Two-dimensional echocardiographic anatomy of the snake heart (Python molurus bivittatus)

Point of Care Ultrasound in Exotic Animal Emergency and Critical Care

Exotic pets are presented to veterinary clinics with increasing frequency for routine, urgent, and emergency needs. With these increased visits, owners' expectations for high-quality veterinary care are also increasing. Many presenting complaints of reptiles, birds, and small mammals can benefit from the use of point of care ultrasound (POCUS) to establish a minimum database, aid in triage, and help guide further diagnostics, treatment, and prognostic discussions with the owner. Hospitalized exotic patients can also have their progress tracked and better assessed with the aid of POCUS.

Comparative and Functional Anatomy of the Ectothermic Sauropsid Heart

The heart development, form, and functional specializations of chelonians, squamates, crocodilians, and birds characterize how diverse structure and specializations arise from similar foundations. This review aims to summarize the morphologic diversity of sauropsid hearts and present it in an integrative functional and phylogenetic context. Besides the detailed morphologic descriptions, the integrative view of function, evolution, and development will aid understanding of the surprising diversity of sauropsid hearts. This integrated perspective is a foundation that strengthens appreciation that the sauropsid hearts are the outcome of biological evolution; disease often is linked to arising mismatch between adaptations and modern environments.

Two-dimensional and doppler echocardiographic evaluation in twenty-one healthy Python regius

Echocardiographic evaluation is a diagnostic tool for the in vivo diagnosis of heart diseases. Specific and unique anatomical characteristics of the ophidian heart such as the single ventricular cavity, a tubular sinus venosus opening into the right atrium, the presence of three arterial trunks and extreme mobility in the coelomic cavity during the cardiac cycle directly affect echocardiographic examination. Twenty‐one awake, healthy ball pythons (Python regius) were analysed based on guidelines for performing echocardiographic examinations. Imaging in the sagittal plane demonstrated the caudal vena cava, sinus venosus valve (SVV) and right atrium and the various portions of the ventricle, horizontal septum, left aortic arch and pulmonary artery. Transverse imaging depicted the spatial relationship of the left and right aortic arches, the pulmonary artery and the horizontal septum. Basic knowledge of cardiac blood flow in reptiles is necessary to understand the echocardiographic anatomy. The flow of the arterial trunks and SVV was analysed using pulsed‐wave Doppler based on the approach used for humans and companion mammals. The walls and diameters of the cavum arteriosum, cavum venosum and cavum pulmonale were also evaluated. This study should improve the veterinarian's knowledge of ophidian heart basal physiology and contribute to the development of cardiology in reptiles.

A fixed moderate-dose combination of tiletamine+zolazepam outperforms midazolam in induction of short-term immobilization of ball pythons (Python regius)

Laboratory animals are commonly anesthetized to prevent pain and distress and to provide safe handling. Anesthesia procedures are well-developed for common laboratory mammals, but not as well established in reptiles. We assessed the performance of intramuscularly injected tiletamine (dissociative anesthetic) and zolazepam (benzodiazepine sedative) in fixed combination (2 mg/kg and 3 mg/kg) in comparison to 2 mg/kg of midazolam (benzodiazepine sedative) in ball pythons (Python regius). We measured heart and respiratory rates and quantified induction parameters (i.e., time to loss of righting reflex, time to loss of withdrawal reflex) and recovery parameters (i.e., time to regain righting reflex, withdrawal reflex, normal behavior). Mild decreases in heart and respiratory rates (median decrease of <10 beats per minute and <5 breaths per minute) were observed for most time points among all three anesthetic dose groups. No statistically significant difference between the median time to loss of righting reflex was observed among animals of any group (p = 0.783). However, the withdrawal reflex was lost in all snakes receiving 3mg/kg of tiletamine+zolazepam but not in all animals of the other two groups (p = 0.0004). In addition, the time for animals to regain the righting reflex and resume normal behavior was longer in the drug combination dose groups compared to the midazolam group (p = 0.0055). Our results indicate that midazolam is an adequate sedative for ball pythons but does not suffice to achieve reliable immobilization or anesthesia, whereas tiletamine+zolazepam achieves short-term anesthesia in a dose-dependent manner.

Monitoring the reproductive activity in captive bred female ball pythons (P. regius) by ultrasound evaluation and noninvasive analysis of faecal reproductive hormone (progesterone and 17β-estradiol) metabolites trends

The royal python (Python regius) is commonly bred in captivity. To have a successful breeding season, accurate monitoring of the reproductive activity is necessary. The use of non-invasive monitoring methods in exotics is important in order to minimize stress. For this purpose ultrasound has been anecdotally used to monitor royal python reproductive activity. However, there is limited information regarding the reproductive cycle of this species. The aim of the present study is to monitor the female reproductive cycle of the royal python using ultrasonography and gonadal steroid metabolite measurements in the faeces. The reproductive activity of one hundred twenty-nine adult female P. regius was examined during two consecutive years. We performed brief scans on non-anaesthetized snakes using a portable ultrasound system and a 10–12 MHz linear array transducer (MyLab™ 30 Gold, Esaote). Ultrasound features, dimension and echogenicity of the reproductive structures were determined. During the second reproductive cycle, the hormonal profiles of 30 animals were also evaluated, with a monthly collection of faecal samples. These samples were classified according to reproductive stage, as identified by ultrasonographic examination, and the mean faecal progesterone and 17β-estradiol levels were calculated using the results from an enzyme-linked immunosorbent assay (ELISA). Progesterone levels increased during the reproductive cycle. Estradiol levels showed greater variability, although they appeared to increase before coupling when compared to the levels between coupling and egg laying. The present study suggests that it is possible to identify different phases in the female royal python reproductive cycle: anovulatory phase, transition, folliculogenesis and embryogenesis. Ultrasound is also useful for identifying follicular regression or slugs. Gonadal steroid metabolite measurements from the faeces could help integrate reproductive information. The use of ultrasonography in addition to the steroid metabolite measurement in the faeces gives an accurate picture of ovarian activity in captive adult female royal pythons.

Ultrasonographic anatomy of reproductive female leopard geckos (Eublepharis macularius)

Captive leopard geckos (Eublepharis macularius) often present to the exotic clinic for gastrointestinal impactions, follicular stasis, or dystocia. To our knowledge, normal ultrasonographic anatomy of these lizards has not been described. The objectives of this prospective, anatomic, analytical study were to develop ultrasound techniques for this species and to describe the normal sonographic anatomy of the head, coelomic cavity, and tail. Eleven, healthy, female leopard geckos were included. A linear array 13-18 MHz transducer was used. Geckos were sedated and restrained in dorsal recumbency for coelomic structure examination and in ventral recumbency for head and tail examinations. Sagittal and transverse images were acquired and authors recorded qualitative and quantitative ultrasonographic characteristics of anatomic structures. The ventral surface of the lungs, liver, gallbladder, caudal vena cava, portal vein, ventral abdominal vein, aorta, ovarian follicles, fat bodies, tail, and brain were visualized in 10 of 11 individuals. In one individual, molt precluded ultrasonographic examination. The heart, kidneys, urinary bladder, spleen, and pancreas were not visualized. The digestive tract was observed in 10 individuals but was too small to be measured. Findings from the current study could be used as a reference for future studies of leopard geckos.

Standardization of the two-dimensional transcoelomic echocardiographic examination in the central bearded dragon (Pogona vitticeps)

OBJECTIVES

To objectively and subjectively describe the normal spectrum of two-dimensional echocardiographic findings in the central bearded dragon (Pogona vitticeps).

ANIMALS

Sixteen central bearded dragons.

METHODS

Central bearded dragons were prospectively evaluated under manual restraint in right and left lateral recumbency to identify imaging planes for reproducible measurements of cardiac chambers, subjective two-dimensional analysis and color Doppler assessment.

RESULTS

Echocardiography can be performed through windows in the left and right axillae. The window in the left axilla allows for a subjective and objective assessment of cardiac structure and function. The right axillary window allows for evaluation of pulmonary artery flow. Both views provide data for the presence of pericardial effusion or valvular insufficiency. With optimized imaging planes, cardiac chambers and fractional area change along with fractional shortening in the longitudinal and transverse planes can be calculated. Body weight and cardiac chamber dimensions of males were significantly larger than females. Ventricular fractional area change was the most consistent functional assessment. The majority of animals were found to have no evidence of valvular insufficiency, while approximately half had evidence of pericardial fluid. Pulmonary artery flow was assessed in all patients. Left and right aortic velocities cannot be reliably obtained.

CONCLUSIONS

This study is the first to generate reference values for cardiac structure and function in clinically healthy central bearded dragons. Valvular insufficiency is not a normal finding in central bearded dragons, while mild pericardial effusion may be.

Contrast echocardiography for analysis of heart anatomy in tortoises

OBJECTIVE

The cardiac anatomy in tortoises depicted on B-mode and color-Doppler should be better differentiated by additional contrast-echocardiography.

MATERIAL AND METHODS

An intravenous contrast agent (INN-sulphur hexafluoride [SonoVue®]) was injected in four tortoises (three Testudo hermanni, one Agrionemys horsfieldii), via the coccygeal vein, with parallel B-mode echocardiographic examination. The results of the contrast-enhanced echocardiography were compared with the contrast-free B-mode recordings and color-Doppler ultrasound.

RESULTS

The use of SonoVue® enabled clearer distinction of the cardiac structures, differentiation of the arising major arteries, identification of wash-out-shunts, and visualization of blood flow patterns throughout the tortoise heart.

CONCLUSION AND CLINICAL RELEVANCE

This study enables the accurate depiction and differentiation of cardiac anatomy in tortoises through the use of a combination of B-mode, color-Doppler and contrast-echocardiography. Basic knowledge of blood flow in the reptile heart is essential to understand echocardiographic anatomy. Blood-flow-patterns and anatomy of the tortoise heart as found in this study will help to establish a basis for further echocardiographic examinations of these animals.

Effect of biometric variables on two-dimensional echocardiographic measurements in the red-tailed boa (Boa constrictor constrictor)

The effects of body biometrics on cardiac measurements and description of cardiac anatomy were performed in red-tailed boas (Boa constrictor constrictor) (n = 29) using real-time B-mode ultrasonography. Statistical comparison of measured cardiac metrics according to sex and body measurements demonstrated no significant difference between sexes but a highly significant linear increase between body length and mass and all cardiac metrics.

Echocardiographic and radiographic findings in a cohort of healthy adult green iguanas (Iguana iguana)

OBJECTIVES

To describe characteristics of echocardiography and cranial coelomic radiography in a cohort of iguanas.

ANIMALS

Twenty apparently healthy adult green iguanas (Iguana iguana) from a reptile sanctuary.

METHODS

Physical examination, radiography, two-dimensional and color Doppler echocardiography were performed to assess cardiac structures and function, and any related normal or abnormal findings were recorded.

RESULTS

Echocardiographic examination was possible without sedation and allowed visualization of the great vessels, atria, and ventricle. Some structures could not be evaluated in a minority of the iguanas due to individual differences in bony conformation and imaging quality. Suspected abnormal echocardiographic findings in 3 iguanas included pericardial effusion (n = 1) and enlarged caudal vena cava and/or sinus venosus (n = 2). Objective measurements were repeatable as assessed by within-subject coefficient of variation, and reliable as assessed by intra-observer intraclass correlation coefficient. Left atrial and ventricular measurements were significantly correlated with body weight. Valve regurgitation was common, with atrioventricular valve regurgitation present in 53% (9/17) and aortic or pulmonic valve regurgitation in 71% (12/17) of otherwise normal iguanas. A heart murmur was not appreciated during examination of any of the iguanas. Heart size cannot be measured radiographically due to superimposition and silhouetting of other coelomic structures. Echocardiographic or radiographic findings consistent with mineralization of the great vessels were present in 76% of iguanas (13/17).

CONCLUSIONS

Echocardiography in iguanas is well tolerated without sedation and allowed both subjective evaluation and structural measurements. Valve regurgitation and great vessel mineralization were commonly observed in this cohort of apparently healthy adult iguanas.

Evaluation of radiographic, computed tomographic, and cadaveric anatomy of the head of boa constrictors

OBJECTIVE

To evaluate the radiographic, computed tomographic (CT), and cadaveric anatomy of the head of boa constrictors.

ANIMALS

4 Boa constrictor imperator cadavers.

PROCEDURES

Cadavers weighed 3.4 to 5.6 kg and had a body length ranging from 189 to 221 cm. Radiographic and CT images were obtained with a high-detail screen-film combination, and conventional CT was performed with a slice thickness of 1.5 mm. Radiographic images were obtained in ventrodorsal, dorsoventral, and left and right laterolateral recumbency; CT images were obtained with the animals positioned in ventral recumbency directly laying on a plastic support. At the end of the radiographic and CT imaging session, 2 heads were sectioned following a stratigraphic approach; the other 2, carefully maintained in the same position on the plastic support, were moved into a freezer (-20°C) until completely frozen and then sectioned into 3-mm slices, respecting the imaging protocol. The frozen sections were cleaned and then photographed on each side. Anatomic structures were identified and labeled on gross anatomic images and on the corresponding CT or radiographic image with the aid of available literature.

RESULTS

Radiographic and CT images provided high detail for visualization of bony structures; soft tissues were not easily identified on radiographic and CT images.

CONCLUSIONS AND CLINICAL RELEVANCE

Results provide an atlas of stratigraphic and cross-sectional gross anatomy and radiographic and CT anatomy of the heads of boa constrictors that might be useful in the interpretation of any imaging modality in this species.

Anatomy of the python heart

The hearts of all snakes and lizards consist of two atria and a single incompletely divided ventricle. In general, the squamate ventricle is subdivided into three chambers: cavum arteriosum (left), cavum venosum (medial) and cavum pulmonale (right). Although a similar division also applies to the heart of pythons, this family of snakes is unique amongst snakes in having intracardiac pressure separation. Here we provide a detailed anatomical description of the cardiac structures that confer this functional division. We measured the masses and volumes of the ventricular chambers, and we describe the gross morphology based on dissections of the heart from 13 ball pythons (Python regius) and one Burmese python (P. molurus). The cavum venosum is much reduced in pythons and constitutes approximately 10% of the cavum arteriosum. We suggest that shunts will always be less than 20%, while other studies conclude up to 50%. The high-pressure cavum arteriosum accounted for approximately 75% of the total ventricular mass, and was twice as dense as the low-pressure cavum pulmonale. The reptile ventricle has a core of spongious myocardium, but the three ventricular septa that separate the pulmonary and systemic chambers--the muscular ridge, the bulbuslamelle and the vertical septum--all had layers of compact myocardium. Pythons, however, have unique pads of connective tissue on the site of pressure separation. Because the hearts of varanid lizards, which also are endowed with pressure separation, share many of these morphological specializations, we propose that intraventricular compact myocardium is an indicator of high-pressure systems and possibly pressure separation.

Functional morphology and patterns of blood flow in the heart of Python regius

Brightness-modulated ultrasonography, continuous-wave Doppler, and pulsed-wave Doppler-echocardiography were used to analyze the functional morphology of the undisturbed heart of ball pythons. In particular, the action of the muscular ridge and the atrio-ventricular valves are key features to understand how patterns of blood flow emerge from structures directing blood into the various chambers of the heart. A step-by-step image analysis of echocardiographs shows that during ventricular diastole, the atrio-ventricular valves block the interventricular canals so that blood from the right atrium first fills the cavum venosum, and blood from the left atrium fills the cavum arteriosum. During diastole, blood from the cavum venosum crosses the muscular ridge into the cavum pulmonale. During middle to late systole the muscular ridge closes, thus prohibiting further blood flow into the cavum pulmonale. At the same time, the atrio-ventricular valves open the interventricular canal and allow blood from the cavum arteriosum to flow into the cavum venosum. In the late phase of ventricular systole, all blood from the cavum pulmonale is pressed into the pulmonary trunk; all blood from the cavum venosum is pressed into both aortas. Quantitative measures of blood flow volume showed that resting snakes bypass the pulmonary circulation and shunt about twice the blood volume into the systemic circulation as into the pulmonary circulation. When digesting, the oxygen demand of snakes increased tremendously. This is associated with shunting more blood into the pulmonary circulation. The results of this study allow the presentation of a detailed functional model of the python heart. They are also the basis for a functional hypothesis of how shunting is achieved. Further, it was shown that shunting is an active regulation process in response to changing demands of the organism (here, oxygen demand). Finally, the results of this study support earlier reports about a dual pressure circulation in Python regius.

Reptile cardiology

Cardiovascular disease in reptiles generally is considered an uncommon finding in captive animals, but no large-scale, cross-sectional studies have been performed to determine its prevalence. It is possible that cardiovascular disease is more common than is generally accepted and that the current belief results from limited clinical and diagnostic experience. This article offers guidance drawn from the author's clinical experience and the available literature. It is important that veterinarians pursue a thorough history, physical examination, and diagnostic work-up when managing cardiovascular disease in a reptile case. Veterinarians working with these cases should document their findings and share them with their colleagues to build an evidence-based foundation for reptile medicine.

Normal echoanatomy of the red-eared slider terrapin (Trachemys scripta elegans )

Thirty red-eared slider terrapins (Trachemys scripta elegans) were examined by ultrasound to establish the normal ultrasonographic appearance of their coelomic structures. They were not sedated, and owing to their small size they were examined through the inguinal window of the carapace. High resolution transducers (7.5 and 11 MHz) enhanced the ultrasonographic imaging of the bowel, urinary bladder, liver, gall bladder, heart, kidney and gonads, but the pancreas, adrenal glands, thyroid glands and spleen could not be visualised.

A comparative echocardiographic assessment of ventricular function in five species of sharks

A comparative echocardiographic study was carried out on five shark species that differ in heart morphology and in aspects of their behavior and natural history. The study contrasted the ventricular function in the highly active mako shark (heart type IV) and four other sharks (heart type III) that differ in activity levels (i.e. the sedentary horn and swell sharks vs. the moderately active blue and smooth-hound sharks). All five species exhibited biphasic ventricular filling characterized by an early (conduit) and late (atrial systole) phase. In the mako shark, early filling was dominant as indicated by a higher early flow peak velocity, a greater early:late velocity ratio, and a greater early velocity time integral. In contrast, the late filling phase was the more important filling agent in the other species. Indices of systolic function such as ventricular ejection fraction and ventricular fractional shortening also reflect a more efficient cardiac pumping capacity in mako shark relative to the other four sharks. The comparative echocardiographic assessment of in vivo ventricular function integrates structural and functional features with shark activity level to arrive at a new perspective blending the occurrence of biphasic filling with functional concepts based on heart morphological typology and changing views regarding the role of factors such as central filling pressure and pericardial pressure on end-diastolic ventricular volume.

Atrioventricular valvular insufficiency and congestive heart failure in a carpet python

Right atrioventricular valve insufficiency and bilateral congestive heart failure were identified in a carpet python (Morelia spilota variegata) with the aid of colour Doppler echocardiography, electrocardiography and radiography. The snake failed to respond to diuretic therapy and was euthanased. Based on this case, it appears that bilateral congestive failure is feasible in univentricular animals with lesions restricted to one side of the heart. Loop diuretic therapy may be inappropriate in non-crocodilian reptiles because reptiles lack a loop of Henle.