Echocardiographic and angiographic comparison of ductal dimensions in dogs with patent ductus arteriosus

BACKGROUND

Transcatheter occlusion of patent ductus arteriosus (PDA) is a minimally invasive treatment option in dogs. Device selection based on appropriately acquired PDA dimensions and morphology can minimize procedural complications, including minimizing residual ductal flow and inappropriate embolization.

HYPOTHESIS

Transesophageal echocardiographic (TEE) derived minimum ductal diameter measurements would most accurately reflect angiographic measurements. Color Doppler (CD) TEE and transthoracic echocardiographic (TTE) ductal measurements would overestimate two-dimensional (2D) measurements.

ANIMALS

Fifteen client-owned dogs with PDA.

METHODS

PDA dimensions obtained with angiography, 2D and CD TTE, 2D and CD TEE from the right and left views were prospectively evaluated.

RESULTS

PDA dimensions were measured by using TEE most closely approximated angiographic measures. CD TTE and TEE frequently overestimated angiographic measures of minimum ductal diameter. TEE accurately identified a type III (tubular) PDA morphology in 1 dog. Fourteen of 15 dogs were determined to have hemodynamically significant reductions in left to right shunting documented by a first-pass nuclear angiocardiographic ratio of pulmonary to systemic blood flow < or = 1.2 and trivial (n = 3) to no (n = 11) CD TTE flow at approximately 1 month after PDA occlusion.

CONCLUSIONS

TEE provided accurate anatomic information regarding PDA morphology and closely approximated angiographic ductal dimensions while aiding in both coil deployment and confirmation of intra-operative ductal closure.

An Experimental Study of Apico-Aortic Valved Conduit (AAVC) for Surgical Treatment of Aortic Stenosis in Dogs

A new valved conduit was developed using a canine aortic valve. The bioprosthetic valve was fixed with glutaraldehyde and epoxy compound (Denacol-EX313/810). A vascular graft composed of ultra-fine polyester fiber (10 mm in diameter, 200 mm in length) was used. Four dogs underwent apico-aortic valved conduit (AAVC) implantation and aortic banding (bypass group, BG), while another 4 dogs underwent aortic banding without AAVC implantation (control group, CG). Cardiac catheterization and angiocardiography were performed for assessment of hemodynamics 2 weeks and 6 months after surgery. Left ventricular systolic pressure, left ventricular end-diastolic pressure and the left ventricular-aortic pressure gradient differed significantly (P<0.01) between the BG and CG dogs. Left ventricular angiocardiography showed patency of the valved conduit in all the BG dogs. Echocardiography was performed before and 2, 4 and 6 months after surgery, and showed that while pressure overload caused concentric myocardial hypertrophy in the CG dogs, the left ventricle dilated eccentrically in the BG dogs. Furthermore, relief of left ventricular pressure overload by AAVC was maintained.

Increased Pulmonary Transit Times in Asymptomatic Dogs with Mitral Regurgitation

Pulmonary transit time (PTT) normalized to heart rate (nPTT) is a measure of the pulmonary blood volume (PBV) to stroke volume ratio (PBV/SV). It is an index of cardiac performance. To determine the effect of compensated mitral regurgitation (CMR) and decompensated mitral regurgitation (DMR) caused by valvular endocardiosis on the index nPTT, we measured nPTT by first-pass radionuclide angiocardiography and ECG in 13 normal dogs, 18 dogs with CMR, and 13 dogs with DMR. PTT was measured as time between onset of appearance of activity at the pulmonary trunk and the left atrium. In the normal dogs, the relationship between PTT and mean R-R interval (mRR) was PTT = 4.08 x mRR + 0.15 (R2 = 0.71). Normal nPTT was 4.4 +/- 0.6 (SD) (range. 3.6-5.3). in CMR, 6.3 +/- 1.6 (SD) (range, 4.0-9.7). and in DMR, 11.9 +/- 3.4 (SD) (range, 8.0-18.8). The differences among all groups were significant. Heart rates were 110 +/- 22 bpm in normal dogs, 111 +/- 20 in dogs with CMR, and 144 +/- 18 in dogs with DMR (P < .001 for difference between DMR group and normal and CMR groups). Increased nPTT in CMR indicates preclinical heart pump dysfunction. Heart rate-normalized pulmonary transit times may be a useful index of heart function in mitral regurgitation.

First-pass nuclear angiocardiography in the evaluation of patent ductus arteriosus in dogs

First-pass nuclear angiocardiography (FPNA) was performed in 5 normal dogs and in 19 dogs with left-to-right shunting patent ductus arteriosus (PDA). Affected dogs were evaluated before and after an occlusion procedure (surgical ligation or transarterial coil embolization). Two methods of analysis were used to evaluate the pulmonary time-activity curves and assess the magnitude of the shunt. One method involved the calculation of a simple count ratio (C2:C1). The other method used gamma variate modeling to estimate the ratio of pulmonary to systemic blood flow (QP:QS). Values for normal dogs (mean +/- SD) were C2:C1 = 0.39 +/- 0.11 and QP:QS = 1.10 +/- 0.03. Values for affected dogs were C2:C1 = 0.59 +/- 0.17, QP:QS = 2.01 +/- 0.46 before intervention and QP:QS = 1.21 +/- 0.17, C2:C1 = 0.42 +/- 0.12 after intervention. Both methods detected significant differences between normal and affected dogs (QP:QS, t-test, P < .001; C2:C1; t-test; P = .018) and between affected dogs pre- and postocclusion (QP:QS. paired t-test, P < .001; C2:C1, paired t-test, P = .002). However, QP:QS was a better separator of normal from affected animals. First-pass nuclear angiocardiography, by the gamma variate method, may be a useful, adjunct diagnostic test in evaluation of animals with left-to-fight shunting PDA, particularly in animals with residual shunting after an occlusion procedure.

Aberrant branch of the bronchoesophageal artery resembling patent ductus arteriosus in a dog

An anomalous shunt between the bronchoesophageal artery and pulmonary artery was diagnosed in a 1-year- old, 3.5 kg female Miniature Dachshund by selective contrast angiography. A cardiac murmur had been observed in the dog during examination at another hospital. The machinery murmur was auscultated at the left side of the base of the heart. Although thoracic radiography revealed mild cardiomegaly, the characteristic findings of patent ductus arteriosus (PDA), including as aortic arch enlargement and pulmonary artery enlargement were not observed. Echocardiography demonstrated shunting of blood flow presumably from the arterial duct at the pulmonary artery carina. Based on the above findings the case was diagnosed as PDA. Angiocardiography was performed to confirm the diagnosis in preparation for surgical treatment, but later we confirmed that the shunt vessel was not PDA, but apparently a branch of the bronchoesophageal artery. The shunt vessel was branching in a complicated manner and shunted to the pulmonary artery.

Left ventricular outflow tract to left atrial fistula associated with endocarditis in a dog

A one-year-old, intact male, 28-kg, mixed-breed dog developed neurological episodes consistent with emboli. An acquired III/VI holosystolic heart murmur was ausculted in the mitral area, and valvular endocarditis with pulmonic and aortic insufficiency were noted at echocardiographic examination. An abnormal communication (i.e., fistula) between the left ventricular outflow tract (LVOT) and the left atrium adjacent to the mitral valve annulus was noted with Doppler imaging and confirmed with angiography. Infective valvular endocarditis was confirmed based on two of three blood cultures being positive for Staphylococcus intermedius. In humans, a sequela to infective endocarditis of the aortic or mitral valve, or both, is rupture of the mitral-aortic intervalvular fibrosa, resulting in a communication between the LVOT and the left atrium. This is the first report of this sequela in the dog.

Dilated coronary sinus in a dog with persistent left cranial vena cava

This paper describes the electrocardiographic, echocardiographic (two-dimensional, M-mode, contrast and Doppler) and non-selective angiocardiographic features in a 3 year old female Beagle with dilated coronary sinus due to persistent left cranial vena cava. Negative P waves in leads III and aVR and a positive P wave in lead aVL were seen. Echocardiographically, a hypoechoic circular structure was seen between the left atrium and the pericardium in the area where the coronary sinus is located. A velocity pattern with two peaks was obtained, one systolic with velocity = 0.44 +/- 0.05 m/sec and the other diastolic with velocity = 0.27 +/- 0.01 m/sec. By M-mode echocardiography, at level of the aorta and the left atrium, a linear structure was identified between the left atrium and the pericardium; this structure was characterized by phasic movements of the anterior wall during the cardiac cycle. Following a left cephalic vein injection of saline, bubbles were seen within the coronary sinus; when saline was injected into the right cephalic vein, bubbles were also seen within the coronary sinus and right atrium and ventricle. Non-selective angiocardiography confirmed a dilated coronary sinus with persistent left cranial vena cava. The right cranial vena cava was absent. The dog was clinically normal and the unusual vessel was an incidental finding.

Dyserythropoiesis, polymyopathy, and cardiac disease in three related English springer spaniels

A polysystemic disorder was observed in three related English Springer Spaniel dogs that demonstrated regurgitation from an early age, slowly progressive temporal muscle atrophy with partial trismus, and less pronounced generalized skeletal muscle atrophy. All dogs exhibited moderate dyserythropoietic anemia, polymyopathy with megaesophagus, and varying degrees of cardiomegaly. The prevalence, etiology, underlying pathomechanism, and possible mode of inheritance remain to be elucidated.

Cardiopulmonary values in dogs with artificial model of caval syndrome in heartworm disease

Cardiopulmonary values were determined in dogs with an artificial model of heartworm caval syndrome, which was produced by insertion of heartworm-like silicone tubes into the tricuspid valve orifice and right atrium. Fifteen to 25 tubes with some knots were inserted in 6 dogs (knot group), and 7 to 11 tubes (small-number group) or 29 to 37 tubes (large-number group) without a knot in 3 dogs, respectively. After tube insertion, angiographic contrast medium infused into the right ventricle regurgitated to the right atrium in all cases, and the regurgitation was the most severe in the large-number group. On electrocardiographic findings, the atrial and/or ventricular premature beat developed. The height of a- and v-wave of right atrial pressure curves elevated in all groups. The elevation in v-wave was obvious in the large-number group. The pulmonary arterial pressure tended to fall or to elevate slightly, and total pulmonary resistance increased in all groups. The right cardiac output decreased significantly in all cases. The right heart hemodynamics of the model might resemble those in spontaneous cases without disturbed pulmonary circulation.

An open patch-graft technique for correction of pulmonic stenosis in the dog

An open patch-graft technique for correction of pulmonic stenosis was performed in four dogs. A synthetic patch-graft was presutured to a partial-thickness incision in the right ventricular outflow tract and to the pulmonary artery along its cranial border. The pulmonary artery and right ventricle were incised during venous inflow occlusion, and dysplastic pulmonic valve leaflets were excised. The arteriotomy was closed by suturing the caudal margin of the incision to the patch-graft. The entire procedure was performed during mild hypothermia (30 degrees - 32 degrees C). The mean circulatory arrest time was 5.5 +/- 0.2 minutes. The mean systolic pressure gradient across the pulmonic valve before surgery was 121 +/- 29 mm Hg; after surgery it was 9 +/- 2 mm Hg.

Pulmonic stenosis caused by single coronary artery in dogs: four cases (1965-1984)

Single right coronary artery (CA) associated with pulmonic stenosis was found in 3 English Bulldogs and a Boxer, suggesting a genetic predisposition for the associated anomalies. The left main coronary branch arose from the single right CA, encircled the pulmonic root over hypoplastic pulmonic valves at the level of the obstruction, and appeared to be the primary cause of underlying pulmonic stenosis. Patch-graft surgery to relieve pulmonic stenosis caused death in 1 dog when the unrecognized anomalous CA was served during the procedure. The anomalous left CA was detectable by use of angiocardiography in all 4 dogs and was recognized before surgery in 2 of them. In 1 dog, a right ventricle-to-pulmonary trunk-bridging conduit was implanted to improve outflow from the right side of the heart.

Right ventricular outflow obstruction caused by primary cardiac neoplasia. Clinical features in two dogs

Obstruction to pulmonary blood flow as a result of neoplasia in the right ventricular outflow tract is described in two dogs. Whereas one dog had exertional syncope and a systolic ejection murmur, the other had signs of congestive failure and hypoxia. In both animals the mass was detected in the right ventricle with two-dimensional echocardiography and confirmed angiographically. Although rare, primary right ventricular neoplasia represents a potentially treatable form of cardiac disease and should be considered as a cause of acquired outflow tract obstruction.

Pulmonary atresia with intact ventricular septum and agenesis of the ductus arteriosus in a pup

A 7-week-old Wire Fox Terrier was admitted with pulmonary atresia with intact ventricular septum. The right ventricle and tricuspid valve were hypoplastic, and venous return to the right atrium reached the left side through an atrial septal defect. Oxygenation was via hyperplastic bronchial arteries. There was no evidence of the ductus arteriosus. Physical examination, plain and contrast radiography, and electrocardiography were performed. Clinical findings for this combination of defects were similar to those of more common defects (tetralogy of Fallot, patent ductus arteriosus.

The angiocardiographic diagnosis of a persistent truncus arteriosus in a foal

Persistent truncus arteriosus is a relatively rare cardiac anomaly which is associated with a single large artery arising from the ventricles. An interventricular septal defect is invariably present. The vessel gives origin to the pulmonary trunk, aorta and coronary arteries. A description of the angiocardiographic diagnosis of this condition is given as well as a general review of the relative developmental anatomy.

Right-to-left patent ductus arteriosus with dysplastic left ventricle in a dog

A 6-week-old Siberian Husky pup had an unusual group of congenital heart anomalies that included a right-to-left patent ductus arteriosus, a small left ventricular chamber and ascending aorta, and a dysplastic mitral valve that may have been stenotic. Anomalies were diagnosed, using cardiac catheterization, angiocardiography, and blood gas determinations. Findings were confirmed by postmortem examination.

Treatment of congenital pulmonic stenosis in two dogs by balloon valvuloplasty

Balloon valvuloplasty was performed on two dogs with pulmonic valve stenosis. Immediately following balloon valvuloplasty, peak right ventricular systolic pressure declined from 92 to 44 mm Hg in the first dog and from 108 to 46 mm Hg in the second dog. The peak systolic pressure gradient across the pulmonic valve declined from 60 to 12 mm Hg in the first dog and from 84 to 22 mm Hg in the second dog. Hemodynamic improvement was sustained in both dogs at the time of recatheterization 3 months later. Both dogs tolerated the procedure well and there were no serious complications. It was concluded that balloon valvuloplasty offers an alternative to surgery for the treatment of valvular pulmonic stenosis in dogs. The exact indications for and limitations of balloon valvuloplasty must await the results of additional and more long-term studies.

Equine heart disease. An overview

The clinician must appreciate unique aspects of equine cardiovascular physiology in order to distinguish normal variation from a pathophysiologic state. Cardiovascular problems in the horse include auscultation of cardiac murmurs, identification of cardiac arrhythmias, and recognition of congestive heart failure. A cardiac data base including history, general and cardiovascular examination, and resting and postexercise electrocardiogram are necessary to evaluate most horses for significant heart disease. Additional studies, such as echocardiography and cardiac catheterization, are useful in selected cases. Because some types of heart disease are amendable by therapy, an accurate diagnosis is needed to direct treatment and offer a realistic prognosis.

Evaluation of the equine cardiovascular system

A thorough examination of the cardiovascular system is an integral part of a physical examination in the horse. The normal equine cardiovascular parameters are discussed, with an emphasis on auscultatory findings. The availability and application of other diagnostic techniques are discussed based upon findings of the physical examination.

Diagnostic radiology and nuclear cardiology. Their use in assessment of equine cardiovascular disease

Survey thoracic radiography, although limited by physical considerations in the adult horse, can supply clinically useful information about changes in cardiac size and function. The radiographic features of cardiomegaly, altered pulmonary circulation, pulmonary edema, and pleural effusion as manifested in the horse are discussed. Nuclear cardiology can be performed in the standing horse. The initial transit of a radioactive tracer through the central circulation provides information about cardiac chamber size, efficiency of ventricular contraction, valvular competence, and presence of intracardiac or extracardiac shunts. Computer analysis of similar studies allows quantitation of several useful cardiac parameters including ventricular ejection fraction and shunt size (QP/QS). Gated blood pool nuclear studies are better suited to evaluate cardiac response to stress but are difficult to perform in the conscious horse with standard imaging equipment.

Congenital cardiac disease in dogs

Ventricular septal defect (VSD) generally occurs high in the membranous septum rather than lower in the muscular portion. The English Bulldog and Siberian Husky may be predisposed. Clinical signs include a holosystolic or crescendo-decrescendo murmur best heard low on the right side at the 3rd-4th intercostal space and, with large defects, pulmonary congestion, exercise intolerance, cyanosis and ascites. The ECG is normal unless the right ventricle is hypertrophied, which causes right axis deviation and other electrocardiographic signs of right-sided heart enlargement. Plain film thoracic radiographs reveal signs of right-sided heart enlargement but often are not diagnostic. Nonselective angiocardiography is often not useful in diagnosing VSD with a left-to-right shunt of blood. Selective angiocardiography, in which contrast medium is injected directly into the left ventricle via a catheter, is the method of choice for diagnosis of VSD. Dogs with a small VSD remain asymptomatic, but those with large defects require surgical correction with a prosthetic septal pathic or pulmonary artery band.

Congenital cardiac disease in dogs

Patent ductus arteriosus (PDA) is thought to be inherited and occurs twice as often in females as in males, most commonly in Poodles, Collies, Cocker Spaniels and Shetland Sheepdogs. About half of untreated dogs develop left-sided heart failure by 8 months of age. Clinical signs include coughing, decreased exercise tolerance, pulmonary edema, a "machinery" murmur in the pulmonic-aortic region, and a bounding pulse. An ECG may reveal an increased amplitude of the R wave and a lengthened P wave. Plain LAT films reveal loss of the cranial and caudal cardiac waists, increased sternal contact of the heart, increased width and straightened caudal border of the cardiac silhouette, elevated carina, and an enlarged left atrium. Changes on plain DV films include an elongated cardiac silhouette, enlarged right ventricle, and 3 bulges on the left side of the cardiac silhouette. Nonselective angiocardiography can be used for a definitive diagnosis and to demonstrate a reverse right-to-left PDA, in which the ascending aorta, brachiocephalic trunk and left subclavian artery are not opacified by contrast medium. Animals with a right-to-left shunt PDA are cyanotic in caudal body parts. Treatment of left-to-right shunt PDA involves ligation with 2 nonabsorbable sutures. A right-to-left shunt PDA should not be ligated but is treated by restricted exercise and periodic phlebotomy.

Congenital cardiac disease in dogs

Nonselective angiocardiography is used to delineate certain congenital cardiac defects. It is useful in demonstrating lesions causing a right-to-left shunt, as in tetralogy of Fallot and a reverse right-to-left patent ductus arteriosus, but not for lesions causing a left-to-right shunt, as in ventricular septal defect. Positive-contrast medium, injected IV as a bolus at 0.5 ml/lb, opacifies the heart chambers and great vessels. Using a rapid film-changing device, 3 films are made in 6 seconds. A rapid film changer can be constructed from plywood, wooden slats and plexiglass. Three cassettes are loaded into the device, the first beneath the x-ray beam and overlying plexiglass window and patient. The first film is exposed just after injection of the contrast medium, and the second and third 2 and 4 seconds later, respectively.

Method of selective and non-selective angiocardiography for the horse

A practical and safe method of angiocardiography for the horse is described. The technique involved the rapid injection of 50 to 150 ml contrast agent via catheters in the right and left heart, pulmonary artery and aorta. The examination was carried out with the horse in the standing position or under general anaesthesia. Angiocardiograms were performed on 10 normal horses and satisfactory pictures of the right and left ventricles, pulmonary arteries, aorta and coronary circulation were obtained. The technique was also used in a foal with severe congenital heart disease. The most practical methods of recording the images in the standing position were cinefilm or video taperecording. In the recumbent position both cinefilm and radiographs were taken. No damage to the heart was inflicted by the catheters and only a few ventricular premature contractions (less than five) were produced by the pressure of injection. No signs of toxicity were recorded using repeated injections of contrast material (ie, less than 600 ml).

Epidemiologic and genetic studies of congenital heart disease in the dog

The prevalence rate for cardiovascular malformations in dogs presented to a large university veterinary clinic was 6.8 per 1000. Patent ductus arteriosus, as in man, was found predominantly in females. Breed-specific prevalence rates were significantly greater in purebred dogs than in mongrels, and the breed distributions of patent ductus arteriosus, pulmonic stenosis, subaortic stenosis, persistent right aortic arch, and tetralogy of Fallot were significantly different than would be expected if all breeds were equally susceptible to each type of malformation. On the basis of these observations, two hypotheses were made: (1) Genetic factors are determinants of certain types of congenital heart disease in the dog. (2) These genetic factors have specific effects on cardiac morphogenesis, resulting in specific types of cardiovascular malformations. Preliminary genetic studies confirmed the specific hereditary transmission of valvular pulmonic stenosis in beagles, persistent right aortic arch in German shepherds, and conal septal defects (including ventricular septal defects and tetralogy of Fallot) in keeshonden. The pattern of inheritance of these defects was not consistent with any simple genetic hypothesis. Patent ductus arteriosus in dogs of poodle ancestry and fibrous subaortic stenosis in Newfoundlands were shown provisionally to be transmitted in a manner consistent with autosomal dominant inheritance. The significance of these findings is considered in relation to present and future understanding of the etiology and pathogenesis of congenital heart disease.