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Ciccozzi M, Stauthammer CD, Gavic E, Masters A. Trans-pulmonary stent placement for pulmonary stenosis in a dog with a type R2A coronary artery anomaly. J Vet Cardiol 2024; 55:19-25. [PMID: 39116587 DOI: 10.1016/j.jvc.2024.07.001] [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: 02/02/2024] [Revised: 06/29/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024]
Abstract
A one-year-old male intact American bulldog was presented for evaluation of previously diagnosed pulmonary stenosis. Echocardiography identified ultra-severe stenosis with an instantaneous trans-pulmonary pressure gradient of 240 mmHg. Angiography confirmed the presence of an anomalous coronary artery with a prepulmonic course of the left coronary artery arising from a single right coronary ostium consistent with a type R2A coronary anomaly. A trans-pulmonary stent was successfully placed transvenously with diameter sizing based on coronary compression testing. No coronary compression was present on postimplantation angiography. A marked reduction in the pressure gradient was obtained on postoperative echocardiography (reduction to 68 mmHg), despite selecting a stent diameter less than the pulmonary annulus diameter. This is the first report of the use of coronary compression testing in transvenous trans-pulmonic stent implantation in a dog with a type R2A coronary artery anomaly. Selection of a stent diameter less than the pulmonary annulus diameter conveyed a clinically relevant reduction in the trans-pulmonic pressure gradient while avoiding coronary compression in this case.
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Affiliation(s)
- M Ciccozzi
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1365 Gortner Ave, St Paul, MN 55108, USA.
| | - C D Stauthammer
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1365 Gortner Ave, St Paul, MN 55108, USA
| | - E Gavic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1365 Gortner Ave, St Paul, MN 55108, USA
| | - A Masters
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1365 Gortner Ave, St Paul, MN 55108, USA
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Hallman C, Baumwart R, Hallman RM. 64-Slice ECG-gated computed tomographic angiography for assessment of coronary arteries in brachycephalic dogs with pulmonary stenosis. Vet Rec 2024; 194:e3857. [PMID: 38379246 DOI: 10.1002/vetr.3857] [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: 05/08/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Brachycephalic dogs with pulmonary stenosis are known to have a higher incidence of concurrent coronary artery abnormalities than non-brachycephalic breeds, which increases risk when performing balloon valvuloplasty. The use of ECG-gated CT angiography has been reported for the evaluation of coronary arteries in normal dogs and dogs with pulmonary stenosis. The purpose of this study was to report findings of coronary artery origination and morphology of main branches using ECG-gated CT angiography in brachycephalic dogs with pulmonary stenosis. METHODS An ECG-gated CT angiographic protocol was used to image coronary artery anatomy in nine brachycephalic dogs with pulmonary stenosis. Images were assessed for quality as well as coronary artery morphology by one veterinary radiologist, one veterinary cardiologist and one veterinary radiology resident. RESULTS All nine dogs had good to excellent image quality. Coronary artery anomalies were identified in three of nine dogs: one R2A anomaly, one L2A anomaly and one L2C anomaly. Two dogs were assessed to be poor balloon valvuloplasty candidates based on CT angiographic images. LIMITATION Coronary artery morphology was not confirmed via postmortem examination in all patients. CONCLUSION ECG-gated CT angiography is a minimally invasive imaging modality capable of diagnosing various coronary artery anomalies in brachycephalic dogs with pulmonary stenosis and aiding in the determination of patient candidacy for balloon valvuloplasty.
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Affiliation(s)
- Clay Hallman
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Ryan Baumwart
- Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Ruth Mackenzie Hallman
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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3
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Phillips V, Linney C, Pedro B, Neves J, Mavropoulou A, Sarcinella F, Swift S, Sparks T, Mathis A. Prophylactic use of a lidocaine constant rate infusion versus saline in dogs undergoing balloon valvuloplasty for management of pulmonic stenosis: A randomized control trial. Vet Anaesth Analg 2023; 50:388-396. [PMID: 37302956 DOI: 10.1016/j.vaa.2023.04.007] [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: 06/16/2022] [Revised: 02/06/2023] [Accepted: 04/29/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the effect of a prophylactic lidocaine constant rate infusion (CRI) on the incidence and malignancy of catheter-induced ventricular ectopic complexes (VECs) during balloon valvuloplasty for management of pulmonic stenosis in dogs. STUDY DESIGN Single-centre, prospective, randomized study. ANIMALS Client-owned dogs (n = 70) with pulmonic stenosis. METHODS Dogs were randomly assigned to one of two anaesthetic protocols: administration of lidocaine 2 mg kg-1 bolus followed by a CRI (50 μg kg-1 minute-1; group LD) or a saline placebo (group SL) during balloon valvuloplasty. All dogs were premedicated with methadone (0.3 mg kg-1) intramuscularly and a digital three-lead Holter monitor was applied. Anaesthetic co-induction was performed with administration of alfaxalone (2 mg kg-1) and diazepam (0.4 mg kg-1), and anaesthesia was maintained with isoflurane vaporised in 100% oxygen. CRIs were started on positioning of the dog in theatre and discontinued as the last vascular catheter was removed from the heart. All dogs recovered well and were discharged 24 hours postoperatively. Blinded Holter analysis was performed by an external veterinary cardiologist using commercially available dedicated analysis software; p < 0.05. RESULTS Of the 70 dogs enrolled in the study, 61 were included in the final analysis: 31 in group LD and 30 in group SL. There was no significant difference between sinus beats (p = 0.227) or VECs (p = 0.519) between groups. In group LD, 19/31 (61.3%) dogs had a maximum ventricular rate ≥250 units and 20/30 (66.7%) dogs in group SL (p = 0.791). CONCLUSION AND CLINICAL RELEVANCE In this study, the use of a prophylactic lidocaine bolus followed by CRI in dogs undergoing balloon valvuloplasty for management of pulmonic stenosis did not significantly decrease the incidence nor the malignancy of VECs during right heart catheterization compared with a saline CRI.
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Affiliation(s)
| | | | | | - Joao Neves
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | | | | | - Simon Swift
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - Tim Sparks
- Waltham Petcare Science Institute, Leicestershire, UK
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Keating S, Eberhard J, Friederich J, Wess G. Systolic function in dogs with pulmonic stenosis of different severities and the effect of balloon valvuloplasty. J Vet Cardiol 2023; 46:40-54. [PMID: 37058905 DOI: 10.1016/j.jvc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION/OBJECTIVES Pulmonic stenosis (PS) is one of the most common congenital heart diseases in dogs leading to right ventricular (RV) pressure overload, myocardial remodeling, and potential RV dysfunction. Our objectives were to investigate the extent of RV systolic dysfunction in canine PS and to examine the immediate influence of balloon valvuloplasty (BV) on systolic function. ANIMALS, MATERIALS AND METHODS This prospective study evaluated 72 dogs with PS and 86 healthy dogs. Echocardiographic parameters of systolic function included normalized tricuspid annular plane systolic excursion (N-TAPSE), normalized systolic myocardial tissue Doppler velocity of the lateral tricuspid annulus (N-RVFW-S'), fractional area change, and speckle-tracking longitudinal endocardial RV strain. Forty-four dogs underwent BV and were re-examined after surgery. RESULTS Systolic function at the basal segment of the RV was significantly lower in the PS group when compared to healthy dogs (mean N-TAPSE 4.29 ± standard deviation 1.18 mm/kg0.285 vs. 5.60 ± 1.29 mm/kg0.285; median N-RVFW-S' 5.28 [lower-upper 25% quantile 4.35-6.43 cm/s/kg0.186] vs. 7.82 [6.73-8.79 cm/s/kg0.186]; all P<0.001). Global longitudinal RV endocardial strain showed no significant difference between the two groups (-28.50 ± 6.23% vs. 28.61 ± 4.64%; P=0.886), but segmental strain analyses revealed basal hypo- and potential compensatory hyperkinesis of the apical RVFW. Furthermore, BV affected most parameters of systolic function, but not the segmental strain values and N-TAPSE. CONCLUSIONS Right ventricular basal longitudinal systolic function is decreased in dogs with PS in comparison to a healthy cohort. Regional and global function does not necessarily coincide.
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5
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Cambruzzi M, Borgeat K, MacFarlane P. Anaesthetic management of a dog with severe pulmonary stenosis and R2A right coronary artery anomaly undergoing placement of a hybrid transventricular pulmonary stent. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Martina Cambruzzi
- Small Animal Hospital Langford Vets University of Bristol Langford UK
| | - Kieran Borgeat
- Small Animal Hospital Langford Vets University of Bristol Langford UK
| | - Paul MacFarlane
- Small Animal Hospital Langford Vets University of Bristol Langford UK
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6
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Transvalvular pulmonic stent angioplasty: procedural outcomes and complications in 15 dogs with pulmonic stenosis. J Vet Cardiol 2021; 38:1-11. [PMID: 34653742 DOI: 10.1016/j.jvc.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Balloon valvuloplasty is the treatment of choice for dogs with severe type A pulmonic stenosis (PS), but less successful for dogs with annular hypoplasia and unsuitable for supravalvular stenosis or cases with a circumpulmonary coronary malformation. We report outcomes and complications of the first 15 consecutive transvalvular pulmonic stent angioplasty procedures performed by a single center in dogs with PS. ANIMALS Fifteen dogs with naturally occurring PS were included in the study. MATERIALS AND METHODS Dogs underwent echocardiography before and four weeks after the procedure. Transvenous approaches were used to deploy a pre-mounted, balloon-expandable metallic stent in all cases. RESULTS Of 15 dogs, all had annular hypoplasia, and in addition, supravalvular stenosis was diagnosed in 11 of 15 dogs, and three had R2A coronary malformation. All dogs survived to discharge. One dog died less than four weeks postoperatively (non-cardiac), but 14 of 15 dogs were re-examined at four weeks. Severity reduced in all cases; median pressure gradient reduced from 137 mmHg (range 81-202 mmHg) to 83 mmHg (range 31-155 mmHg). Clinical signs improved in all cases, and hematocrit reduced in all dogs with erythrocytosis. The median follow-up time was 280 days (range 95-896 days). Over one-year follow-up was available in six of fifteen dogs. Two dogs died because of refractory right-sided congestive heart failure signs: one at 10 months and one at 22 months postoperatively. CONCLUSIONS Transvalvular pulmonic stent angioplasty technique was associated with an improvement in clinical signs and reduction in stenosis severity for all dogs in this population, including cases with supravalvular PS or circumpulmonary coronary malformation.
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Funk LL, Rodriguez KT, Leach SB. Balloon valvuloplasty in 2 juvenile alpacas with severe valvular pulmonic stenosis. J Vet Intern Med 2021; 35:2069-2074. [PMID: 34101907 PMCID: PMC8295714 DOI: 10.1111/jvim.16198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022] Open
Abstract
Two juvenile alpacas, 1 male and 1 female, were presented for evaluation of grade V/VI bilateral basilar systolic heart murmurs. Both animals were ultimately diagnosed with severe valvular pulmonic stenosis and a small ventricular septal defect. Transvenous balloon valvuloplasty was performed in each animal using methods described in the dog. A double balloon technique was employed in the first case, with a balloon‐annulus ratio of ~1.55. For the second case, a high‐pressure dilatation balloon catheter with a balloon‐annulus ratio of ~1.33 was selected. Experience with both procedures indicates that balloon pulmonary valvuloplasty is technically feasible in alpacas using techniques extrapolated from those used in dogs. Furthermore, accepted criteria for procedural success were fulfilled for both alpacas, with more than a 50% reduction in the echocardiographically derived transpulmonic pressure gradient after intervention.
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Affiliation(s)
- Logan L Funk
- Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, Columbia, Missouri, USA
| | - Kiira T Rodriguez
- University of Tennessee Veterinary Medical Center, Knoxville, Tennessee, USA
| | - Stacey B Leach
- Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, Columbia, Missouri, USA
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8
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Morgan KRS, Stauthammer C, Stewart B, Gordon-Evans W, Arai S, Baldo C, Gruenstein D. Coronary arterial compression testing by simultaneous balloon valvuloplasty and coronary angiography in an English bulldog with pulmonary valve stenosis. J Vet Cardiol 2021; 35:124-129. [PMID: 33951596 DOI: 10.1016/j.jvc.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
A 4-year-old male neutered English bulldog presented for heart murmur evaluation. Echocardiography identified severe pulmonic stenosis (an echocardiography-derived transpulmonary pressure gradient of 100 mmHg), and computed tomography confirmed the presence of an anomalous coronary artery with a prepulmonic course of the left coronary artery arising from the right coronary ostium. Before artificial pulmonic valve implantation, a coronary compression test was performed. A simultaneous aortic root angiogram and pulmonic balloon valvuloplasty revealed complete occlusion of the circumflex branch. Artificial valve implantation was aborted with concern for fatal coronary compression after implantation. Coronary compression testing is a critical component of the evaluation before catheter-based implantation of conduits across the pulmonic valve.
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Affiliation(s)
- K R S Morgan
- University of Minnesota, Veterinary Medical Center, Cardiology Department, 1365 Gortner Avenue St. Paul, Minnesota 55108, USA.
| | - C Stauthammer
- University of Minnesota, Veterinary Medical Center, Cardiology Department, 1365 Gortner Avenue St. Paul, Minnesota 55108, USA
| | - B Stewart
- University of Minnesota, Veterinary Medical Center, Cardiology Department, 1365 Gortner Avenue St. Paul, Minnesota 55108, USA
| | - W Gordon-Evans
- University of Minnesota, Veterinary Medical Center, Surgery Department, 1365 Gortner Avenue St. Paul, Minnesota 55108, USA
| | - S Arai
- University of Minnesota, Veterinary Medical Center, Surgery Department, 1365 Gortner Avenue St. Paul, Minnesota 55108, USA
| | - C Baldo
- University of Minnesota, Veterinary Medical Center, Anesthesia Department, 1365 Gortner Avenue St. Paul, Minnesota 55108, USA
| | - D Gruenstein
- University of Chicago, Pediatric Cardiology, Chicago, IL, USA
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9
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Andreis ME, Panopoulos I, Domenech O, Lacava G, Rondelli V, Zini E, Auriemma E. Novel coronary artery anomaly in a French bulldog with pulmonary stenosis. J Vet Cardiol 2021; 35:1-7. [PMID: 33789180 DOI: 10.1016/j.jvc.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022]
Abstract
A 9-month-old French Bulldog with pulmonary stenosis (PS) underwent transthoracic echocardiography (TTE) and electrocardiogram-gated coronary computed tomography angiography (ECG-CCTA) for presurgical planning of pulmonary balloon valvuloplasty (PBV). Transthoracic echocardiography revealed severe PS and identified two distinct coronary ostia (left and right). Electrocardiogram-gated coronary computed tomography angiography showed a circumpulmonary course of the interventricular paraconal coronary artery, which abnormally originated from the right coronary artery. Based on this case report, the echocardiographic identification of two coronary ostia does not rule out a coronary artery anomaly with circumpulmonary course (as previously hypothesized), and coronary computed tomography angiography may be recommended for presurgical planning of PBV in French Bulldogs.
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Affiliation(s)
- M E Andreis
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, NO, 28060, Italy
| | - I Panopoulos
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, NO, 28060, Italy
| | - O Domenech
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, NO, 28060, Italy
| | - G Lacava
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, NO, 28060, Italy
| | - V Rondelli
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, NO, 28060, Italy
| | - E Zini
- Department of Animal Medicine, Production and Health, University of Padova, Viale Dell'Università 16, 35020, Legnaro, PD, Italy
| | - E Auriemma
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, NO, 28060, Italy.
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10
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Repeat balloon valvuloplasty for dogs with recurrent or persistent pulmonary stenosis. J Vet Cardiol 2021; 34:29-36. [PMID: 33548736 DOI: 10.1016/j.jvc.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION/OBJECTIVES Pulmonary stenosis (PS) is a common congenital defect in the dog. Severe valvar PS can be treated with balloon valvuloplasty (BV) to reduce obstruction severity and improve clinical signs. Repeat BV is often unnecessary, as restenosis is uncommon. Repeated pulmonary BV in people is generally successful and safe, but outcomes in dogs with recurrent or persistent stenosis have not been reported. The objectives of this study were to retrospectively evaluate outcomes of repeat BV in dogs. ANIMALS, MATERIALS, AND METHODS Medical records and stored echocardiographic images were reviewed from dogs that received repeat BV for pulmonary valvar restenosis or persistent stenosis. Echocardiographic variables included maximum systolic ejection velocity (PVmax), velocity-derived maximal pressure gradient (PGmax) and velocity time integral (VTI) across the pulmonary valve, and ratios of pulmonic to aortic maximum velocity (PVmax/AVmax) and VTI (VTIPV/VTIAV). RESULTS Twenty-three dogs were included; one underwent three BV procedures. The median time between BV procedures was 18.3 months (interquartile range, 6.3-43.6). One dog died during repeat BV, but no others experienced adverse effects. Reductions in PVmax, PGmax, and VTIPV after initial and repeat BV were 1.85 m/s, 76.2 mmHg, and 44.7 cm and 1.33 m/s, 55.6 mmHg, and 30.2 cm, respectively (all p < 0.01). Differences between pre-BV and post-BV PVmax, PGmax, VTIPV, PVmax/AVmax, and VTIPV/VTIAV were not different comparing initial to repeat BV (all p > 0.10). CONCLUSIONS Repeat BV for recurrent or persistent PS is well tolerated and effective in a majority of dogs.
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Transpulmonary Stent Implantation for Dysplastic Pulmonary Valve Stenosis with a Single Left Coronary Ostium and Anomalous Prepulmonary Right Coronary Artery in an English Bulldog. ACTA ACUST UNITED AC 2020; 4:540-545. [PMID: 33376850 PMCID: PMC7756185 DOI: 10.1016/j.case.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Coronary artery anomalies may exist with congenital PS. PS occurs in both animals and humans. Transpulmonary stenting may be considered in dogs with PS and coronary anomalies.
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12
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Outcomes after combined percutaneous balloon valvuloplasty and external beam radiation therapy for the treatment of congenital pulmonic stenosis in four dogs. J Vet Cardiol 2020; 28:1-10. [DOI: 10.1016/j.jvc.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
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13
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Chetboul V, Damoiseaux C, Poissonnier C, Lavennes M, Bertrand S, Borenstein N, Behr L, Pouchelon JL, Gouni V, Desquilbet L. Specific features and survival of French bulldogs with congenital pulmonic stenosis: a prospective cohort study of 66 cases. J Vet Cardiol 2018; 20:405-414. [DOI: 10.1016/j.jvc.2018.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022]
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To A, Hostnik ET, Rhinehart JD, Scansen BA. Electrocardiography-gated cardiac CT angiography can differentiate brachycephalic dogs with and without pulmonary valve stenosis and findings differ from transthoracic echocardiography. Vet Radiol Ultrasound 2018; 60:145-158. [PMID: 30475441 DOI: 10.1111/vru.12701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022] Open
Abstract
Pulmonary valve stenosis (PS) is one of the most commonly diagnosed congenital heart defects in dogs. Currently, transthoracic echocardiography (TTE) is the standard modality used to evaluate PS. Image acquisition by TTE can be challenging in some brachycephalic breeds of dogs. The use of echocardiographic-gated CT angiography (ECG-gated CTA) in veterinary medicine is limited. This retrospective method comparison study investigated right and left ventricular outflow diameters by sedated ECG-gated CTA and unsedated TTE in 14 brachycephalic dogs with PS and 12 brachycephalic dogs without PS. Measurements of ventricular outflow structures were made in early systole and end diastole for both modalities and then compared for significance between systolic and diastolic phases, as well as between the two modalities. Ratios of the pulmonary trunk diameter to the aorta at different locations (aortic valve, aortic annulus, and ascending aorta) and in different planes (transverse, sagittal) were compared between dogs with PS and without PS, as well as within dogs, by both TTE and ECG-gated CTA. Transthoracic echocardiography and ECG-gated CTA both detected significantly greater pulmonary trunk to aorta ratios in dogs with PS at all aortic locations (P < 0.05). Pulmonary valve to aortic valve ratios were significantly smaller in dogs with PS (P < 0.05). Pulmonary trunk to aorta and pulmonary valve to aorta ratios were achieved with good anatomic detail using ECG-gated CTA. Ratios of the pulmonary trunk and pulmonary valve relative to the aorta may be useful to evaluate for PS using a modality that is underutilized for cardiac assessment.
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Affiliation(s)
- Ada To
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Eric T Hostnik
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Jaylyn D Rhinehart
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Brian A Scansen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio.,Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
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Auriemma E, Armienti F, Morabito S, Specchi S, Rondelli V, Domenech O, Guglielmini C, Lacava G, Zini E, Khouri T. Electrocardiogram-gated 16-multidetector computed tomographic angiography of the coronary arteries in dogs. Vet Rec 2018; 183:473. [DOI: 10.1136/vr.104711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 05/17/2018] [Accepted: 06/06/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Edoardo Auriemma
- Istituto Veterinario di Novara; Granozzo con Monticello (No) Novara Italy
| | - Felice Armienti
- Diagnostic Imaging Department; Policlinico di Monza Hospital; Monza Italy
| | - Simona Morabito
- Istituto Veterinario di Novara; Granozzo con Monticello (No) Novara Italy
- Department of Veterinary Science; University of Messina; Messina Italy
| | - Swan Specchi
- Istituto Veterinario di Novara; Granozzo con Monticello (No) Novara Italy
| | - Vincenzo Rondelli
- Istituto Veterinario di Novara; Granozzo con Monticello (No) Novara Italy
| | - Oriol Domenech
- Istituto Veterinario di Novara; Granozzo con Monticello (No) Novara Italy
| | - Carlo Guglielmini
- Department of Animal Medicine, Production and Health; University of Padova; Legnaro (PD) Italy
| | - Giuseppe Lacava
- Istituto Veterinario di Novara; Granozzo con Monticello (No) Novara Italy
| | - Eric Zini
- Istituto Veterinario di Novara; Granozzo con Monticello (No) Novara Italy
- Department of Animal Medicine, Production and Health; University of Padova; Legnaro (PD) Italy
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - Toufic Khouri
- Diagnostic Imaging Department; Policlinico di Monza Hospital; Monza Italy
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16
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Gunther-Harrington CT, Phillips KL, Visser LC, Fousse SL, Stern JA. Non-electrocardiographic-gated computed tomographic angiography can be used to diagnose coronary artery anomalies in Bulldogs with pulmonary valve stenosis. Vet Radiol Ultrasound 2018; 60:38-46. [DOI: 10.1111/vru.12689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 07/20/2018] [Accepted: 07/21/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Catherine T. Gunther-Harrington
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California, Davis; Davis California 95616
| | - Kathryn L. Phillips
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California, Davis; Davis California 95616
| | - Lance C. Visser
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California, Davis; Davis California 95616
| | - Samantha L. Fousse
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California, Davis; Davis California 95616
| | - Joshua A. Stern
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California, Davis; Davis California 95616
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Coronary Artery Anomalies in Animals. Vet Sci 2017; 4:vetsci4020020. [PMID: 29056679 PMCID: PMC5606599 DOI: 10.3390/vetsci4020020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/02/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022] Open
Abstract
Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.
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Laborda-Vidal P, Pedro B, Baker M, Gelzer AR, Dukes-McEwan J, Maddox TW. Use of ECG-gated computed tomography, echocardiography and selective angiography in five dogs with pulmonic stenosis and one dog with pulmonic stenosis and aberrant coronary arteries. J Vet Cardiol 2016; 18:418-426. [PMID: 27693045 DOI: 10.1016/j.jvc.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 12/16/2022]
Abstract
Pulmonic stenosis (PS) is the most common congenital cardiac disease in dogs. Boxers and English bulldogs are among the most commonly affected breeds and also commonly associated with an aberrant coronary artery (CA). If an aberrant CA is suspected and balloon valvuloplasty indicated, an intra-operative angiography is recommended prior to the procedure. ECG-gated computed tomography (CT) can be used to screen for CA anomalies in a quick and minimally-invasive way (preventing side effects associated with selective catheter angiography) and allowing early planning of the procedure. The aim of this case series was to report CT findings associated with PS diagnosed by echocardiography. Our database was retrospectively searched for cases of dogs with PS diagnosed by echocardiography, where an ECG-gated CT was performed. A total of six cases were retrieved: all were diagnosed with severe PS. Four dogs had concurrent congenital defects: two dogs had a patent ductus arteriosus, one dog had a ventricular septal defect and an overriding aorta, one dog had an aberrant CA. Detailed CT findings of all cases were reported, including one case of a patent ductus arteriosus and an overriding aorta not identified by transthoracic echocardiography. In addition, an abnormal single left coronary ostium, with a pre-pulmonic right CA was described. In conclusion, despite echocardiography remaining the gold standard for diagnosis and assessment of PS, ECG-gated-CT angiography is a complementary diagnostic method that may provide additional relevant information, shorten surgery/anaesthesia time and reduce the amount of radiation to which the clinician is subjected.
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Affiliation(s)
- P Laborda-Vidal
- University of Liverpool School of Veterinary Science, Leahurst, Chester High Road, Neston, CH64 7TE, UK
| | - B Pedro
- University of Liverpool School of Veterinary Science, Leahurst, Chester High Road, Neston, CH64 7TE, UK.
| | - M Baker
- University of Liverpool School of Veterinary Science, Leahurst, Chester High Road, Neston, CH64 7TE, UK
| | - A R Gelzer
- University of Liverpool School of Veterinary Science, Leahurst, Chester High Road, Neston, CH64 7TE, UK
| | - J Dukes-McEwan
- University of Liverpool School of Veterinary Science, Leahurst, Chester High Road, Neston, CH64 7TE, UK
| | - T W Maddox
- University of Liverpool School of Veterinary Science, Leahurst, Chester High Road, Neston, CH64 7TE, UK
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19
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Transesophageal echocardiography to diagnose anomalous right coronary artery type R2A in dogs. J Vet Cardiol 2015; 17:262-70. [PMID: 26521221 DOI: 10.1016/j.jvc.2015.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 07/23/2015] [Accepted: 08/17/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the feasibility of transesophageal echocardiography (TEE) as an alternative to angiography for the diagnosis of R2A coronary artery (CA) abnormalities. ANIMALS Twenty-two dogs with a diagnosis of type R2A CA anomaly were reviewed/analyzed. METHODS A retrospective study of case records. Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), angiography, and follow-up investigations of pulmonic stenosis (PS) with R2A CA were carried out to compare different diagnostic methods. RESULTS Based on the TTE morphology, PS with an aberrant CA was suspected in all dogs (n = 22) and later confirmed by angiography in 18 cases (18/22), and necropsy in two cases (2/22). In 12 cases (12/22), TEE and angiography were both performed and confirmed the diagnosis of an R2A anomaly. Two cases (2/22) were diagnosed only with TEE. CONCLUSIONS Transesophageal echocardiography may be considered an effective tool to diagnose CA abnormalities, in particular when TTE is inconclusive. Transesophageal echocardiography offers detailed and easily reproducible views of coronary ostia, and the spatial relationship between the right common CA and the great arteries. Although it is not possible to define the course of the more distal coronary branches, TEE has proven reliable in recognizing those elements that can constitute a risk for the execution of a balloon valvuloplasty (BV). Therefore, TEE can be used to confirm this type of CA anomaly and prevent a BV, which is contraindicated in these cases. In addition, TEE avoids any further vascular access, radiation exposure, and contrast medium injection.
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20
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Waterman MI, Abbott JA. Novel coronary artery anomaly in an English Bulldog with pulmonic stenosis. J Vet Intern Med 2013; 27:1256-9. [PMID: 23869559 DOI: 10.1111/jvim.12142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 05/08/2013] [Accepted: 06/04/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- M I Waterman
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA
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21
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Visser LC, Scansen BA, Schober KE. Single left coronary ostium and an anomalous prepulmonic right coronary artery in 2 dogs with congenital pulmonary valve stenosis. J Vet Cardiol 2013; 15:161-9. [PMID: 23660401 DOI: 10.1016/j.jvc.2013.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 02/12/2013] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
Abstract
A coronary artery anomaly characterized by the presence of a single left coronary ostium with absence of the right coronary ostium and an anomalous prepulmonic right coronary artery course was observed in two dogs with concurrent congenital pulmonary valve stenosis. This unique coronary artery anatomy is similar to the previously described single right coronary ostium with anomalous prepulmonic left coronary artery, the so-called type R2A anomaly, in that an anomalous coronary artery encircles the pulmonary valve annulus. Both dogs of this report, a boxer and an English bulldog, were of breeds known to be at risk for the type R2A anomaly. As such, veterinarians should be aware that the echocardiographic presence of a left coronary ostium in a dog with pulmonary valve stenosis does not exclude the possibility of a prepulmonic coronary artery anomaly that may enhance the risk of complications during balloon pulmonary valvuloplasty. A descriptive naming convention for coronary artery anomalies in dogs is also presented, which may be preferable to the older coding classification scheme.
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Affiliation(s)
- Lance C Visser
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
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22
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Transthoracic echocardiographically-guided interventional cardiac procedures in the dog. J Vet Cardiol 2012; 14:431-44. [DOI: 10.1016/j.jvc.2012.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 02/03/2012] [Accepted: 02/21/2012] [Indexed: 11/22/2022]
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23
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Case example: Pulmonic stenosis in a Miniature Schnauzer. IN PRACTICE 2012. [DOI: 10.1136/inp.f6019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fonfara S, Martinez Pereira Y, Dukes McEwan J. Balloon Valvuloplasty for Treatment of Pulmonic Stenosis in English Bulldogs with an Aberrant Coronary Artery-2 Years Later. J Vet Intern Med 2011; 25:771. [DOI: 10.1111/j.1939-1676.2011.0769.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Drees R, Frydrychowicz A, Reeder SB, Pinkerton ME, Johnson R. 64-multidetector computed tomographic angiography of the canine coronary arteries. Vet Radiol Ultrasound 2011; 52:507-15. [PMID: 21521398 DOI: 10.1111/j.1740-8261.2011.01826.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Canine coronary artery angiography (CTA) was performed in four anesthetized healthy dogs using 64-multidetector computed tomography. Esmolol, a β-1 adrenergic receptor antagonist, and sodium nitroprusside, an arteriolar and venous dilator, were administered to enhance visualization of the coronary arteries by reducing heart rate and creating vasodilation. The left main coronary artery with its three main branches and the right coronary artery were visualized and subdivided in 13 segments for evaluation. Optimal reconstruction interval, expressed as percentage of the R-to-R interval, was determined at 5% in 2.9%, 35% in 1%, 75% in 21.2%, 85% in 43.3%, and 95% in 31.7% of the segments. Overall image quality was good in 41.3% of the segments and excellent in 14.4%. There was blur in 98.1%, motion in 17.3%, and stair step in 6.7% of the evaluated segments, but these artifacts did not interfere with anatomic depiction of the arteries. Cross-sectional anatomy of the coronary arteries as evaluated from the coronary CTA agreed well with gross anatomic evaluation and published information. The use of esmolol did not lead to the target heart rate of 60-65 beats/min. Nitroprusside had no significant effect on visualized length or diameter of the coronary artery branches. Coronary CTA is useful for the anatomic depiction of coronary artery branches in the dog.
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Affiliation(s)
- Randi Drees
- Department of Surgical Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Oliveira P, Domenech O, Silva J, Vannini S, Bussadori R, Bussadori C. Retrospective review of congenital heart disease in 976 dogs. J Vet Intern Med 2011; 25:477-83. [PMID: 21418326 DOI: 10.1111/j.1939-1676.2011.0711.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Knowledge of epidemiology is important for recognition of cardiovascular malformations. OBJECTIVE Review the incidence of congenital heart defects in dogs in Italy and assess breed and sex predispositions. ANIMALS Nine hundred and seventy-six dogs diagnosed with congenital heart disease (CHD) of 4,480 dogs presented to Clinica Veterinaria Gran Sasso for cardiovascular examination from 1997 to 2010. METHODS A retrospective analysis of medical records regarding signalment, history, clinical examination, radiography, electrocardiography, echocardiography, angiography, and postmortem examination was performed. Breed and sex predisposition were assessed with the odds ratio test. RESULTS CHD was observed in 21.7% of cases. A total of 1,132 defects were observed with single defects in 832 cases (85%), 2 concurrent defects in 132 cases (14%), and 3 concurrent defects in 12 cases (1%). The most common defects were pulmonic stenosis (PS; 32.1%), subaortic stenosis (SAS; 21.3%), and patent ductus arteriosus (20.9%), followed by ventricular septal defect (VSD; 7.5%), valvular aortic stenosis (AS; 5.7%), and tricuspid dysplasia (3.1%). SAS, PS, and VSD frequently were associated with other defects. Several breed and sex predispositions were identified. CONCLUSIONS AND CLINICAL RELEVANCE The results of this study are in accordance with previous studies, with slight differences. The breed and sex predilections identified may be of value for the diagnosis and screening of CHD in dogs. Additionally, the relatively high percentage of concurrent heart defects emphasizes the importance of accurate and complete examinations for identification. Because these data are from a cardiology referral center, a bias may exist.
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Affiliation(s)
- P Oliveira
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Milano, Italia.
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Tobias AH, Stauthammer CD. Minimally invasive per-catheter occlusion and dilation procedures for congenital cardiovascular abnormalities in dogs. Vet Clin North Am Small Anim Pract 2010; 40:581-603. [PMID: 20610013 DOI: 10.1016/j.cvsm.2010.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Anthony H Tobias
- Veterinary Clinical Sciences Department, University of Minnesota, St Paul, MN 55108, USA.
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