The predictive value of clinical, radiographic, echocardiographic variables and cardiac biomarkers for assessing risk of the onset of heart failure or cardiac death in dogs with preclinical myxomatous mitral valve disease enrolled in the DELAY study

OBJECTIVES

To identify the predictive value on time to onset of heart failure (HF) or cardiac death of clinical, radiographic, and echocardiographic variables, as well as cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I in dogs with preclinical myxomatous mitral valve disease (MMVD).

ANIMALS

One hundred sixty-eight dogs with preclinical MMVD and left atrium to aortic root ratio ≥1.6 (LA:Ao) and normalized left ventricular end-diastolic diameter ≥1.7 were included.

METHODS

Prospective, randomized, multicenter, single-blinded, placebo-controlled study. Clinical, radiographic, echocardiographic variables and plasma cardiac biomarkers concentrations were compared at different time points. Using receiving operating curves analysis, best cutoff for selected variables was identified and the risk to develop the study endpoint at six-month intervals was calculated.

RESULTS

Left atrial to aortic root ratio >2.1 (hazard ratio [HR] 3.2, 95% confidence interval [95% CI] 1.9-5.6), normalized left ventricular end-diastolic diameter > 1.9 (HR: 6.3; 95% CI: 3.3-11.8), early transmitral peak velocity (E peak) > 1 m/sec (HR: 3.9; 95% CI: 2.3-6.7), and NT-proBNP > 1500 ρmol/L (HR: 5.7; 95% CI: 3.3-9.5) were associated with increased risk of HF or cardiac death. The best fit model to predict the risk to reach the endpoint was represented by the plasma NT-proBNP concentrations adjusted for LA:Ao and E peak.

CONCLUSIONS

Logistic and survival models including echocardiographic variables and NT-proBNP can be used to identify dogs with preclinical MMVD at higher risk to develop HF or cardiac death.

DELay of Appearance of sYmptoms of Canine Degenerative Mitral Valve Disease Treated with Spironolactone and Benazepril: the DELAY Study

INTRODUCTION

Efficacy of renin-angiotensin-aldosterone system (RAAS) blockade using angiotensin-converting enzyme inhibitors (ACEi) in dogs with preclinical myxomatous mitral valve disease (MMVD) is controversial.

HYPOTHESIS

Administration of spironolactone (2-4 mg q 24 h) and benazepril (0.25-0.5 mg q 24 h) in dogs with preclinical MMVD, not receiving any other cardiac medications, delays the onset of heart failure (HF) and cardiac-related death. Moreover, it reduces the progression of the disease as indicated by echocardiographic parameters and level of cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI).

ANIMALS

184 dogs with pre-clinical MMVD and left atrium-to-aortic root ratio (LA:Ao) ≥1.6 and normalized left ventricular end-diastolic diameter (LVEDDn) ≥1.7.

METHODS

This is a prospective, randomized, multicenter, single-blinded, placebo-controlled study. Primary outcome variable was time-to-onset of first occurrence of HF or cardiac death. Secondary end points included effect of treatment on progression of the disease based on echocardiographic and radiographic parameters, as well as variations of NT-proBNP and cTnI concentrations.

RESULTS

The median time to primary end point was 902 days (95% confidence interval (CI) 682-not available) for the treatment group and 1139 days (95% CI 732-NA) for the control group (p = 0.45). Vertebral heart score (p = 0.05), LA:Ao (p < 0.001), LVEDDn (p < 0.001), trans-mitral E peak velocity (p = 0.011), and NT-proBNP (p = 0.037) were lower at the end of study in the treatment group.

CONCLUSIONS

This study failed in demonstrating that combined administration of spironolactone and benazepril delays onset of HF in dogs with preclinical MMVD. However, such treatment induces beneficial effects on cardiac remodeling and these results could be of clinical relevance.

P6093D echocardiography versus cardiovascular magnetic resonance in the evaluation of the right ventricle in patients with congenital heart disease after pulmonary valve replacement

Background

Cardiac MR (CMR) is the gold standard for right ventricular (RV) quantification. Three-dimensional echo (3DE) is a relatively new technique which may offer a rapid alternative for the examination of the right heart. The purpose of this study was to investigate the clinical significance and interchangeability of these modalities to evaluate patients with congenital heart disease (CHD) who underwent percutaneous pulmonary valve implantation (PPVI) for RV outflow tract dysfunction.

Methods

36 patients who underwent PPVI were evaluated with 3DE and CMR to quantify the RV. RV volumes and ejection fraction (EF) were measured for both imaging techniques with commercially available softwares (Tomtec-Germany for 3DE and Medimatic-Netherlands for CMR data). Paired t-test, Bland-Altman analysis, and Pearson's correlation analysis were used as most appropriate to compare both measured techniques with CMR regarded as the reference standard.

Results

86% of the patients (31 patients) had adequate image quality on 3DE and was included in the study. Patients underwent both 3D echo and CMR within a mean of 9 days of each other and at a mean time of 3 years after PPVI. Compared to CMR, 3D echo significantly underestimated volumes in all patients and overestimate RV ejection fraction (EF). Mean RV End-diastolic Volumes (EDV) and End-Systolic Volumes (ESV) were significantly greater when measured by CMR compared to 3D echo (EDV: 99 ml/m2 vs. 85 ml/m2; p<0.01, ESV: 52 ml/m2 vs. 41 ml/m2; p<0.01). Mean RV EF was lower when measured by CMR compared to 3D echo (48% vs 52%; p<0.05). Linear regression analysis showed high correlation coefficients between 3DE and CMR (r=0,68 for EDV, r=0,62 for ESV, and r=0,57 for EF; p<0.001). Bland-Altman analysis demonstrated that for both RV EDV and RV ESV there was a significant and systematic under-estimation of volume by 3D echo compared to CMR. Both 3DE and CMR measurements were found to be highly reproducible in terms of intra-observer variability.

Conclusions

Statistically significant and clinically meaningful differences in volumetric measurements were observed between 3DE and CMR in the evaluation of RV volumes and function in patients with CHD after PPVI. Despite linear regression and Bland-Altman analysis showed that the two techniques are related and present some degree of agreement, 3D Echocardiography systematically underestimates volumes and overestimates EF and this would have to be considered in the clinical practice.

Speckle-Tracking Echocardiography in Dogs With Patent Ductus Arteriosus: Effect of Percutaneous Closure on Cardiac Mechanics

BACKGROUND

Patent ductus arteriosus (PDA) is 1 of the most common congenital heart defects in dogs and percutaneous closure is effective in achieving ductal closure; PDA closure is associated with abrupt hemodynamic changes.

HYPOTHESIS

A marked decrease in standard parameters of systolic function as assessed by M- or B-mode echocardiography after PDA closure was identified in previous studies. Speckle tracking echocardiography can provide further insight into the effect of PDA closure on cardiac mechanics in dogs affected by PDA.

ANIMALS

Twenty-five client-owned dogs with PDA.

METHODS

Prospective study. Dogs were recruited over a 2-year period. Complete echocardiographic evaluation was performed before and 24 hours after PDA closure, including standard (end-diastolic volumes indexed to body surface area in B- and M-mode [EDVIB /M ], end-systolic volumes indexed to body surface area in B- and M-mode [ESVIB /M ], allometric scaling in diastole [AlloD] and systole [AlloS], pulmonary flow to systemic flow [Qs/Qp], ejection fraction [EF], and fractional shortening [FS]), and advanced speckle-tracking echocardiography (STE): global longitudinal, radial, circumferential and transverse strain (S), and strain rate (SR).

RESULTS

Patent ductus arteriosus closure was associated with statistically significant decreases in EDVIM /B and ESVIM /B , AlloD and AlloS, SI, EF, and FS. A statistically significant decrease in the absolute values of radial, transverse, and circumferential S and SR was observed, whereas longitudinal S and SR did not change significantly.

CONCLUSION AND CLINICAL IMPORTANCE

Patent ductus arteriosus closure by percutaneous approach is associated with marked decreases of conventional echocardiographic parameters as a result of the changes in loading conditions, but no evidence of systolic dysfunction was identified by means of STE, as none of the S and SR values were below reference ranges. In the short term, contractility is enhanced in the long axis (long S/SR values were not statistically different before and after closure) and decreases to normal values in short axis (circumferential, radial, and transversal S/SR decreased to normal reference range).

Echocardiographic Assessment of Cardiac Function by Conventional and Speckle-Tracking Echocardiography in Dogs with Patent Ductus Arteriosus

Background

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects in dogs. Advanced echocardiographic techniques such as speckle‐tracking echocardiography (STE) have not been extensively used to evaluate cardiac function in affected dogs.

Hypothesis

Advanced echocardiographic techniques are more sensitive than standard echocardiographic techniques in analyzing systolic function in dogs with PDA.

Animals

Forty‐four client‐owned dogs: 34 dogs with PDA (preoperative evaluation) and 10 healthy sex‐ and weight‐matched controls.

Methods

Prospective study. Dogs were recruited over a 2‐year period. Complete echocardiographic evaluation was performed, including conventional (end‐diastolic volumes indexed to body surface area in B and M‐mode [EDVI_B/M], end‐systolic volumes indexed to body surface area in B and M‐mode [ESVI_B/M], allometric scaling in diastole and systole [AlloD/S], pulmonary flow to systemic flow [Qp/Qs], ejection fraction [EF] and fractional shortening [FS]) and speckle‐tracking echocardiography ([STE]: global longitudinal, radial and circumferential strain [S] and strain rate [SR]).

Results

Dogs with PDA had significantly different EDVI_B/M, ESVI_B/M, AlloD/S, Qp/Qs and all STE‐derived parameters (global longitudinal S and SR, global circumferential S and SR, global radial S and SR)compared to healthy dogs. No correlation was found between standard techniques (EDVI_B/M, ESVI_B/M, AlloD/S, Qp/Qs) and STE‐derived parameters (global longitudinal, circumferential and radial S and SR).

Conclusion and Clinical Importance

Conventional parameters routinely used to assess systolic function (EF and FS) were not different between the groups; STE‐derived parameters identified subtle changes in cardiac systolic function and contractility between the 2 groups of dogs. Based on these findings, STE may be a more appropriate tool to assess cardiac contractility in dogs with PDA.

Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement

OBJECTIVES

There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised.

METHODS

Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species.

RESULTS

Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD.

DISCUSSION

The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine.

The influence of emotional stress on Doppler-derived aortic peak velocity in boxer dogs

Background

Subaortic stenosis (SAS) is a common congenital heart disease in Boxers. Doppler‐derived aortic peak velocity (AoPV) is a diagnostic criterion for the disease.

Objectives

To investigate the influence of emotional stress during echocardiographic examination on AoPV in normal and SAS‐affected Boxers. To evaluate the effects of aortic root diameters on AoPV in normal Boxers.

Dogs

Two hundred and fifteen normal and 19 SAS‐affected Boxers.

Methods

The AoPV was recorded at the beginning of echocardiographic examination (T0), and when the emotional stress of the dog was assumed to decrease based on behavioral parameters and heart rate (T1). AoPV0–AoPV1 was calculated. In normal dogs, stroke volume index was calculated at T0 and T1. Aortic root diameters were measured and their relationship with AoPV and AoPV0–AoPV1 was evaluated.

Results

In normal dogs, AoPV was higher at T0 (median, 1.95 m/s; range, 1.60–2.50 m/s) than at T1 (median, 1.76 m/s; range, 1.40–2.20 m/s; P < .0001; reduction 9.2%). The stroke volume index at T0 also was greater than at T1 (P < .0001). Weak negative correlations were detected between aortic root size and aortic velocities. In SAS‐affected dogs, AoPV0 was higher than AoPV1 (P < .0001; reduction 7.3%).

Conclusion and Clinical Importance

Aortic peak velocity was affected by emotional stress during echocardiographic examination both in SAS‐affected and normal Boxers. In normal Boxers, aortic root size weakly affected AoPVs, but did not affect AoPV0–AoPV1. Stroke volume seems to play a major role in stress‐related AoPV increases in normal Boxers. Emotional stress should be taken into account when screening for SAS in the Boxer breed.

A new method of computing the vertebral heart scale by means of direct standardisation

OBJECTIVES

The aim of this study was to describe and compare a simplified vertebral heart scale computation method (Objective VHS) with the original Buchanan method (Buchanan VHS).

METHODS

The Objective VHS was compared to the Buchanan VHS method in 42 dogs including 14 healthy dogs and 28 dogs with mitral insufficiency. For the Objective VHS, the sum of the length of the long and short axes of the cardiac silhouette obtained in centimetres using a metric ruler was subsequently converted into units of vertebral length by means of a direct standardization method. The Buchanan VHS was obtained as previously described.

RESULTS

No significant differences in vertebral heart scale values were found between the two methods in all dogs. There was a strong positive correlation (0·99) between Objective VHS and Buchanan VHS.

CLINICAL SIGNIFICANCE

The use of a direct standardization method based on a unit conversion allows -computation of vertebral heart scale values without transposing long and short axes to the cranial edge of T4.

Retrospective review of congenital heart disease in 976 dogs

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.

A prospective study of systolic ejection murmurs and left ventricular outflow tract in boxers

OBJECTIVES

To investigate the prevalence and progression of murmurs and the development of the left ventricular outflow tract (LVOT) and flow velocities in the great arteries in boxer puppies through adolescence until three years of age.

METHODS

Nineteen boxer puppies with or without a low-intensity murmur, but without evidence of congenital heart disease, were studied prospectively. Examinations were carried out at 7 weeks, 3, 4, 6, 9, 12 and 36 months of age by cardiac auscultation and Doppler echocardiography.

RESULTS

Presence and intensity of heart murmurs varied in the same dog and between dogs, but flow velocities did not change. Estimated effective orifice diameter (EOD) and indexed EOD was significantly narrower than measured subvalvular and valvular diameters.

CLINICAL SIGNIFICANCE

The variability in presence and intensity of low-intensity ejection murmurs is high during growth in boxers.

Histologic characterization of dilated cardiomyopathy in Estrela mountain dogs

Dilated cardiomyopathy (DCM) is the second-most-important acquired cardiovascular disease in dogs (excluding heartworm disease in some geographic regions) and a major cause of morbidity and mortality in Estrela Mountain Dogs. The objective of this study is to describe the histologic features of DCM in Estrela Mountain Dogs, with special attention to the localization and quantification of attenuated wavy fibers (AWFs), fibrosis, and fatty infiltration. Myocardial samples from 10 areas were collected from the hearts of 10 dogs with DCM and 7 dogs without signs of cardiac disease-namely, the basal, middle, and apical portions of the free wall of both cardiac ventricles and the interventricular septum, as well as the left ventricular papillary muscle. In each sample, the presence or absence of AWFs was noted, and fatty infiltration and fibrosis were quantified. Fatty infiltration, fibrosis, and AWFs were observed in the myocardium of all dogs with DCM, in contrast to what has been described in other breeds. The left ventricular myocardium was the best tissue for diagnosis of DCM, based on these histologic features. The authors concluded that quantification of fibrosis and observation of AWFs in the left ventricular myocardium are useful in the histologic diagnosis of DCM in Estrela Mountain dogs.

A new 2D-based method for myocardial velocity strain and strain rate quantification in a normal adult and paediatric population: assessment of reference values

BACKGROUND

Recent advances in technology have provided the opportunity for off-line analysis of digital video-clips of two-dimensional (2-D) echocardiographic images. Commercially available software that follows the motion of cardiac structures during cardiac cycle computes both regional and global velocity, strain, and strain rate (SR). The present study aims to evaluate the clinical applicability of the software based on the tracking algorithm feature (studied for cardiology purposes) and to derive the reference values for longitudinal and circumferential strain and SR of the left ventricle in a normal population of children and young adults.

METHODS

45 healthy volunteers (30 adults: 19 male, 11 female, mean age 37 +/- 6 years; 15 children: 8 male, 7 female, mean age 8 +/- 2 years) underwent transthoracic echocardiographic examination; 2D cine-loops recordings of apical 4-four 4-chamber (4C) and 2-chamber (2C) views and short axis views were stored for off-line analysis. Computer analyses were performed using specific software relying on the algorithm of optical flow analysis, specifically designed to track the endocardial border, installed on a Windows based computer workstation. Inter and intra-observer variability was assessed.

RESULTS

The feasibility of measurements obtained with tissue tracking system was higher in apical view (100% for systolic events; 64% for diastolic events) than in short axis view (70% for systolic events; 52% for diastolic events). Longitudinal systolic velocity decreased from base to apex in all subjects (5.22 +/- 1.01 vs. 1.20 +/- 0.88; p < 0.0001). Longitudinal strain and SR significantly increased from base to apex in all subjects (-12.95 +/- 6.79 vs. -14.87 +/- 6.78; p = 0.002; -0.72 +/- 0.39 vs. -0.94 +/- 0.48, p = 0.0001, respectively). Similarly, circumferential strain and SR increased from base to apex (-21.32 +/- 5.15 vs. -27.02 +/- 5.88, p = 0.002; -1.51 +/- 0.37 vs. -1.95 +/- 0.57, p = 0.003, respectively). Values of global systolic SR, both longitudinal and circumferential, were significantly higher in children than in adults (-1.3 +/- 0.2, vs. -1.11 +/- 0.2, p = 0.006; -1.9 +/- 0.6 vs. -1.6 +/- 0.5, p = 0.0265, respectively). No significant differences in longitudinal and circumferential systolic velocities were identified for any segment when comparing adults with children.

CONCLUSION

This 2D based tissue tracking system used for computation is reliable and applicable in adults and children particularly for systolic events. Measured with this technology, we have established reference values for myocardial velocity, Strain and SR for both young adults and children.

Percutaneous fine-needle biopsy of deep thoracic and abdominal masses in dogs and cats

Percutaneous fine-needle biopsy was used to investigate thoracic and abdominal masses in the dog and cat. One hundred and thirty-two cases were included in the study; 20 cases were excluded from the comparative study due to poor cellularity or blood contamination (retrieval rate 86.8 per cent). One hundred samples (56 dogs and 44 cats) were classified by cytology as neoplastic. All the cytological diagnoses of neoplasia were confirmed by histological samples obtained either by non-surgical methods, at surgery or during postmortem examination. No false positive diagnoses of neoplasia were made. Thirty-two samples were cytologically classified as 'negative for neoplasia'. Subsequent histological examination revealed 18 true negative and 14 false negative results. The procedure had an overall 89.4 per cent (118 cases out of 132) agreement between the diagnosis of inflammatory disease versus neoplasia, with a sensitivity of 87.8 per cent, a specificity of 100 per cent, a predictive value of a positive test of 100 per cent and a predictive value of a negative test of 56.3 per cent.

Blood lymphocyte subsets in canine idiopathic pericardial effusion

The immunophenotype of peripheral blood lymphocytes was investigated in 23 dogs diagnosed with idiopathic pericardial effusion in order to provide information about a possible role of the immune system in this pathology. Flow cytometric analysis showed a significant reduction in nearly all lymphocyte subsets examined and a strong, significant (P < 0.001) reduction of the CD4 subset, which gave rise to a significantly lower CD4/CD8 ratio. Our data suggest that an imbalance in the immune system is present during the course of the disease, preferentially affecting the T helper cell response.

Diffuse bronchiolo-alveolar carcinoma in a dog

An eight-year-old female German wirehaired pointer was presented with signs of respiratory distress. Clinical examination, laboratory results, thoracic radiography and echocardiography indicated the presence of a diffuse interstitial lung disease with secondary appropriate erythrocytosis, pulmonary hypertension and cor pulmonale. Transthoracic fine needle aspiration biopsy of the lung suggested malignant epithelial neoplasia. A primary lung cancer with an unusually diffuse distribution of miliary/micronodular lesions was found at postmortem examination. Histological diagnosis was bronchiolo-alveolar carcinoma. Bronchiolo-alveolar carcinoma can occasionally occur in a diffuse fashion involving most or all of the lung parenchyma. In man, diffuse bronchiolo-alveolar carcinoma is considered a great imitator of other, more common diffuse interstitial forms of lung disease. This case report indicates that it is also a differential diagnosis to consider in dogs.

Balloon valvuloplasty in 30 dogs with pulmonic stenosis: effect of valve morphology and annular size on initial and 1-year outcome

Case records of 30 dogs in which valvular pulmonic stenosis (PS) was treated by balloon dilation were reviewed retrospectively. Physical examination, thoracic radiographs, 9-lead ECG, echocardiography, and Doppler studies were performed in all dogs. Two-dimensional and Doppler echocardiography were repeated after 24 h and 1 year after treatment. Dogs were divided into 2 groups based on their valvular anatomy on echocardiography and aortic:pulmonary ratio: 18 had type A PS with normal annulus diameter and aortic:pulmonary ratio < or = 1.2, and 12 had type B PS with pulmonary annulus hypoplasia and aortic:pulmonary ratio > 1.2. Most dogs in the type B group were brachycephalic and had no poststenotic dilatation on thoracic radiographs. Of the dogs with type A stenosis, 100% survived valvuloplasty with resolution of clinical signs. At 1-year follow-up, 94.4% were still alive and remained asymptomatic. Of those with type B stenosis, 66.6% had favorable outcome postvalvuloplasty. At 1-year follow-up, 66.6% of dogs were alive, and resolution of clinical signs was obtained in 50%. This study revealed the immediate and long-term efficacy of balloon valvuloplasty in dogs with PS.

[The percutaneous drainage of prostatic abscesses in the dog]

INTRODUCTION

Prostatic abscesses are an uncommon finding in the dog; they are most frequently seen in dogs over six years old, often in association with benign hyperplasia. Ultrasonography (US) is an essential technique to study prostatic conditions in the dog, because the particular anatomical site of this gland in the dog makes rectal palpation insufficient to assess even macroscopic changes. Presently, US-guided drainage makes a particularly efficient tool for treatment of this condition in these patients. We report on our personal technique of percutaneous drainage of prostatic abscesses in the dog.

MATERIAL AND METHODS

Forty-five dogs of different breeds and age were examined. Some of them were given short anesthesia or mild sedation for restraining purposes, although this procedure is painless and could be performed under local anesthesia like in human patients. In man, the approach is perineal, but in the dog it is best to use an abdominal approach with right or left inguinal positions. US is necessary for correct drainage of the abscess and for monitoring throughout the procedure.

DISCUSSION AND CONCLUSION

US-guided percutaneous drainage of prostatic abscesses in the dog proved to be a safe and quick tool providing excellent results. No patients exhibited any postoperative complication and we had as little as 10% relapses at 30 days. The following drainage with alcoholization of the abscessual cavity resolved the conditions definitively. This technique was particularly interesting for both its success rate and the lack of postoperative complications, which are usually quite common after conventional surgery.

Lymphocyte beta -adrenoceptor downregulation in great danes with occult dilated cardiomyopathy (DCM) and with DCM and heart failure

The importance of the adrenergic nervous system in supporting the failing heart has long been known. The adrenergic drive on cardiac structure and function has however some adverse effects, which include myocardial beta-adrenoceptor (beta-AR) downregulation and decreased beta-adrenergic responsiveness to cathecolamines. In dog lymphocytes, beta(1)-AR and beta(2)-AR populations are almost equally represented (with a slight prevalence of beta(2)) and a significant correlation between cardiac and lymphocytic adrenoceptors has been found. The aim of the present study was to investigate possible differences between the concentration of lymphocytic beta-AR in healthy dogs, dogs with dilated cardiomyopathy (DCM) and dogs with occult DCM. Three groups of great danes were considered: a control group (n =10), dogs with DCM (n =9) and dogs with occult DCM (n =4). Lymphocytic beta-AR populations were determined in all dogs. A substantial and significant decrease (P<0.05) in total-AR, beta(1)-AR and beta(2)-AR concentrations in the lymphocytes of dogs with symptomatic DCM and occult DCM compared to the control group was found. Although the mean value of the lymphocyte beta(1)-AR number in the asymptomatic group was double compared to the DCM group, this difference was not statistically significant. We conclude that in dogs beta-AR downregulation occurs early in the course of dilated cardiomyopathy. This finding may suggest the value of early use of a beta-blocker in the therapeutic regimen. Moreover, the continuous monitoring of lymphocytic beta-AR may represent a useful tool for the development of a more effective individual therapy.

[Percutaneous pericardiotomy with balloon catheter in the treatment of malignant pericardial effusion in dogs]

INTRODUCTION

Cardiac tamponade is an emergency clinical condition both in man and the dog. Neoplastic pericardial effusion caused by primary or metastatic tumors is one of the most frequent causes in the dog. The frequent relapses after pericardiocentesis have led to developing different procedures for pericardial removal or fenestration to improve the quality of life in both terminal and treated patients. The often critical condition of these patients calls for procedures causing as little surgical stress as possibile, which is the case of percutaneous pericardial balloon dilatation. We report our experience with this procedure in the first two dogs whose long-term follow-up is available.

MATERIAL AND METHODS

Dogs need a short general anesthesia for restraining problems, while in man a slight sedation is sufficient. The anatomy being different, the percutaneous approach is intercostal in the dog and transdiaphragmatic in man. Echocardiographic guidance and fluoroscopic control are necessary during the procedure in both species. We report the clinical history of two dogs with neoplastic pericardial effusion, primary in one case and metastatic in the other. Both dogs were treated with pericardial balloon dilation.

DISCUSSION AND CONCLUSIONS

Our experience in the dog and in man shows that percutaneous pericardial balloon dilation causes less patient stress than thoracotomic or thoracoscopic pericardiectomy. Moreover, the surgical cost is lower and hospitalization time is reduced. On the other hand, the surgical methods permit bioptic sampling and better and more thorough studies of chest structures. We suggest percutaneous pericardiectomy as a valid alternative to surgery to treat chronic benign pericarditis, which obviously needs further confirmation from dedicated studies.

Doppler echocardiographic study of left ventricular diastole in non-anaesthetized healthy cats

The current study: (1) describes the Doppler technique for the assessment of diastolic function in feline patients; (2) reports normal Doppler diastolic values; and (3) determines the effect of ageing on these parameters. Doppler echocardiography was performed on 20 non-anaesthetized healthy cats. Each diastolic parameter was correlated with age, body weight, body surface area and R-R interval. To assess the isovolumetric relaxation phase of diastole, isovolumetric relaxation time was measured. To assess the filling phase of diastole, we measured peak flow velocities of the E and A waves, diastolic filling time, acceleration and deceleration time of the E wave and the E/A ratio of transmitral flow, peak flow velocity of the S, D and the A retrograde waves, as well as the S/D ratio and the systolic fraction of pulmonary venous flow. We found a significant correlation between age and peak flow velocity of the A wave, normalized peak flow velocity of the A wave, the E/A ratio, the acceleration time of the E wave, the diastolic filling time, the velocity time integral of the E wave, the peak flow velocity of the S wave and the systolic fraction. It was concluded that Doppler echocardiographic analysis of diastole is possible in the cat and that age has most effect on filling parameters.

[The pathology of mitral valve prolapse in dogs]

The authors present investigations of the prolapse of the mitral valves in dogs. In 18 cases there were dogs with a prolapse, in 6 dogs there was a prolapse of the tricuspid valves, and in 3 cases a prolapse of both valves was observed. In all cases prolapse occurred together with endocardiosis of the valves or as a consequence of it.