Temporal changes in clinical and radiographic variables in dogs with preclinical myxomatous mitral valve disease: The EPIC study.

BACKGROUND: The Evaluation of pimobendan in dogs with cardiomegaly caused by preclinical myxomatous mitral valve disease (EPIC) study monitored dogs with myxomatous mitral valve disease (MMVD) as they developed congestive heart failure (CHF). OBJECTIVES: To describe the changes in clinical and radiographic variables occurring as dogs with MMVD and cardiomegaly develop CHF, compared to similar dogs that do not develop CHF. ANIMALS: One hundred and thirty-five, and 73 dogs that did or did not develop CHF, respectively. MATERIALS AND METHODS: The following variables were evaluated in 2 groups of dogs (dogs that did or did not develop CHF): Heart rate (HR), clinic respiratory rate (RR), home-measured resting respiratory rate (RRR), rectal temperature (RT), body weight (BW), and vertebral heart sum (VHS). Absolute value and rate of change of each variable were calculated for each day a dog was in study. Daily means were calculated and plotted against time. The onset of CHF or last visit before leaving the study were set as reference time points. RESULTS: The most extreme values and rate of change occurred in variables immediately before onset of CHF. Vertebral heart sum increased earliest. Heart rate, RR, and RRR also increased. Rectal temperature and BW decreased. Increases in RR and RRR were most extreme and occurred immediately before CHF. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with MMVD and cardiomegaly experience increases in HR, RR, RRR, and VHS, and decreases in BW and RT as they develop CHF. The variables with highest absolute change and rate of change were RR and RRR. These findings reinforce the value of RR and RRR as indicators of impending or incipient CHF.

Evaluation of benazepril in cats with heart disease in a prospective, randomized, blinded, placebo-controlled clinical trial.

BACKGROUND: Heart disease is an important cause of morbidity and mortality in cats, but there is limited evidence of the benefit of any medication. HYPOTHESIS: The angiotensin-converting enzyme inhibitor benazepril would delay the time to treatment failure in cats with heart disease of various etiologies. ANIMALS: One hundred fifty-one client-owned cats. METHODS: Cats with heart disease, confirmed by echocardiography, with or without clinical signs of congestive heart failure, were recruited between 2002 and 2005 and randomized to benazepril or placebo in a prospective, multicenter, parallel-group, blinded clinical trial. Benazepril (0.5-1.0 mg/kg) or placebo was administered PO once daily for up to 2 years. The primary endpoint was treatment failure. Analyses were conducted separately for all-cause treatment failure (main analysis) and heart disease-related treatment failure (supportive analysis). RESULTS: No benefit of benazepril versus placebo was detected for time to all-cause treatment failure (P = .42) or time to treatment failure related to heart disease (P = .21). Hazard ratios (95% confidence interval [CI]) from multivariate analysis for benazepril compared with placebo were 1.00 (0.57-1.74) for all-cause failure, and 0.99 (0.50-1.94) for forward selection and 0.93 (0.48-1.81) for bidirectional selection models for heart disease-related failure. There were no significant differences between groups over time after administration of the test articles in left atrium diameter, left ventricle wall thickness, quality of life scores, adverse events, or plasma biochemistry or hematology variables. CONCLUSIONS AND CLINICAL RELEVANCE: Benazepril was tolerated well in cats with heart disease, but no evidence of benefit was detected.

Management of a tracheal intussusception in a dog.

A 5-year-old Belgian Malinois dog was presented for evaluation of dyspnea of 1-month duration. Tracheal intussusception was diagnosed by tracheoscopy. Treatment consisted of surgical resection of the invaginated tracheal ring and the immediate cranial and caudal tracheal rings. The dog recovered uneventfully; complications included temporary emphysema after surgery. Seven months after surgery, the dog was still clinically normal. To the authors' knowledge, this is the first report of a tracheal intussusception treated surgically in a dog.

Gestion d'une intussusception trachéale chez un chien. Un chien Malinois âgé de 5 ans a été présenté pour l'évaluation d'une dyspnée d'une durée de 1 mois. L'intussusception trachéale a été diagnostiquée par trachéoscopie. Le traitement instauré consistait en la résection chirurgicale de l'anneau trachéal et des anneaux trachéaux crâniaux et caudaux immédiats. Le chien s'est rétabli sans incident; les complications ont inclus un emphysème temporaire après la chirurgie. Sept mois après la chirurgie, le chien était toujours cliniquement normal. À la connaissance des auteurs, il s'agit du premier rapport d'une intussusception trachéale traitée par chirurgie chez un chien.(Traduit par Isabelle Vallières).

Epidemiological, clinical, and echocardiographic features and survival times of dogs and cats with tetralogy of Fallot: 31 cases (2003-2014).

OBJECTIVE To characterize the epidemiological, clinical, and echocardiographic features of dogs and cats with tetralogy of Fallot (TOF) and determine their survival times. DESIGN Retrospective case series. ANIMALS 15 dogs and 16 cats with a diagnosis of TOF as determined via echocardiography. PROCEDURES Medical records of dogs and cats were reviewed to extract information on signalment, clinical status at the time of TOF diagnosis, echocardiographic findings, and any outcome data. RESULTS The most common canine breeds were terrier types (n = 7). Most animals (28/31 [90%]) had clinical signs of TOF at the time of diagnosis, including cyanosis (16/31 [52%]). Pulmonic stenosis was characterized by a variable systolic Doppler-derived pressure gradient (median [range], 108 mm Hg [26 to 255 mm Hg]). Most ventricular septal defects were large, with a median (range) ratio of the diameter of the ventricular septal defect to that of the aorta of 0.60 (0.18 to 1.15). Median age at cardiac-related death was 23.4 months, with no significant difference between dogs and cats. Median survival time from TOF diagnosis to cardiac-related death was briefer for animals with no or low-grade heart murmur (3.4 months) than for those with higher-grade heart murmur (16.4 months). After adjustment for age and sex, having a lack of or a low- to mild-grade systolic heart murmur was significantly associated with a briefer survival time. CONCLUSIONS AND CLINICAL RELEVANCE With a few exceptions, cardiac-related death occurred predominantly in young adult dogs and cats with TOF, and most animals had severe clinical signs at the time of TOF diagnosis.

Signalment, clinical features, echocardiographic findings, and outcome of dogs and cats with ventricular septal defects: 109 cases (1992-2013).

OBJECTIVE: To determine the signalment, clinical features, echocardiographic findings, and outcome of dogs and cats with ventricular septal defects (VSDs). DESIGN: Retrospective case series. ANIMALS: 56 dogs and 53 cats with VSDs. PROCEDURES: Medical records of dogs and cats with VSDs diagnosed by means of conventional and Doppler echocardiography were reviewed. Signalment, clinical status, echocardiographic findings, and outcome data were recorded. Variables of interest were analyzed for the study population and subgroups according to species and clinical status. RESULTS: VSDs were isolated (ie, solitary defects) in 53 of 109 (48.6%) patients. Most (82/109 [75.2%]) VSDs were membranous or perimembranous. Terriers and French Bulldogs were commonly represented canine breeds. Most isolated VSDs were subclinical (43/53 [81%]) and had a pulmonary-to-systemic flow ratio < 1. 5 (24/32 [75%]). The VSD diameter and VSD-to-aortic diameter ratio were significantly correlated with pulmonary-to-systemic flow ratio in dogs (r = 0.529 and r = 0.689, respectively) and in cats (r = 0.713 and r = 0.829, respectively). One dog underwent open surgical repair for an isolated VSD and was excluded from survival analysis. Of the remaining animals with isolated VSDs for which data were available (37/52 [71%]), no subclinically affected animals developed signs after initial diagnosis, and median age at death from all causes was 12 years. CONCLUSIONS AND CLINICAL RELEVANCE: Most dogs and cats with isolated VSDs had a long survival time; few had clinical signs at diagnosis, and none with follow-up developed clinical signs after diagnosis.

An evidence-based medicine approach to small animal anaesthetic mortality in a referral practice: the influence of initiating three recommendations on subsequent anaesthetic deaths.

OBJECTIVE: To evaluate anaesthetic death after implementation of recommendations and its risk factors in a small animal practice. STUDY DESIGN: Observational cohort study. ANIMALS: All cats and dogs anaesthetized at the Centre Hospitalier Vétérinaire des Cordeliers during two periods, from April 15th, 2008 to April 15th, 2010 (period 1) and from June 15th, 2010 to August 24th, 2011 (period 2). METHODS: Death occurring during or before full recovery from anaesthesia was recorded. At the end of period 1, a logistic regression model was generated to describe anaesthetic death and identify risk factors. Potential risk factors in our practice setting were identified, and three recommendations, relating to improving physical status and anaesthetic/analgesic regimen implemented for period 2. The relationship between anaesthetic death and recorded variables were analyzed, and where relevant, compared between periods. RESULTS: Six thousand two hundred and thirty-one animals underwent general anaesthesia. The overall death rate during period 1 was 1.35% (48 in 3546, 95% CI [1.0-1.7%]) and during period 2 was 0.8% (21 in 2685, 95% CI [0.6-1.2%]). For sick animals (ASA status 3 and over), the overall death rate was 4.8% (45 of 944 95% [CI 3.5-6.4%]) during period 1 and 2.2% (18 of 834 95% CI [1.3-3.5%]) during period 2; this represented a significant decrease in death rate in period 2 (p = 0.002). In period 2, the main factors associated with an increased odds ratio of anaesthetic death were poor health status (ASA physical status classification) and old age. Species, gender, anaesthetic regimen, the nature and urgency of the procedure were not associated with risk. CONCLUSION AND CLINICAL RELEVANCE: Following evidence based recommendations, the death rate related to anaesthesia was significantly decreased during period 2 compared to period 1. Application of evidence-based medicine may contribute to an effective approach to decrease death rates. Other factors, not monitored in this study, may also have had an impact.

Myelomeningocoele and a dermoid sinus-like lesion in a French bulldog.

A 2-year-old male French bulldog was presented for investigation of lumbosacral pain and hindlimb ataxia associated with urinary and fecal incontinence. Survey radiography, myelography, and computed tomography images were suggestive of a dermoid sinus with associated spina bifida. Surgical intervention led to a resolution of pain and neurological deficits. Histopathological analysis of the excised tissue was compatible with a myelomeningocoele of the 7th lumbar vertebra.

Méningo-myélocèle et lésion dermoïde s'apparentant à un sinus chez un Bouledogue français. Un Bouledogue français mâle âgé de deux ans a été présenté pour faire enquête sur une douleur lombo-sacrée et une ataxie des jambes postérieures associée à une incontinence urinaire et fécale. La radiographie, la myélographie et les images par tomodensitométrie pour faire enquête sur les symptômes suggéraient un sinus dermoïde avec spina-bifida connexe. L'intervention chirurgicale a donné lieu à une résolution de la douleur et des autres déficits neurologiques. L'analyse histopathologique du tissu excisé était compatible avec un méningo-myélocèle de la 7e vertèbre lombaire.(Traduit par Isabelle Vallières).

Thoracoscopic resection of right auricular masses in dogs: 9 cases (2003-2011).

OBJECTIVE: To determine the feasibility of thoracoscopic resection of masses located on the right auricle in dogs. DESIGN: Retrospective case series. ANIMALS: Dogs (n = 9) with a mass on the right auricle. PROCEDURES: Hospital records from 2003 to 2011 were reviewed. Only dogs that underwent thoracoscopic resection of a mass on the right auricle were selected. Data collected included history, clinicopathologic findings, surgical technique, and outcome. RESULTS: All dogs with pericardial effusion were examined by means of echocardiography. Cardiac masses on the right auricle were identified in 5 dogs. Eight dogs had clinical signs of cardiac tamponade and right-sided heart failure. All dogs underwent thoracoscopic resection of a mass on the right atrium. Eight hemangiosarcomas and 1 pyogranulomatous lesion were resected. One dog with a mass located at the base of the right auricle died during surgery. No postoperative complications were noted. CONCLUSIONS AND CLINICAL RELEVANCE: Right auricular masses were successfully removed in 8 dogs. Masses close to the base of the right atrial appendage may not be amenable to resection with thoracoscopy. Resection of small masses at the tip of the right auricular appendage can be performed thoracoscopically.

Risk of anaesthetic mortality in dogs and cats: an observational cohort study of 3546 cases.

OBJECTIVE: To evaluate the anaesthetic death risk for dogs and cats in a French private practice. STUDY DESIGN: Observational cohort study. ANIMAL POPULATION: All small animals anesthetized at the Centre Hospitalier Vétérinaire des Cordeliers between April 15th, 2008 and April 15th, 2010. METHODS: General anaesthesia was defined as a drug-induced unconsciousness characterised by a controlled and reversible depression of the central nervous system and analgesia, sufficient to allow endotracheal intubation. Patient outcome (alive or dead) was assessed at the end of anaesthesia defined as the meeting point of the return of consciousness, rectal temperature >36 °C and ability to maintain sternal recumbency. Death occurring during anaesthesia was recorded. Relationship between anaesthetic death and ASA status, species, age, nature of the procedure, anaesthetic protocol and occurrence of epidural administration of a combination of morphine and bupivacaine were analysed. RESULTS: During the study period 3546 animals underwent general anaesthesia. The overall death rate in the present study was 1.35% (48 in 3546, 95% CI 0.96-1.75). The death rate of healthy animals (ASA 1 and 2) was 0.12% (3 in 2602 95% CI 0.02-0.34). For sick animals (ASA status 3 and over), the overall death rate was 4.77% (45 in 944 95% CI 3.36-6.18). The death rates in the ASA 3, 4 and 5 categories were 2.90%, 7.58% and 17.33%, respectively. The main factor associated with increased odds of anaesthetic death in ASA categories 3 and over was poor health status (ASA physical status classification). The nature of the procedure the patient underwent and epidural administration of a combination of morphine and bupivacaine were not correlated with the occurrence of death during anaesthesia. Neither species nor age effects were detected. CONCLUSION AND CLINICAL RELEVANCE: Specific factors were associated with increased odds of anaesthetic death, especially poor health status. Efforts must be directed towards thorough preoperative patient evaluation and improvement of clinical conditions if possible. Identification of risk factors before anaesthesia should lead to increased surveillance by trained staff. This could result in better outcomes.

Comparison of the effects of imidapril and enalapril in a prospective, multicentric randomized trial in dogs with naturally acquired heart failure.

OBJECTIVE: To compare the efficacy and tolerability of the long-term administration of two different angiotensin-converting enzyme inhibitors, imidapril and enalapril, in a multicentric, prospective, randomized parallel-group scheme clinical trial in dogs with naturally acquired heart disease. ANIMALS: One hundred twenty eight dogs with clinical signs of heart failure (stage II (64-50%) - III (45-35%) - IV (19-15%) New York Heart Association) caused by chronic valvular disease or dilated cardiomyopathy were selected. PROCEDURE: Imidapril (minimum dosage 0.25 mg/kg) or enalapril (median dosage 0.5 mg/kg) was administered orally once daily for 12 months, either alone or as an add-on therapy to diuretics and/or digoxin. RESULTS: The primary outcome measure was the quality of life score after 3 months of therapy. Sixty-one percent of the dogs in the imidapril group (36/59) and 52 % in the enalapril group (30/58) were considered responders. After 12 months, a clear improvement compared to baseline was maintained in each treatment group for most parameters reflecting the quality of life such as fatigue, exercise tolerance, dyspnea, cough and general condition. Quality of life scores and survival times were similar in both groups after 12 months. Both drugs were well tolerated over the one-year follow-up. CONCLUSIONS: Imidapril proved to be as effective as the reference drug enalapril in the treatment of dogs with NYHA class II-IV heart failure. As with enalapril, imidapril was well tolerated during the long-term treatment period of one year in the dose range used in the study.