Retrospective Comparison of Surgical Ligation and Transarterial Catheter Occlusion for Treatment of Patent Ductus Arteriosus in Two Hundred and Four Dogs (1993?2003)

Doppler Ultrasonographic Assessment of Abdominal Aortic Flow to Evaluate the Hemodynamic Relevance of Left-to-Right Shunting Patent Ductus Arteriosus in Dogs

In this multicenter, prospective, observational study, abdominal aortic flow was examined with pulsed-wave Doppler ultrasound in dogs with a left-to-right shunting patent ductus arteriosus (PDA) and in apparently healthy dogs. Forty-eight dogs with a PDA and 35 controls were included. In the dogs with a PDA, 37/48 had hemodynamically significant PDAs (hsPDAs) while 11/48 had non-hsPDAs, based on the presence or absence of echocardiographic signs of left-sided volume overload, respectively. In 12 dogs (4/35 control dogs, 7/37 dogs with an hsPDA and 1/11 dogs with a non-hsPDA), the diastole was too short to visualize the end-diastolic flow. Antegrade end-diastolic flow was observed in 30/35 controls and 6/11 dogs with a non-hsPDA. Absent end-diastolic flow was observed in 1/35 control dogs and 3/11 dogs with a non-hsPDA. Retrograde end-diastolic flow was observed in 30/37 dogs with an hsPDA and 1/11 dogs with a non-hsPDA. Twenty-one dogs (15 with an hsPDA and 6 with a non-hsPDA) were reassessed after PDA closure, and, in 19/21, end-diastolic flow was visualized: 17/19 showed an antegrade flow, 1/19 an absent flow and 1/19 a retrograde flow. Sensitivity and specificity of retrograde end-diastolic flow for detection of hsPDAs were 100% and 90%, respectively. In conclusion, ultrasonographic assessment of abdominal aortic flow was feasible in dogs with PDA. However, end-diastolic flow was not always visualized. The presence of a retrograde end-diastolic flow was an accurate finding for discriminating hsPDAs and non-hsPDAs.

[Diagnosis and treatment of feline persistent ductus arteriosus: a retrospective evaluation of 17 cats]

OBJECTIVE

The objective of this study was to evaluate the signalement, clinical features, and echocardiographic findings of cats diagnosed with patent ductus arteriosus (PDA) as well as short- and medium-term outcome after successful ligation of the PDA.

MATERIAL AND METHODS

Over a 10-year period 17 cats were diagnosed with PDA by transthoracic echocardiography. Thirteen cats were surgically treated by thoracotomy and ligation of the PDA.

RESULTS

In all cats, a heart murmur was detected. In 88.2% of the cases, this presented as grade 4 out of 6 murmur (15/17 cats). A continuous murmur was more common (10/17 cats; 58.9%) than a systolic murmur (7/17 cats; 41.1%). Echocardiography showed that left ventricular internal diameter end diastole (LVIDd) and left ventricular internal diameter end systole (LVIDs) were significantly above reference values in the majority of cats. Mean diameter of the PDA measured at the widest point of the vessel was 3.4 mm (± 1.08 mm) and mean maximum flow velocity amounted to 5,06 m/sec (2,6m/sec-6,4m/sec). Surgery was successfully performed in all cats treated by surgical ligation and all of these patients were discharged after postoperative inpatient therapy. One cat experienced perioperative bleeding from the PDA, which was stopped efficaciously. This cat exhibited a residual shunt directly postoperatively; this could no longer be visualized in a re-check echocardiography 3 months later. Six cats were followed over a longer period of time.

CONCLUSIONS

The surgical prognosis in this case study is very good with a postoperative survival rate of 100%.

CLINICAL RELEVANCE

Surgical treatment of PDA is curative in animals not displaying advanced cardiac lesions. The auscultation of a heart murmur can provide initial findings indicative of PDA. Therefore, cardiac auscultation is warranted at every first presentation of a kitten. It must however be taken into consideration that not every cat with PDA necessarily has a continuous murmur but may display a systolic heart murmur. Therefore, it is important give utmost attention to the patients' clinical signs.

Granulomatous Inflammation and Pericarditis Induced by Silk Granuloma Related to Previous Surgical Ligation of Patent Ductus Arteriosus in a Dog

Surgical ligation of a patent ductus arteriosus is regarded as a standard treatment approach with a low complication rate if performed by experienced surgeons, and it has been performed successfully for decades in dogs. However, there are no reports describing the clinical symptoms related to granulomatous inflammation after the surgical ligation of the patent ductus arteriosus. This report describes the clinical symptoms caused by granulomatous inflammation and subacute pericarditis in a dog that had undergone the surgical closure of a patent ductus arteriosus 2 years previously. Exploratory thoracotomy was performed for subtotal pericardiectomy, and a biopsy was performed to obtain specimens for histopathological examination and culture tests. The clinical symptoms were relieved after surgery. The persistent leukocytosis improved with steroid administration. This case illustrates that the granulomatous inflammatory response associated with silk suture granuloma is a rare postoperative complication of ductal ligation. In such cases, pericardiectomy can help relieve the clinical symptoms.

Information Provided by Breeders and Referring Veterinarians about the Presence and Meaning of a Murmur to Owners of Newly Purchased Puppies with a Later Confirmed Congenital Heart Disease

Background: A recent study revealed that only 10% of puppies diagnosed with a congenital heart disease were referred for murmur investigation to a veterinary cardiology specialist while the puppies were in the breeders' possession. Whether the new owners had been informed about the presence of a murmur before purchasing a puppy was not investigated. Methods: New owners whose dogs were diagnosed with a congenital heart disease at the authors' institution in a 1-year period received a questionnaire during the consult after cardiac auscultation but before performing an echocardiogram. The main study aims were to reveal whether the breeders had informed the new owners about the presence of a murmur before purchasing the puppy, and whether the owners would have still chosen to buy that specific puppy if they had known about a potentially present congenital heart disease. Results: Of the 60 interviewed owners, 72% would have refrained from buying the puppy if they had known about the presence of a congenital heart disease. However, only 23% of them were informed about the presence of a cardiac murmur before purchase. Conclusions: Most owners would have chosen to buy a healthy puppy without a heart disease if they had been informed.

Surgical ligation of patent ductus arteriosus in dogs: Incidence and risk factors for rupture

OBJECTIVE

To determine the rates of rupture and mortality associated with surgical ligation of patent ductus arteriosus (PDA) in dogs and to identify risk factors for rupture.

STUDY DESIGN

Retrospective cohort.

ANIMALS

Two-hundred and eighty-five dogs with PDA undergoing surgical ligation.

METHODS

Information regarding signalment, weight, surgical findings, complications, presence of residual flow, and survival was recorded. Age, weight, and presence of residual flow were compared between cases with and without rupture.

RESULTS

The initial surgical approach was extrapericardial (144), intrapericardial (46), not reported (94), or Jackson-Henderson (1). Rupture of the PDA occurred in 7.0% of dogs (20/285, 13 extrapericardial, 3 intrapericardial, 4 not reported). No difference in age or weight was found between dogs with and without rupture. Overall mortality was 0.4% (1/285). Additional major complications occurred in 1.4% of dogs, all in the nonrupture group. The overall rate of residual flow after ligation was 9.4%. Dogs with rupture were more likely to have residual flow than those without rupture (P = .012). If ligation was performed after rupture (rather than hemostasis only), no difference in residual flow rates (P = .398) was noted between dogs with rupture and those without.

CONCLUSION

The rate of rupture with surgical ligation of PDAs was low. No specific risk factors for rupture were identified.

CLINICAL SIGNIFICANCE

Successful treatment of PDA rupture is possible, evidenced by the low mortality rate in this population of dogs. Ligation of the PDA after rupture, either in the concurrent or a subsequent procedure, reduces the odds of residual flow.

Branham sign in dogs undergoing interventional patent ductus arteriosus occlusion or surgical ligation: A retrospective study

Background:

The Branham sign is a baroreceptor response that follows patent ductus arteriosus (PDA) closure. Although described in dogs following both interventional and surgical ductal closure, a direct comparison of the Branham sign elicited by these two techniques has not been made.

Aim:

Since closure with an Amplatz canine ductal occluder (ACDO) occurs over 10 minutes and surgical ligation (SL) is more rapid, we hypothesized that the Branham sign following occlusion of a PDA with an ACDO would be less severe than following SL.

Methods:

Clinical records of dogs diagnosed with left-to-right shunting PDA between 2008 and 2018 were retrospectively reviewed. Of 139 dogs undergoing PDA occlusion, only 41 dogs (ACDO n = 32, SL n = 9) were included after applying exclusion criteria. Heart rate (HR) and blood pressure (BP) from occlusion time (T₀) until 30 minutes post occlusion (T₃₀) were recorded. Signalment and anesthetic protocol were also recorded. The influence of age and weight on the hemodynamic variations was assessed. Hemodynamic variables and calculations were compared between and within groups using a repeated measures general linear model, and post hoc tests were applied if significance was identified.

Results:

A mild Branham sign was present in both groups, and hemodynamic changes were not significantly different between groups. In both groups, there was a significant decrease in HR (11 bpm, 5.3–16.3; p < 0.001) (10.4%, 5.4–15.5; p < 0.001) and increase in diastolic BP (9.5 mmHg, 3–16; p = 0.002) (23.5%, 7.1–39.9; p = 0.002), but systolic BP did not change significantly (p = 0.824). Age and weight did not influence Branham sign.

Conclusion:

The Branham sign in dogs is mild in both groups, lasts for at least 30 minutes, and is independent of the method of PDA closure.

Age of puppies at referral to veterinary cardiology specialists for murmur investigation

Background

Cardiac auscultation is an important screening test at the first health examination of puppies because most clinically relevant congenital cardiac anomalies cause a loud murmur from birth. This retrospective study aimed to investigate the age at which dogs with suspected congenital cardiac anomalies were referred to a veterinary cardiology specialist for murmur investigation. A secondary aim was to establish the time interval between the visit to the cardiologist and the first available murmur documentation. The digital archive of a veterinary teaching hospital was searched for dogs with congenital cardiac anomalies and puppies with innocent murmurs during a 5-year period. Dogs had to be referred because of a murmur, and they had to undergo physical examination and echocardiography by a veterinary cardiology specialist. The health certificate section of the pet passport, and the medical records from the referring veterinarian, were reviewed to identify the date when the murmur was first documented.

Results

Of the 271 included dogs, 94% had a congenital cardiac anomaly and 6% had an innocent murmur. The dogs’ median age was 190 days when they were examined by the cardiologist. Only 10% of the dogs were referred by the breeder’s veterinarian, while 90% of the dogs were referred by the new owner’s veterinarian. The median age of the first available murmur documentation by a first opinion veterinary practitioner was 95 days.

Conclusions

Only 10% of the puppies in the present study were referred to a veterinary cardiology specialist for murmur investigation before they were sold to a new owner. Referral prior to re-homing would have been feasible if the murmur had been detected and documented by the breeder’s veterinarian, if referral was offered by the breeder’s veterinarian and the referral was accepted by the breeder.

Key considerations in the approach to congenital heart disease in dogs and cats

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.

Jackson-Henderson technique for the revision surgery following PDA rupture in a dog

A 3-month-old female intact Maltese dog, was referred for further investigation and management of a patent ductus arteriosus (PDA), which was diagnosed with a grade V murmur during thoracic auscultation and a palpable thrill in the left third intercostal space during routine vaccination. Echocardiographic findings included left ventricle dilatation, high velocity continuous ductal flow in the pulmonary valve and a patent ductus arteriosus. Hematological and biochemical abnormalities were not detected. A left forth intercostal thoracotomy was performed and during dissection, the medial wall of the duct was perforated resulting in hemorrhage. Digital pressure was applied over the ductus and bleeding ceased. An attempt for further dissection aggravated bleeding so it was decided to abandon surgery and to reoperate the dog using a different technique. Three months after surgery a second procedure was scheduled. A Jackson-Henderson technique was chosen for the ductus ligation, which was completed through a left fourth intercostal thoracotomy and the dog was discharged 2 days postoperatively. The dog was reexamined at 2 and 8 months after surgery and found with no clinical evidence of heart disease. In conclusion the Jackson-Henderson technique was used in the second surgery for closure of the ductus in order to avoid dissection of the medial aspect of the ductus, where adhesions were formed and the dog was free of clinical signs of heart disease 2 and 8 months postoperatively.

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.

Prevalence of major complications and procedural mortality in 336 dogs undergoing interventional cardiology procedures in a single academic center

INTRODUCTION

Overall complication rates associated with a wide range of diagnostic and therapeutic interventional cardiac procedures in a contemporary academic setting have not been reported.

ANIMALS, MATERIALS AND METHODS

Consecutive interventional procedures performed for client-owned dogs were retrospectively analyzed to characterize procedural complications and mortality.

RESULTS

Three hundred sixty-four procedures were performed on 336 dogs. Interventions included attempted or completed transvenous pacemaker (PM) implantation (n = 134) with subsequent pacing system revision (n = 8), pulmonic balloon valvuloplasty (BVP) (n = 117) with a subset of patients undergoing an additional BVP (n = 14), transarterial closure of left-to-right shunting patent ductus arteriosus (PDA) (n = 66), diagnostic angiography and/or cardiovascular pressure measurement (n = 9), transvenous temporary pacing (n = 7), septal defect occlusion (n = 5), heartworm extraction (n = 3), and BVP catheter fragment retrieval (n = 1). The prevalence of major perioperative and postoperative complications for all procedures was 5% and 6%, respectively, and the procedural mortality rate was 2%. The overall rate of major complications was 12% for the PM group, 11% for the BVP group, and 2% for the PDA occlusion group. Both PM implantation and BVP have higher rates of major complications overall compared with PDA occlusion (p=0.0151).

CONCLUSIONS

The results of this study indicate that the prevalence of major complications and mortality associated with interventional cardiac procedures is low; however, significant differences exist in complication rates between procedures.

An experimental canine patent ductus arteriosus occlusion device based on shape memory polymer foam in a nitinol cage

Patent ductus arteriosus (PDA) is a congenital cardiovascular defect in which a fetal connection between the aorta and pulmonary artery does not spontaneously close shortly after birth. If left uncorrected serious complications and even death can occur. Surgical ligation is the traditional treatment method; however, it is an invasive procedure, that motivates development of a minimally invasive option. Shape memory polymer (SMP) foams are unique materials that hold promise in the field of minimally invasive occlusion devices. In this work, a prototype nitinol foam cage (NFC) incorporating SMP foams has been designed and evaluated in multiple mechanical and in vitro verification tests. The NFC demonstrated acceptable fatigue resistance in a preliminary strut integrity test, withstanding one million cycles without complete strut fracture. Radial force analysis of both thick- and thin-walled prototype variations generated less vessel distension and wall tension in a vessel mimic compared to a commercial device. The NFCs exhibited negligible in vitro migration, comparable to that of a commercial device, using simplified, ideal models of PDA. Deployment characteristics of the prototypes were evaluated and compared to that of a commercial device when delivered into physiological models of PDA. During mock deployments, a veterinary cardiologist noted that, while deliverable, the thin-walled NFC prototype exhibited poor deployment characteristics, however the thick-walled NFC had deployment characteristics comparable to that of a commercial device. The promising results of this study warrant further investigation of the NFC device for canine PDA closure.

Mechanical and in vitro evaluation of an experimental canine patent ductus arteriosus occlusion device

Patent ductus arteriosus (PDA) is a congenital cardiovascular malformation in which a fetal connection between the aorta and pulmonary artery remains patent after birth. This defect commonly results in clinical complications, even death, necessitating closure. Surgical ligation is the most common treatment but requires a thoracotomy and is therefore invasive. A minimally invasive option is preferable. A prototype device for PDA occlusion which utilizes shape memory polymer foams has been developed and evaluated using mechanical and in vitro experiments. Removal force and radial pressure measurements show that the prototype device exhibited a lower removal force and radial pressure than a commercially available device. The in vitro experiments conducted within simplified and physiological PDA models showed that the prototype does not migrate out of position into the pulmonary artery at either physiological or elevated pressures in multiple model configurations. While the radial pressure and removal force were lower than commercial devices, the device performed acceptably in the in vitro benchtop experiments warranting further prototype development.

Long-term outcome in dogs with patent ductus arteriosus: 520 cases (1994-2009)

Background

Published information regarding survival and long‐term cardiac remodeling after patent ductus arteriosus (PDA) closure in dogs is limited.

Objectives

To report outcome and identify prognostic variables in dogs with PDA, and to identify risk factors for persistent remodeling in dogs with a minimum of 12 months of follow‐up after closure.

Animals

Five hundred and twenty client‐owned dogs.

Methods

Retrospective review of medical records of 520 dogs with PDA. Outcome was determined by contacting owners and veterinarians. Dogs with PDA closure and ≥ 12 months of follow‐up were asked to return for a re‐evaluation.

Results

In multivariable analysis of 506 dogs not euthanized at the time of diagnosis, not having a PDA closure procedure negatively affected survival (HzR = 16.9, P < .001). In 444 dogs undergoing successful PDA closure, clinical signs at presentation (HzR = 17, P = .02), concurrent congenital heart disease (HD) (HzR = 4.8, P = .038), and severe mitral regurgitation (MR) documented within 24 hours of closure (HzR = 4.5, P = .028) negatively affected survival. Seventy‐one dogs with ≥ 12 months follow‐up demonstrated a significant reduction in radiographic and echocardiographic measures of heart size (P = 0) and increased incidence of acquired HD (P = .001) at re‐evaluation. Dogs with increased left ventricular size and low fractional shortening at baseline were more likely to have persistent remodeling at re‐evaluation.

Conclusions and Clinical Importance

Patent ductus arteriosus closure confers important survival benefits and results in long‐term reverse remodeling in most dogs. Clinical signs at presentation, concurrent congenital HD, and severe MR negatively affect survival. Increased left ventricular systolic dimensions and systolic dysfunction at baseline correlated significantly with persistent remodeling.

Unilateral laryngeal paralysis subsequent to surgical ligation of a patent ductus arteriosus in an 8-week-old domestic shorthair cat

CASE DESCRIPTION

An 8-week-old female domestic shorthair cat was treated for patent ductus arteriosus (PDA) with surgical ligation. Seven weeks postoperatively, the cat was evaluated because of increased upper respiratory noise, inspiratory stridor, wheezing, and episodes of intermittent open-mouth breathing that had developed 1 week following the surgical ligation.

CLINICAL FINDINGS

The cat was sedated, and examination of the larynx revealed left-sided laryngeal paralysis.

TREATMENT AND OUTCOME

At the time left-sided laryngeal paralysis was diagnosed, the clinical signs of laryngeal dysfunction were not considered severe enough to warrant surgical intervention. No treatment was administered, and the owner monitored the cat for respiratory distress and worsening of clinical signs for an additional 5 months. During those 5 months, the clinical signs improved but persisted. Seven months after PDA ligation, the cat was again sedated and the larynx examined. The examination revealed persistent left arytenoid dysfunction, which was believed to be the result of permanent damage to the recurrent laryngeal nerve that was sustained during the surgical ligation of the PDA. The owner was counseled about surgical and medical treatment options for laryngeal paralysis but elected to forego treatment at that time.

CLINICAL RELEVANCE

Unilateral laryngeal paralysis caused by iatrogenic damage to the recurrent laryngeal nerve is a potential complication subsequent to surgical ligation of a PDA. The frequency of iatrogenically induced laryngeal paralysis is likely underestimated in small animal patients. Laryngoscopy should be performed in any small animal with a history of PDA attenuation and clinical signs of respiratory tract disease.

An unusual morphology of patent ductus arteriosus in a dog

A 12-week old, entire female Border terrier weighing 3·5 kg was presented for investigation of a continuous left heart base murmur. The clinical presentation and preoperative echocardiogram were consistent with a standard morphology of patent ductus arteriosus (PDA) but a discrete ductal vessel was not identified during surgical dissection. Surgery had to be abandoned due to deterioration of the patient's condition under general anaesthesia which led to cardiorespiratory arrest and death despite attempts at resuscitation. Necropsy identified a recess within the wall of the aorta communicating with the pulmonary artery via an ostium at the heart base which determined this structure as an intramural PDA. This morphology of PDA is previously unreported. This report demonstrates that an intramural PDA is not readily identifiable surgically because of the absence of a discrete ductal vessel and it is important to appreciate that unusual morphologies of PDA may occur.

Patent ductus arteriosus in a family of Chihuahuas

This report describes a patent ductus arteriosus (PDA) in four puppies from the same family of Chihuahuas, bred from the same mother and from two different litters. Identification of this congenital anomaly relies on clinical examination, radiography and ultrasonography. Three of these puppies were female, and had a type-1 PDA. A conventional surgical ligation was performed on one of them, whilst the others underwent no treatment. One puppy was male, and presented with a type-4 PDA, requiring euthanasia. Post-mortem examination and histopathological examination of the PDA allowed characterisation of the histological anomalies, which were identical to those described in other breeds. The mother and the two stud dogs were not affected. Even though the mode of transmission has not been fully identified, it is evident that this PDA is hereditary in nature. To the authors' knowledge this is the first description of this congenital cardiopathy in a family of this breed, and in a significant number of first-generation individuals.

Minimally invasive per-catheter occlusion and dilation procedures for congenital cardiovascular abnormalities in dogs

With ever-increasing sophistication of veterinary cardiology, minimally invasive per-catheter occlusion and dilation procedures for the treatment of various congenital cardiovascular abnormalities in dogs have become not only available, but mainstream. Much new information about minimally invasive per-catheter patent ductus arteriosus occlusion has been published and presented during the past few years. Consequently, patent ductus arteriosus occlusion is the primary focus of this article. Occlusion of other less common congenital cardiac defects is also briefly reviewed. Balloon dilation of pulmonic stenosis, as well as other congenital obstructive cardiovascular abnormalities is discussed in the latter part of the article.

Therapeutic changes of plasma N-terminal pro-brain natriuretic peptide concentrations in 9 dogs with patent ductus arteriosus

The plasma N-terminal proBNP (NT-proBNP) concentration is measured for determining the diagnosis and severity of heart failure in dogs. However, it is still unclear whether measurements of circulating NT-proBNP levels provide clinical utility as an indicator of therapeutic efficacy. Thus, we investigated the surgical correction-related changes of plasma NT-proBNP concentrations in 9 dogs with patent ductus arteriosus (PDA). Physical examination, thoracic radiography and echocardiography were conducted both before and after surgery. Similarly, the plasma NT-proBNP concentrations were determined using an enzyme immunoassay for canine pro-BNP. The International Small Animal Cardiac Health Council (ISACHC) class and murmur grade were significantly improved after surgery compared with before surgery. Vertebral heart size (VHS) and cardiothoracic ratio (CTR) were significantly decreased after surgery. Fractional shortening was significantly decreased and relative wall thickness (RWT) was significantly increased after surgery. Furthermore, the plasma NT-proBNP concentrations were significantly decreased by surgical correction. The plasma NT-proBNP concentration showed significant positive correlation with the ISACHC class, murmur grade, VHS and CTR and significant negative correlation with the RWT. Therefore, measurement of plasma NT-proBNP levels can be used to monitor the effectiveness of therapies such as surgical correction of PDA.

Percutaneous endovascular retrieval of an intravascular foreign body in five dogs, a goat, and a horse

CASE DESCRIPTION-5 Dogs, 1 goat, and 1 horse underwent percutaneous endovascular retrieval of intravascular foreign bodies between 2002 and 2007. CLINICAL FINDINGS-Foreign bodies were IV catheters in 4 dogs, the horse, and the goat and a piece of a balloon valvuloplasty catheter in 1 dog. Location of the foreign bodies included the main pulmonary artery (1 dog), a branch of a pulmonary artery (4 dogs), the right ventricle (the goat), and a jugular vein (the horse). TREATMENT AND OUTCOME-The procedure of percutaneous endovascular retrieval of the foreign body was easy to perform in all instances. One dog was euthanized 41 days after retrieval because of worsening of another disease process, and 1 dog had abnormal neurologic signs secondary to a brain mass. All other animals were clinically normal during the follow-up period (follow-up duration, 3 to 57 months). None of the animals developed long-term complications secondary to the foreign body retrieval procedure. CLINICAL RELEVANCE-Intravascular foreign bodies that result from catheters or devices used during minimally invasive techniques are rare but may cause substantial morbidity. Percutaneous endovascular retrieval of intravascular foreign bodies was easily and safely performed in the 7 animals reported here. Use of percutaneous endovascular retrieval techniques should be considered for treatment of animals with intravascular foreign bodies because morbidity can be substantially decreased; however, proper selection of patients for the procedure is necessary.