A Retrospective Cohort Evaluation of Left Ventricular Remodeling, Perioperative Complications and Outcome in Medium and Large Size Dogs with Patent Ductus Arteriosus after Percutaneous Closure.

This retrospective cohort study included one hundred fifty-seven medium and large-size dogs with the aim of evaluating the effect of signalment and echocardiographic features on complications, outcomes and left ventricular modifications before and after patent ductus arteriosus (PDA) closure. The patients were divided in two groups based on the heart remodeling after closure: Group A included dogs that had a reduction in the end-systolic volume index (ESVI) after closure compared to the ESVI measured before; Group B included dogs without a reduction in ESVI after closure. Body weight, minimal ductal diameter (MDD) of PDA, end-diastolic volume index and presence of arrhythmias at presentation were significantly higher in Group B compared to Group A. The shortening fraction and ejection fraction after closure were reduced in both groups, but in Group B there was a major reduction, and the mean values indicated a possible systolic dysfunction. Complications during the procedure and death due to cardiac reasons were greater in Group B compared to Group A. In conclusion, a higher body weight, a larger MDD, a more severe heart enlargement or arrhythmias at presentation increased the risk of developing a worsening structural and functional condition after ductal closure, and this can be associated with perioperative complications and cardiac death.

Is Pulmonary Hypertension a Rare Condition Associated to Angiostrongylosis in Naturally Infected Dogs?

Canine angiostrongylosis due to Angiostrongylus vasorum is one of the cardiopulmonary parasitic diseases in dogs and it can manifest with very different clinical pictures, which often make diagnosis very difficult. Based on the nature of the vascular and parenchymal lesions induced by the infection (thrombo-arteritis and fibrosis), it is not surprising that cases of pulmonary arterial hypertension (PAH) associated with angiostrongylosis have been reported in the literature, although it seems to represent a rare condition. The aim of the present work is to describe the clinical and instrumental aspects referred to cases of canine angiostrongylosis before and after treatment then to evaluate even mild conditions of PAH using echocardiography. PAH was not only conventionally investigated based on characteristic cardiac changes that occur secondary to PAH and by estimating pulmonary pressure from spectral Doppler tracings, but also by using a combination of further selected echocardiographic parameters (AT/ET, PA/Ao, Pulmonary flow profile pattern) able also to reveal PAH in the absence of tricuspid or pulmonary regurgitation. Clinical and instrumental aspects of 17 cases of angiostrongylosis, divided into respiratory cases (n = 6), nonrespiratory (n = 5), and asymptomatic (n = 6), are here described. Radiographic alterations were recorded in 90% of patients despite the reason for clinical presentation. A state of mild to severe PAH was diagnosed in 58.8% of cases. Although the return to a normal clinical condition was achieved 2 months after treatment in almost all patients, radiographic and echocardiographic alterations were persistent for longer. The cases presented reinforce the evidence on the complexity of the clinical picture of angiostrongylosis. PAH associated with canine angiostrongylosis could be a more common condition than previously reported in naturally infected dogs. In some cases, echocardiographic findings suggestive of PAH could be the starting point to address the clinical diagnosis toward angiostrongylosis. PAH may be responsible for worsening of the clinical picture of patients; thus, a careful evaluation is suggested before and after anthelmintic treatment in order to optimize the therapeutic management of each case.

A multimodality imaging approach for guiding a modified endovascular coil embolization of a single intrahepatic portosystemic shunt in dogs.

Intrahepatic portosystemic shunts (IHPSS) in dogs are aberrant vascular anomalies that connect the portal and the systemic venous vessels. In most of the patients, the surgical approach is unfavourable due to the difficulties in isolating the IHPSS, making the option of a percutaneous transvenous coil embolization (PTCE) one of the safer occlusive procedures. This study describes the treatment of eight dogs with a single IHPSS using a multimodality imaging approach to guide the modified PTCE procedure. This new technique results in a decrease of 71% of the time of the entire procedure with the reduction of 91% in the time required involved the IHPSS identification and in the fluoroscopy exposure time avoiding the need for iodinated contrast agents during the procedure. Moreover, the placement of the catheter before the caval stent ensures its greater stability, enhancing the procedural safety in the phase when the coils are released and avoiding the risk of their dislocation.

Transesophageal echocardiography to diagnose anomalous right coronary artery type R2A in dogs.

OBJECTIVES: To assess the feasibility of transesophageal echocardiography (TEE) as an alternative to angiography for the diagnosis of R2A coronary artery (CA) abnormalities. ANIMALS: Twenty-two dogs with a diagnosis of type R2A CA anomaly were reviewed/analyzed. METHODS: A retrospective study of case records. Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), angiography, and follow-up investigations of pulmonic stenosis (PS) with R2A CA were carried out to compare different diagnostic methods. RESULTS: Based on the TTE morphology, PS with an aberrant CA was suspected in all dogs (n = 22) and later confirmed by angiography in 18 cases (18/22), and necropsy in two cases (2/22). In 12 cases (12/22), TEE and angiography were both performed and confirmed the diagnosis of an R2A anomaly. Two cases (2/22) were diagnosed only with TEE. CONCLUSIONS: Transesophageal echocardiography may be considered an effective tool to diagnose CA abnormalities, in particular when TTE is inconclusive. Transesophageal echocardiography offers detailed and easily reproducible views of coronary ostia, and the spatial relationship between the right common CA and the great arteries. Although it is not possible to define the course of the more distal coronary branches, TEE has proven reliable in recognizing those elements that can constitute a risk for the execution of a balloon valvuloplasty (BV). Therefore, TEE can be used to confirm this type of CA anomaly and prevent a BV, which is contraindicated in these cases. In addition, TEE avoids any further vascular access, radiation exposure, and contrast medium injection.

Timing of pulmonary valve replacement after tetralogy of Fallot repair.

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. If left untreated, it carries a 33% mortality in the first year of life and a 50% mortality in the first 3 years of life. Since the introduction of the first open-heart repair by Lillehei and Varco in 1954, surgical management of TOF has evolved to be the primary repair during infancy in the majority of patients. Surgical management of TOF results in anatomic and functional abnormalities in the majority of patients, such as chronic pulmonary valve regurgitation and right ventricular (RV) dysfunction. Long-standing chronic pulmonary valve regurgitation can result in RV dilatation and failure, increasing tricuspid regurgitation, impaired exercise performance and supraventricular or ventricular arrhythmias. A timely reoperation may prevent these consequences, with a complete RV-function recovery. This article provides insight into the questions of when to perform a pulmonary valve implantation and in whom.