Laparoscopic Evaluation of the Epiploic Foramen after Celiotomy for Epiploic Foramen Entrapment in the Horse.

OBJECTIVES: To evaluate the epiploic foramen using laparoscopy in horses previously treated for epiploic foramen entrapment to determine if spontaneous epiploic foramen closure had occurred. STUDY DESIGN: Non-consecutive case series. ANIMALS: Seven horses. METHODS: The epiploic foramen was inspected by right flank laparoscopy between 35 and 71 days after successful surgical treatment for epiploic foramen entrapment. Data were collected on the presence of behavior vices, details of surgery for epiploic foramen entrapment (time from colic onset to surgery, site and length of entrapped intestine, direction of entrapment, compromise of the intestine, intestine resected), the time between surgery for epiploic foramen entrapment and laparoscopy, and the laparoscopic appearance of the epiploic foramen. If the epiploic foramen was open, a mesh was introduced to obliterate the epiploic foramen (Foramen Epiploicum Mesh Closure [FEMC]). Clinical progress of the horses was followed by owner telephone interview at 1 and 4 months after laparoscopy, and a final interview between 135 and 282 days after laparoscopy. Owners were questioned on specific postoperative complications and the exercise level of the horse. RESULTS: At laparoscopy, 3/7 horses had complete closure of the epiploic foramen by dense fibrous tissue. The FEMC was performed in 4 horses without major complications. Postoperative colic episodes were recorded in 3 horses, all of them displaying windsucking/cribbing behavior. CONCLUSION: Laparoscopic evaluation after celiotomy for epiploic foramen entrapment revealed spontaneous closure of the epiploic foramen in 3/7 horses. This finding could explain the reported low recurrence rate after surgical treatment for epiploic foramen entrapment.

Einthoven's triangle adapted for horses: Proposal for the Delta configuration.

BACKGROUND: Reliable ECGs are crucial for diagnosing arrhythmias, yet a lack of standardization impedes arrhythmia diagnosis and treatment in horses. OBJECTIVES: To objectively determine an optimal position of Einthoven's triangle for ECG recordings in horses at rest, which can form the basis for standardized ECG recording and improve diagnosis and treatment of arrhythmias. ANIMALS: The study involved 72 healthy, warmblood horses aged between 3 and 20 years. METHODS: In view of future 12-lead studies and vectorcardiography, requiring an orthogonal system, Einthoven's triangle was positioned around the heart, in the transverse plane. Therefore, 11 electrodes were placed encircling the thorax behind the olecranon, to construct triangles with a horizontal base. Electrocardiogram recordings from different triangles were analyzed. Signal processing involved filtering, R peak detection, and median complex generation. Principal component analysis (PCA) and Euclidean distance measures were employed for data analysis. RESULTS: The left mid-thoracic and ventral regions had high PCA scores, indicating high information content. Base-down triangles exhibited higher summed Euclidean distances, contributing to enhanced diagnostic capabilities. A base-down triangle, called "Delta (Δ) configuration" emerged as most informative, while meeting all criteria. CONCLUSIONS AND CLINICAL IMPORTANCE: The base-down "Delta configuration" is the optimal Einthoven's triangle adapted for horses, providing large amplitudes and potential to provide basic insights into the mechanisms and origins of cardiac arrhythmias. Because the Delta configuration is positioned in the transverse plane, it forms the ideal basis for 12-lead ECG recordings that provide vectorcardiograms in an orthogonal coordinate system. Standardizing electrode positioning could improve ECG data comparability in equine cardiology.

Three-dimensional and catheter-based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale.

This case report describes the 2-dimensional transthoracic (2D-TTE), 3-dimensional transthoracic (3D-TTE) and intracardiac echocardiographic (ICE) characterization of the fossa ovalis region in 2 horses. The first case was presented for poor performance and showed an anechoic zone in the interatrial septum on 2D-TTE. Based on 3D-TTE a deepened fossa ovalis could be identified and using ICE the presence of an interatrial shunt could be excluded. The second case was referred for a cardiac murmur and the presence of turbulent flow in and around the interatrial septum on 2D-TTE color flow Doppler. The complementary use of 2D-TTE, 3D-TTE, and ICE allowed detailed characterization of a patent foramen ovale, with evidence of a left-to-right shunt in a dorsocranial to ventrocaudal direction with limited hemodynamic implications. These 2 cases underline the feasibility of 3D-TTE and ICE in horses and especially show the added value of ICE in a clinical setting.

Unilateral jugular vein stenosis in five horses and experience with percutaneous transluminal angioplasty.

BACKGROUND: Venous stenosis, a possible cause of jugular dilatation and congestion, is well known in human medicine but has poorly been described in horses. OBJECTIVE: To report unilateral jugular vein stenosis as a cause of jugular vein dilatation in horses and describe treatment by percutaneous transluminal angioplasty (PTA). STUDY DESIGN: Case report. METHODS: Details of horses diagnosed with unilateral jugular stenosis were retrieved from medical records. RESULTS: Five horses were presented with a non-painful, unilateral dilatation of the jugular vein of which two horses showed headshaking during exercise. In one horse an indwelling catheter had been used and jugular dilatation developed 4 weeks later. In the other horses, no intravenous injections had been administered in the months before jugular dilatation developed. Ultrasonographic examination revealed venous stenosis in all horses approximately 5-10 cm cranial to the thoracic inlet. The internal diameter at the level of this stenosis was only 1-3.1 mm. The length of the stenosis was about 15-19 mm with a markedly thickened intima and media on ultrasonography. After enoxaparin treatment, PTA was performed in three horses. During the procedure the stenotic vein was dilated three times with progressively increasing pressures up to 12 atm. The stenotic diameter increased to a maximum of 4.9 mm with improved jugular blood flow. Aftercare included anti-inflammatory and anti-thrombotic therapy. CONCLUSION: Jugular vein stenosis occurs in horses and should be included in the differential diagnoses of unilateral jugular vein dilatation. It may present in the absence of previous intravenous treatment. PTA of the jugular vein is feasible to improve jugular blood flow.