Successful balloon angioplasty in a cat with unilateral left pulmonary artery branch stenosis.

A 9-month-old intact male Ragdoll cat was presented for evaluation of a left-sided systolic murmur that was first auscultated during examination for a newly developed cough. Transthoracic echocardiography revealed a narrowed left pulmonary artery and an increase in flow velocities at the level of the narrowing, consistent with left pulmonary artery branch stenosis. The right pulmonary artery appeared normal. Balloon angioplasty was performed and successfully reduced pressure gradient across the stenosis. The patient continues to do well 14 months after the procedure.

Ventricular systolic dysfunction in dogs diagnosed with hypoadrenocorticism.

In human patients with hypoadrenocorticism, a secondary dilated cardiomyopathy is noted that has been reported to resolve with replacement steroid therapy. A similar secondary dilated cardiomyopathy in dogs with hypoadrenocorticism has not been previously described. We present three dogs concurrently diagnosed with hypoadrenocorticism and ventricular dilation with systolic dysfunction. Two dogs were presented with clinical signs consistent with biventricular congestive heart failure and a third dog was presented with signs of acute hypoadrenocorticism without congestive heart failure. All dogs recovered to normal cardiac size and function with therapy. Hypoadrenocorticism should be considered as a differential diagnosis in dogs that present with ventricular dilation and systolic dysfunction if there are other indicators in the clinical and laboratory testing. Additionally, a thorough cardiac evaluation should be recommended for dogs that are found to have a heart murmur at the time of diagnosis of hypoadrenocorticism.

Immediate outcomes of low-pressure balloon valvuloplasty for severe pulmonary valve stenosis in 20 dogs: a retrospective, single-center case series.

INTRODUCTION: The primary objective of this study was to describe the immediate post-procedural outcomes in dogs with severe pulmonary stenosis that were treated with low-pressure balloon valvuloplasty (BV) at a single institution. ANIMALS, MATERIALS AND METHODS: Retrospective case series; medical records of dogs that underwent BV performed with a balloon dilation catheter >20 mm in diameter and a burst pressure of less than 4 atm (atm) were retrospectively reviewed. Twenty animals were identified fitting the criteria. Pre-procedural and post-procedural echocardiograms and peri-procedural angiograms were reviewed. Procedural success was defined as greater than 50% reduction in echocardiographically derived transpulmonary systolic pressure gradient (TPPG) or post-procedural TPPG of less than 50 mmHg. RESULTS: The median percent reduction from initial TPPG was 53% (range = 15-90%). Sixty percent of the dogs met the pre-specified criteria for a successful outcome. Post-procedural TPPG was not different based on valve types A or B (p=0.67), presence or absence of additional supravalvular (p=0.23) or subvalvular (p=0.83) obstructive components. DISCUSSION: The proportion of dogs that reach the successful outcome were not different based on valve type A or B. No relationship was noted between immediate outcomes and bodyweight or pulmonary annulus diameter. CONCLUSION: Dogs with severe pulmonic stenosis that underwent low-pressure BV had good immediate outcomes with no difference in outcome based on valve morphology. Further randomized controlled studies are needed to compare the outcomes of different strategies for BV in dogs with large-diameter pulmonary annulus.

Double-outlet right ventricle in a Vietnamese potbellied pig.

A 6-month-old, neutered male, Vietnamese potbellied pig presented for evaluation of exercise intolerance and intermittent episodes of exertional cyanosis. Initial diagnostic evaluation revealed arterial hypoxemia. Transthoracic echocardiogram revealed double-outlet right ventricle (DORV) and a subaortic ventricular septal defect. Agitated saline contrast study confirmed the entry of saline contrast from the right ventricle into both pulmonary artery and aorta. Due to deterioration of clinical status, the patient was euthanized 3 months later. Gross necropsy examination was performed confirming the congenital cardiac defects noted on the echocardiogram. To the authors knowledge, this is the first case report of DORV in a Vietnamese potbellied pig.

Periprocedural vascular access complications associated with percutaneous femoral arterial access using the modified Seldinger's technique in dogs during cardiac catheterization: a single-center experience.

BACKGROUND: The primary objective of this study is to evaluate the peri-procedural major and minor complications associated with percutaneous femoral arterial access using modified Seldinger's technique in dogs that underwent cardiac catheterization. METHODS: Medical records of 62 client owned dogs that underwent percutaneous femoral arterial access for interventional cardiac procedures were retrospectively evaluated. Post-procedural manual compression was used for hemostasis. Peri-procedural vascular access complications (that occurred from procedure time to discharge) were evaluated. Vascular access complications were divided into two groups: minor complications that did not require specific therapy and major complications that did require an intervention to address the complication associated with vascular access. RESULTS: The minor complication rate was 30.6% (19/62) with most dogs experiencing minor bruising and small hematomas. The major complication rate was 3.2% (2/62). Both major complications were associated with bleeding with one dog requiring blood transfusion and the other dog requiring fluid therapy. No peri-procedural mortality associated with vascular access was noted. CONCLUSION: This retrospective study suggests that percutaneous femoral arterial access using the modified Seldinger's technique with post-procedural manual compression for hemostasis is viable option for vascular access during cardiac catheterization and associated with no peri-procedural mortality in dogs. The lower rate of complications noted in this study may be related to operator experiences and as such complication rate at a single center may not reflect the experience at other centers.

Infective aortic valve endocarditis in a cat with patent ductus arteriosus and perimembranous ventricular septal defect.

A 3-year-old, male neutered, domestic short-haired cat presented for evaluation of respiratory distress. Transthoracic echocardiography revealed a left-to-right shunting ventricular septal defect, a left-to-right shunting patent ductus arteriosus, and a vegetative growth on the aortic valve leaflet consistent with aortic valve endocarditis. Because of poor response to therapy, the owner elected euthanasia, and a necropsy was performed. Gross necropsy examination confirmed the congenital cardiac defects, and aortic valve endocarditis was noted on the echocardiogram. Histopathological examination revealed diffuse interstitial pneumonia and evidence for systemic septic embolism including renal infarcts and brain microabscesses. To the authors' knowledge, this is the first case report of aortic valve endocarditis in a cat in association with congenital cardiac malformations.

Comparison of single- versus seven-day Holter analysis for the identification of dilated cardiomyopathy predictive criteria in apparently healthy Doberman Pinscher dogs.

INTRODUCTION: The primary objective of this study was to test whether seven-day Holter recording improves the sensitivity of detecting dilated cardiomyopathy (DCM) predictive criteria (DCMp) compared with 24-h Holter recording in asymptomatic Doberman Pinscher (DP) dogs. ANIMALS: Twenty-eight asymptomatic DP dogs with normal echocardiographic examinations. METHODS: Dogs with normal echocardiographic examinations underwent seven-day Holter monitoring. The presence of ≥50 ventricular premature complexes and or ≥ one couplet/one triplet/one episode of ventricular tachycardia per 24-h period was considered positive for DCMp. RESULTS: Five dogs were positive on the first day, and an additional six dogs tested positive from day two to seven of the Holter recording. The number of dogs positive for DCMp detected by four days was significantly different (p = 0.031) compared with the first-day Holter recording. CONCLUSIONS: Seven-day Holter recording detected significantly more dogs with DCMp compared with the first-day Holter recording. Follow-up studies are warranted to evaluate the long-term accuracy of multiple-day Holter analysis in predicting the development of DCM in DP dogs.

Pericardial Effusion in a Dog with Pericardial Hemangiosarcoma.

An adult Jack Russel terrier dog presented for evaluation of large-volume peritoneal and pleural effusion. Echocardiography revealed scant pericardial effusion and abnormally thickened pericardium. Electrocardiography revealed complete atrioventricular block with junctional and ventricular escape beats and occasional ventricular premature complexes. Computed tomography of the thorax confirmed diffuse abnormal thickening of the pericardium, and a tentative diagnosis of constrictive-effusive pericarditis was made. The dog underwent subtotal pericardiectomy to remove the parietal pericardium and permanent epicardial pacemaker implantation to manage bradycardia. Based on pericardial histopathology and immunohistochemistry, a diagnosis of pericardial hemangiosarcoma was made. Systemic chemotherapy was initiated with doxorubicin 1 month after surgery. Despite initial improvement with chemotherapy, the dog was euthanized 4 months after surgery because of development of recurrent pleural effusion. To the author's knowledge, this is the first case report in dogs to describe isolated pericardial location of hemangiosarcoma resulting in constrictive-effusive pericarditis.

Sudden cardiac death in a dog during Holter recording-R on T phenomenon.

A 6-year-old castrated male Golden Retriever was diagnosed with severe subaortic stenosis with severe left atrial enlargement and high heart rate due to atrial fibrillation. Treatment with digoxin and diltiazem to control ventricular response rate was initiated. Ambulatory electrocardiographic monitoring (Holter monitoring) was performed at the beginning of treatment and was repeated to evaluate the patient's response to drug therapy. Drug dose adjustments were made based on response to therapy as assessed by Holter monitoring. The dog experienced sudden death at home 19 days after beginning treatment while wearing the Holter monitor. Analysis of the Holter recording revealed marked increase in number and complexity of ventricular arrhythmias. A ventricular premature complex occurring on a T wave (R on T) was noted preceding the polymorphic ventricular tachycardia. This arrhythmia immediately degenerated into ventricular fibrillation followed by asystole. This case report describes the arrhythmia that preceded cardiac arrest and reviews the risk factors that could have potentiated the fatal arrhythmia in this dog.

Prevalence of gastroesophageal reflux symptoms in adolescents: is there a difference in different racial and ethnic groups?

The study aims to determine if differences exist among racial/ethnic groups in the prevalence of gastroesophageal reflux symptoms in adolescents. A cross-sectional questionnaire was administered to a sample of students in four racially and ethnically diverse high schools in suburban Chicago. A total of 2561 questionnaires were analyzed: 33% Hispanics, 30% Caucasians, 22% African Americans, 15% Asians, 54% female, mean age 15.8 (±1.3) years. Thirty-two percent had at least one esophageal and/or respiratory symptom ≥once a week. Caucasians and African Americans had more dysphagia than Hispanics and Asians (7% vs. 4%; P= 0.04). Hispanics had more heartburn (13% vs. 9-11%; P= 0.06) but this was not statistically significant. There was no difference for regurgitation. Hispanic females had more dysphagia (6% vs. 3%; P= 0.02) and heartburn (17% vs. 9%; P= 0.0003) than Hispanic males. African Americans and Caucasians had more respiratory symptoms than Hispanics and Asians (29%, 24% vs. 18%; P= 0.000004). Students with esophageal symptoms were more likely to have respiratory symptoms (46% vs. 17%; P < 0.0005). African Americans and Caucasians with esophageal symptoms had more respiratory symptoms than Hispanics and Asians with esophageal symptoms (55%, 49% vs. 42%, 34%; P= 0.0003). Asians and Hispanics were less likely to treat symptoms than African Americans and Caucasians (26%, 33% vs. 47%, 49%; P= 0.001). We found that differences exist among the racial/ethnic groups with esophageal and respiratory symptoms; esophageal symptoms are a risk factor for respiratory symptoms, and Asians and Hispanics seek less medical help. Future research should focus on whether the differences found continue and reasons for them.

Prevalence and associated features of gastroesophageal reflux symptoms in a Caucasian-predominant adolescent school population.

OBJECTIVE: To determine the prevalence of esophageal symptoms and associated symptoms of gastroesophageal reflux symptoms in 14-18 year-old high school students and the percentage of symptomatic adolescents who saw a physician or received medications. DESIGN AND SETTING: A cross-sectional questionnaire administered to students at two high schools. PARTICIPANTS: 1,286 completed questionnaires were analyzed. The study sample consisted of 57% Caucasians and 57% males, with a mean age of 15.7 (+/-1.3) years. INTERVENTION: No intervention was used. Participants completed questionnaires only. RESULTS: 714 students (56%) reported at least one esophageal or respiratory symptom. Esophageal symptoms reported were: heartburn (22%), regurgitation (21%), and dysphagia (15%). Respiratory symptoms reported were: shortness of breath (24%), wheezing (20%), and cough (18%). Students with at least one esophageal symptom were more likely to experience at least one respiratory symptom than were students with no esophageal symptoms (52% vs. 25%; p < 0.001). Cigarette, alcohol, and non-steroidal anti-inflammatory drug use were risk factors for both respiratory and esophageal symptoms. Of those experiencing one or more of these symptoms, 4% reported that the symptoms affected their daily activities, 23% visited a physician, and 25% took medication in the past year. CONCLUSIONS: Esophageal symptoms of gastroesophageal reflux are frequent in adolescents. Fewer than 25% of students with gastroesophageal reflux symptoms consulted a physician and/or took medications.

Bannayan-Riley-Ruvalcaba syndrome: spectrum of intestinal pathology including juvenile polyps.

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a disorder that includes juvenile polyposis as part of its pathologic spectrum, and it recently has been shown to share phenotypic and genotypic features with Cowden's disease. In existing literature, descriptions of intestinal pathology in patients with BRRS are relatively sparse and occasionally erroneous. We describe the intestinal pathology in multiple specimens from three children with BRRS. Examination of gastrointestinal biopsies from these children revealed predominantly colonic and rectal polyps with the histology of juvenile polyps. Additionally, two cases with clusters of ectopic ganglion cells within the lamina propria, one in a colonic polyp and one in a duodenal biopsy, and an atypical polyp were observed. Bannayan-Riley-Ruvalcaba syndrome should be included in the list of differential diagnostic considerations when a child or young adult presents with a juvenile polyp, particularly if unusual histologic features such as atypical polyps or ectopic ganglion cells are encountered.

Duodenojejunitis: is it idiopathic or is it Henoch-Schönlein purpura without the purpura?

BACKGROUND: Henoch-Schönlein purpura is a small-vessel vasculitic disease that most often affects the skin. Gastrointestinal manifestations have been well described, including duodenojejunal inflammation (DJI). METHODS: Four children with DJI and clinical features of HSP are described, in whom the rash was either not present or appeared atypically late in the illness. RESULTS: The characteristic rash did not develop in three children, and it developed much later in one. The patients (three boys and one girl) were aged between 7 and 9 years (mean, 7.5 years). Growth characteristics were normal. In all patients, pain occurred acutely with colicky abdominal pain in the spring or fall of the year, and all stools were positive for occult blood. No infectious cause was identified. Upper gastrointestinal endoscopic examinations demonstrated significant visual and histologic duodenitis in a pattern consistent with previous reports in children with known HSP. Factor XIII activity was absent. Immunoglobulin A levels were increased in three of four children. All children made a prompt recovery with the administration of intravenous glucocorticoids. In one child, the characteristic rash of HSP developed 18 weeks after the initial examination. CONCLUSION: Duodenojejunal inflammation may be the primary manifestation of HSP, even in the absence of the characteristic rash.

Recurrent gastrointestinal Henoch-Schönlein purpura.

A 7-year-old boy was seen for severe abdominal pain, vomiting, and a 2.0-kg weight loss of 2 weeks duration. Stools were Hemoccult positive. Upper gastrointestinal (UGI) endoscopy showed multiple, raised red lesions in the duodenal bulb and descending duodenum. Although the patient did not have the typical cutaneous eruption, other findings such as acute onset of abdominal pain in a previously healthy boy, absence of infectious or surgical lesions, and more importantly endoscopic changes seen typically in the descending duodenum, led to the likely diagnosis of Henoch-Schönlein purpura (HSP). The patient was treated with prednisone and the duodenal lesions resolved. The diagnosis of HSP was confirmed 24 weeks after the initial symptom when he developed a palpable purpuric rash over both legs. Thirteen months following the initial symptoms and 6 months after the onset of rash, severe abdominal pain with epigastric tenderness recurred and stools were Hemoccult positive. UGI endoscopy showed multiple, raised red lesions in the descending duodenum as seen earlier. The patient was diagnosed with recurrent HSP. This presentation is atypical because of the abnormally long interval between the onset of abdominal pain and the appearance of the skin rash, and unique because of the endoscopically demonstrated recurrent gastrointestinal lesions.