/2019] [Revised: 02/15/2019] [Accepted: 02/23/2019] [Indexed: 11/08/2022] Open
Abstract
Double-chambered right ventricle (DCRV) is a rare congenital heart defect often associated with ventricular septal defect and pulmonary stenosis. Cardiac catheterization or magnetic resonance imaging can differentiate between DCRV and Tetralogy of Fallot when echocardiogram is inconclusive. Patients are at an increased risk for bacterial endocarditis.
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Affiliation(s)
- Neil Salil Bhambi
- Department of Internal MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCalifornia
| | - Abhishek Shah
- Department of Cardiovascular MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCalifornia
| | - Patrick Sarte
- Department of Internal MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCalifornia
| | - David Robert Laughrun
- Department of Cardiovascular MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCalifornia
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11
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Abstract
Supplemental Digital Content is available in the text.
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12
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Chellappan S, Sahu B, Sathe YC. Isolated Double-chambered Right Ventricle with Intact Interventricular Septum. J Cardiovasc Echogr 2017; 26:127-130. [PMID: 28465979 PMCID: PMC5224663 DOI: 10.4103/2211-4122.192180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Double-chambered right ventricle (DCRV) is a developmental cardiac anomaly in which anomalous muscle bundles divide the right ventricular (RV) cavity into two chambers. It is usually associated with other congenital cardiac defects, of which ventricular septal defect is the most common association. Isolated DCRV with an intact interventricular septum is very rarely reported. It manifests itself usually in adolescence and adults as the obstruction progresses gradually. It is important to recognize this anomaly as it can progress to severe RV failure if unaddressed. We report a 13-year-old male who presented to us with an isolated DCRV. He successfully underwent a resection of the RV cavity anomalous muscle bundles. We also stress on the utility of transesophageal echocardiography intraoperatively which accurately delineates the location of the muscle bundles and helps in evaluating the adequacy of resection postsurgery.
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Affiliation(s)
- Subramanian Chellappan
- Department of Pediatric Cardiac Anaesthesia, Sri Satya Sai Sanjeevani Hospital, Chhattisgarh, India
| | - Balaswaroop Sahu
- Department of Pediatric Cardiac Anaesthesia, Sri Satya Sai Sanjeevani Hospital, Chhattisgarh, India
| | - Yogesh C Sathe
- Department of Pediatric Cardiology, Sri Satya Sai Sanjeevani Hospital, Chhattisgarh, India
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13
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Isolated double chambered right ventricle as a rare cause of sudden death in infancy. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Sequential segmental classification of feline congenital heart disease. J Vet Cardiol 2016; 17 Suppl 1:S10-52. [PMID: 26776571 DOI: 10.1016/j.jvc.2015.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/01/2015] [Accepted: 04/21/2015] [Indexed: 12/17/2022]
Abstract
Feline congenital heart disease is less commonly encountered in veterinary medicine than acquired feline heart diseases such as cardiomyopathy. Understanding the wide spectrum of congenital cardiovascular disease demands a familiarity with a variety of lesions, occurring both in isolation and in combination, along with an appreciation of complex nomenclature and variable classification schemes. This review begins with an overview of congenital heart disease in the cat, including proposed etiologies and prevalence, examination approaches, and principles of therapy. Specific congenital defects are presented and organized by a sequential segmental classification with respect to their morphologic lesions. Highlights of diagnosis, treatment options, and prognosis are offered. It is hoped that this review will provide a framework for approaching congenital heart disease in the cat, and more broadly in other animal species based on the sequential segmental approach, which represents an adaptation of the common methodology used in children and adults with congenital heart disease.
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15
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Poser H, Dalla Pria A, De Benedictis GM, Stelletta C, Berlanda M, Guglielmini C. Ventricular septal defect and double-chambered right ventricle in an alpaca. J Vet Cardiol 2015; 17:71-6. [PMID: 25595611 DOI: 10.1016/j.jvc.2014.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/30/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
A 20-month-old male alpaca was referred for evaluation of a cardiac murmur evident since birth. Echocardiography identified a ventricular septal defect (VSD) and a fibro-muscular band causing a stenosis of the right ventricular outflow tract. Right ventricular catheterization and selective angiography confirmed the diagnosis of VSD and double-chambered right ventricle with bidirectional shunting.
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Affiliation(s)
- Helen Poser
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell'Università 16, 35020 Legnaro, PD, Italy.
| | - Angela Dalla Pria
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell'Università 16, 35020 Legnaro, PD, Italy
| | - Giulia M De Benedictis
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell'Università 16, 35020 Legnaro, PD, Italy
| | - Calogero Stelletta
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell'Università 16, 35020 Legnaro, PD, Italy
| | - Michele Berlanda
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell'Università 16, 35020 Legnaro, PD, Italy
| | - Carlo Guglielmini
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell'Università 16, 35020 Legnaro, PD, Italy
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Malakan Rad E, Awad S, Hijazi ZM. Congenital left ventricular outpouchings: a systematic review of 839 cases and introduction of a novel classification after two centuries. CONGENIT HEART DIS 2014; 9:498-511. [PMID: 25159202 DOI: 10.1111/chd.12214] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital left ventricular outpouchings (LVOs) are reported under five overlapping and poorly defined terms including left ventricular accessory chamber, left ventricular aneurysm (LVA), left ventricular diverticulum (LVD), double-chambered LV, and accessory left ventricle. Diagnostic criteria are frequently mixed and not mutually exclusive. They convey no information regarding treatment strategy and prognosis. OBJECTIVES The aim of this systematic review is to provide a clear and inclusive classification, with therapeutic and prognostic implications, for congenital LVOs. DATA SOURCES We performed three separate sets of search on three subjects including "congenital left ventricular outpouchings," "important and simply measurable markers of left ventricular function," and "relationship of mechanics of intraventricular blood flow and optimal vortex formation in left ventricle and elliptical geometry of LV." STUDY ELIGIBILITY CRITERIA We enrolled case series, review articles, and case reports with literature review. All types of acquired LVO's were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS We studied the abstracts of all searched articles. We focused on diagnostic criteria and patients' outcome. To examine the validity and reliability of the novel classification, fifteen previous studies were revisited using the novel classification. RESULTS A total of 20 papers from 11 countries fulfilled our inclusion criteria. The age of patients ranged from prenatal age to geriatric age range. Diagnostic criteria were clearly stated only for two of the above five terms (i.e., congenital LVA and congenital LVD). Cases with mixed diagnostic criteria were frequent.Elliptical geometry of left ventricle was found to have significant impact on effective blood flow mechanics in LV. A simple inclusive classification for congenital LVOs, with therapeutic and prognostic implications, was introduced. CONCLUSION The cornerstone of this classification is elliptical LV geometry. Large-type IIc LVO have dismal prognosis, if left untreated. LVO type I and small LVO type IIa have the best prognosis.
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Affiliation(s)
- Elaheh Malakan Rad
- Section of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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Shankarappa RK, Patra S, Karur S, Singh A, Nanjappa MC, Chandrasekaran D. An adult patient of double-chambered right ventricle with ventricular septal defect incidentally diagnosed after presentation with acute myocardial infarction. Echocardiography 2013; 30:E312-4. [PMID: 24103007 DOI: 10.1111/echo.12334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The double-chambered right ventricle (DCRV) is a rare congenital heart disease caused by hypertrophic anomalous muscle bands that divide the ventricular cavity, resulting in the formation of a high-pressure proximal chamber and other low-pressure distal one. Because of its evolving nature, its diagnosis is usually made during childhood/adolescence and very rarely during adulthood. It accounts for approximately 0.5-1% of patients with congenital heart disease. We report a case of a 50-year-old man who presented to us with acute inferior wall myocardial infarction (MI). Echocardiography revealed the features of DCRV and ventricular septal defect. Coronary angiogram revealed significant stenosis in right coronary artery. This is the first case where an adult patient with DCRV incidentally diagnosed after presentation with acute MI and had undergone successful coronary angioplasty.
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Affiliation(s)
- Ravindranath K Shankarappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka, India
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18
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Chaurasia AS, Nawale JM, Yemul MA. Double-chambered right ventricle with pulmonary valve endocarditis. Echocardiography 2013; 30:E167-70. [PMID: 23551809 DOI: 10.1111/echo.12186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe a rare case of pulmonary valve endocarditis associated with a double-chambered right ventricle in an adolescent male highlighting the two-dimensional and three-dimensional transthoracic echocardiographic findings. He was managed with aggressive antibiotic therapy followed by surgery. The echocardiographic findings were confirmed during surgery.
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Affiliation(s)
- Ajay S Chaurasia
- Department of Cardiology, Topiwala National Medical College & B Y L Nair Charitable Hospital, Mumbai, India
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19
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Abstract
Transesophageal echocardiography (TEE) plays an important role in the anatomical, functional, and hemodynamic assessment of patients with congenital heart disease (CHD). This imaging approach has been applied to both children and adults with a wide range of cardiovascular malformations. Extensive clinical experience documents significant contributions, particularly in the perioperative setting. In fact, in the current medical era, many consider this technology to be an essential adjunct to surgical and anesthetic management in CHD. This review focuses on the applications of TEE in patients with tetralogy of Fallot (TOF), the most common form of cyanotic heart disease. Emphasis is given to the perioperative use of this imaging modality and benefits derived during the prebypass and postbypass periods. Limitations and pitfalls relevant to the TEE assessment in patients with this anomaly are also addressed.
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20
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Park JG, Ryu HJ, Jung YS, Kim KJ, Lee BR, Jung BC, Kang H. Isolated double-chambered right ventricle in a young adult. Korean Circ J 2011; 41:272-5. [PMID: 21731569 PMCID: PMC3116106 DOI: 10.4070/kcj.2011.41.5.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/20/2010] [Accepted: 09/27/2010] [Indexed: 11/24/2022] Open
Abstract
Double-chambered right ventricle (DCRV) is a rare congenital heart disorder in which the right ventricle is divided by an anomalous muscle bundle into a high pressure inlet portion and a low pressure outlet portion. We report a case of isolated DCRV without symptoms in adulthood, diagnosed through echocardiography, cardiac catheterization and cardiac magnetic resonance imaging.
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Affiliation(s)
- Jung-Gil Park
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
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21
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Choi YJ, Park SW. Characteristics of double-chambered right ventricle in adult patients. Korean J Intern Med 2010; 25:147-53. [PMID: 20526387 PMCID: PMC2880687 DOI: 10.3904/kjim.2010.25.2.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 07/21/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS This study evaluated the clinical features of double-chambered right ventricle (DCRV) in adults. Most cases of DCRV are diagnosed and treated during childhood. Consequently, very few reports include cases in which its clinical characteristics are evident in adults. METHODS We reviewed the clinical data for 10 adult patients (age > or = 18 years) with DCRV. RESULTS Electrocardiogram showed right ventricular hypertrophy in 3 DCRV patients. All cases were associated with ventricular septal defect (VSD; 7 for perimembranous, 2 for muscular outlet, and 1 for the subarterial type). Surgical correction was done for 7 DCRV patients all of whom survived operations. Their follow-up echocardiogram showed the pressure gradient in their right ventricle was significantly decreased from 69.4 +/- 17.2 mmHg preoperatively to 10.2 +/- 5.0 mmHg postoperatively (p < 0.05). In the short-term follow-up, there was no significant increase in the pressure gradient in the right ventricle. CONCLUSIONS There are lots of cases of DCRV that are not diagnosed accurately in adults. In our experience, all DCRV cases had VSD and surgical correction of these cases showed excellent results. Therefore, accurate diagnosis of DCRV is necessary so that DCRV is not overlooked and operations are enabled within an appropriate time.
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Affiliation(s)
- Yu Jeong Choi
- Division of Cardiology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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22
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Gadhinglajkar SV, Sreedhar R, Chandranmahaldar DA, Minhaj MM, Tempe DK. Case 2-2010 combined surgery for coronary artery disease, mitral stenosis, and double-chamber right ventricle. J Cardiothorac Vasc Anesth 2010; 24:356-63. [PMID: 20362239 DOI: 10.1053/j.jvca.2010.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Indexed: 11/11/2022]
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23
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Schrope DP. Primary pulmonic infundibular stenosis in 12 cats: Natural history and the effects of balloon valvuloplasty. J Vet Cardiol 2008; 10:33-43. [DOI: 10.1016/j.jvc.2008.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 03/29/2008] [Accepted: 04/01/2008] [Indexed: 11/16/2022]
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24
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Parnell AD, Wilkinson GAL, Morgan-Hughes NJ. Ventriculoseptal defect detected after surgical repair of double-chamber right ventricle. Anesth Analg 2008; 106:1385-6. [PMID: 18420848 DOI: 10.1213/ane.0b013e3181684153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alison D Parnell
- Department of Anaesthesia and Critical Care, Northern General Hospital, Sheffield, UK.
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25
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Koffas H, Fuentes VL, Boswood A, Connolly D, Brockman D, Bonagura J, Meurs K, Koplitz S, Baumwart R. Double Chambered Right Ventricle in 9 Cats. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb02931.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Minors SL, O'Grady MR, Williams RM, O'Sullivan ML. Clinical and Echocardiographic Features of Primary Infundibular Stenosis with Intact Ventricular Septum in Dogs. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb00749.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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Alvarez M, Tercedor L, Lozano JM, Azpitarte J. Sustained monomorphic ventricular tachycardia associated with unrepaired double-chambered right ventricle. ACTA ACUST UNITED AC 2006; 8:901-3. [PMID: 16887865 DOI: 10.1093/europace/eul084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Double-chambered right ventricle (DCRV) is a congenital anomaly characterized by the division of the ventricular cavity into two chambers separated by an abnormal hypertrophied muscular band or by severe hypertrophy of the muscle wall. Two adult patients with a diagnosis of DCRV presented sustained monomorphic ventricular tachycardia. In both cases, the clinical tachycardia was induced with programmed stimulation. After surgically resecting, the muscular band tachycardia could no longer be induced in the patient who underwent follow-up electrophysiological study. The outcome was favourable; there was no clinical recurrence of ventricular tachycardia in the two patients at 48 and 36 months, respectively.
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Affiliation(s)
- Miguel Alvarez
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen de las Nieves, Avda. Fuerzas Armadas, 18014 Granada, Spain.
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28
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López-Pardo F, Aguilera A, Villa M, Granado C, Campos A, Cisneros JM. Double-Chambered Right Ventricle Associated with Mural and Pulmonic Valve Endocarditis: Description of a Clinical Case and Review of the Literature. Echocardiography 2004; 21:171-3. [PMID: 14961798 DOI: 10.1111/j.0742-2822.2004.02171.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A double-chambered right ventricle is a relatively uncommon congenital cardiac defect characterized by the presence of anomalous muscle bundles dividing the right ventricle into a high-pressure proximal chamber and a low-pressure distal chamber. This pathology is often wrongly diagnosed in adult patients. We report the first case of a patient with double-chambered right ventricle associated with a mural and pulmonic valve endocarditis caused by Streptococcus parasanguis diagnosed with two-dimensional echocardiography. During the course of treatment, the patient suffered from a septic pulmonary embolism, and subsequently required surgical intervention, which confirmed the echocardiographic findings.
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Affiliation(s)
- Francisco López-Pardo
- Department of Cardiology and Department of Infectious Diseases, University Hospital Virgen del Rocío, Seville, Spain.
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29
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Oliver JM, Garrido A, González A, Benito F, Mateos M, Aroca A, Sanz E. Rapid progression of midventricular obstruction in adults with double-chambered right ventricle. J Thorac Cardiovasc Surg 2003; 126:711-7. [PMID: 14502143 DOI: 10.1016/s0022-5223(03)00044-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the rate of progression of midventricular obstruction in adolescents and adults with double-chambered right ventricle. METHODS Clinical and echocardiographic findings in 45 patients (mean age 26 +/- 6 years, range 15-44) diagnosed with double-chambered right ventricle were retrospectively analyzed. Twenty patients underwent surgical repair before the age of 15 years. The relationship between Doppler midventricular pressure gradient and patient age was analyzed in 25 patients without previous repair. Sequential change in midventricular obstruction was determined for patients with 2 or more Doppler echocardiographic examinations performed within at least a 2-year interval. RESULTS Right midventricular pressure gradient in nonrepaired patients was 70 +/- 38 mm Hg (range 25-150). A significant relationship between midventricular obstruction and patient age (r = 0.64, P <.001) was found. Midventricular pressure gradient at initial evaluation was 32 +/- 27 mm Hg in 16 patients < 25 years and 73 +/- 45 mm Hg in 9 patients >/= 25 years (P <.03). After the initial study, 5 patients underwent surgical repair and 13 patients without repair were followed up for a period of 6.1 +/- 2.7 years (range 2-9), in which midventricular pressure gradient increased from 32 +/- 26 mm Hg to 67 +/- 35 mm Hg (P <.001). The slope of the change in midventricular pressure gradient was 6.2 +/- 3 mm Hg per year of follow-up. Seven more patients underwent surgical repair during follow-up due to progression of the obstruction. There was no mortality nor residual midventricular obstruction in surgically repaired patients. CONCLUSIONS Mild right midventricular obstruction shows a fast rate of progression in adolescents and young adults. Thus, close clinical and echocardiographic follow-up is advised, and surgical repair should be considered if significant progression of obstruction is detected.
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Affiliation(s)
- José María Oliver
- Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, La Castellana 261, Madrid 28046, Spain.
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MacLean HN, Abbott JA, Pyle RL. Balloon Dilation of Double-Chambered Right Ventricle in a Cat. J Vet Intern Med 2002. [DOI: 10.1111/j.1939-1676.2002.tb01268.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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31
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Martin JM, Orton EC, Boon JA, Mama KR, Gaynor JS, Bright JM. Surgical correction of double-chambered right ventricle in dogs. J Am Vet Med Assoc 2002; 220:770-4, 768. [PMID: 11918270 DOI: 10.2460/javma.2002.220.770] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Double-chambered right ventricle (DCRV) is possibly an emerging congenital cardiac anomaly in dogs. The defect causes clinical and pathophysiologic signs similar to those of congenital pulmonic stenosis in dogs but has distinct diagnostic features, breed predilections, and implications for treatment. The defect is often associated with clinical signs early in life. Surgical correction of DCRV can be undertaken with the aid of cardiopulmonary bypass and offers the prospect of an improved clinical outcome.
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Affiliation(s)
- Julie M Martin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins 80523, USA
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32
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Affiliation(s)
- M E Lascano
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abstract
A 32-month-old spayed female Pug was referred for an MRI study due to convulsions. The MRI examination indicated encephalitis. However, echocardiography and pathological examinations revealed that this case had a ventricular septal defect and double chambered right ventricle which is a rare congenital heart disease in the dog. An anomalous muscle bundle crossed the right ventricular outflow tract, dividing the right ventricle into 2 chambers.
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Affiliation(s)
- H Koie
- Animal Medical Center, Nihon University, Kanagawa, Japan
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