Clinical presentation, echocardiographic findings, treatment strategies, and prognosis of dogs with myxomatous mitral valve disease presented with pericardial effusion due to suspected left atrial tear: a retrospective case-control study.

INTRODUCTION/OBJECTIVES: Left atrial tear (LAT) is a life-threatening complication in dogs with myxomatous mitral valve disease (MMVD). The study objective was to describe clinical presentation, echocardiographic findings, treatment strategies, and survival in dogs with LAT compared to a control group of dogs with a similar stage of MMVD but no LAT. ANIMALS AND MATERIALS AND METHODS: Two-center retrospective case-controlled study including 15 dogs with and 15 dogs without LAT was conducted. Clinical and echocardiographic data were reviewed, and survival information were collected. RESULTS: Nine dogs in each group were in stage C of MMVD, while the remaining were in stage B2. No differences between groups were found regarding age, body weight, sex, kidney values, and echocardiography-derived cardiac dimensions. Most reported clinical signs associated with LAT included weakness, respiratory signs, and syncope. Treatment varied and was mainly focused on the management of congestive heart failure. Three dogs with LAT received a pericardiocentesis. All 15 dogs with LAT had died of cardiac causes, five dogs during the first seven days after admission. The median survival time for all 15 dogs with LAT was 52 days compared to 336 days in the control group (P=0.103). When excluding five dogs with LAT that died during the first seven days, the median survival increased to 407 days, not different compared to the control group (P=0.549). CONCLUSIONS: Dogs with MMVD and LAT have a high short-term mortality; however, when surviving the acute phase, the long-term prognosis may not differ from dogs with a similarly advanced degree of MMVD but without LAT.

Balloon dilation and transient stenting of unilateral membranous choanal atresia in a British Shorthair cat with chronic purulent rhinitis and ascending meningoencephalitis.

INTRODUCTION: Choanal atresia is a rare congenital anomaly in humans and animals, characterized by the absence of communication of one or both nasal cavities with the nasopharynx. The severity of clinical signs depends on the presence of unilateral versus bilateral stenosis as well as comorbidities. With bilateral atresia, respiration may be severely compromised particularly during sleep, as airflow can only occur when breathing through the open mouth. Various therapeutic modalities have been described in people and adopted for animals. All treatments may be associated with complications, the most important being post-therapeutic scar formation with re-stenosis. This report describes a 10-month-old British Shorthair cat with chronic unilateral serosal nasal discharge that changed to mucopurulent discharge. When acute neurological signs developed, the cat was presented to the veterinary hospital. A diagnosis of primary, membranous right sided choanal atresia was achieved via computed tomography (CT) and nasopharyngeal (posterior) rhinoscopy. Secondary changes included destructive rhinitis with progression to the CNS with a subdural empyema and meningoencephalitis. Retinal changes and aspiration bronchopneumonia were suspected additional complications. After recovery from the secondary infections, the membranous obstruction was perforated and dilated using a valvuloplasty balloon by an orthograde transnasal approach under endoscopic guidance from a retroflexed nasopharyngeal view. To prevent re-stenosis, a foley catheter was placed as a transient stent for 6 days. The cat recovered uneventfully and was asymptomatic after the stent removal. Endoscopic re-examination after 5 months confirmed a persistent opening and patency of the generated right choanal passage. The cat remains asymptomatic 10 months after the procedure. Transnasal endoscopic balloon dilation and transient stenting of choanal atresia is a minimally invasive and relatively simple procedure with potentially sustained success.

INTRODUCTION: L'atrésie des choanes est une anomalie congénitale rare chez l'homme et l'animal, caractérisée par l'absence de communication d'une ou des deux cavités nasales avec le nasopharynx. La gravité des signes cliniques dépend de la présence d'une sténose unilatérale ou bilatérale, ainsi que des comorbidités. En cas d'atrésie bilatérale, la respiration peut être gravement compromise, en particulier pendant le sommeil, car l'air ne peut circuler que par la bouche ouverte. Diverses modalités thérapeutiques ont été décrites chez l'homme et adaptées pour les animaux. Tous les traitements peuvent être associés à des complications, la plus importante étant la formation de cicatrices post-thérapeutiques avec resténose. Ce rapport décrit un chat British Shorthair de 10 mois présentant un écoulement nasal séreux unilatéral chronique qui s'est finalement transformé en un écoulement muco-purulent. Lorsque des signes neurologiques aigus sont apparus, le chat a été présenté à l'hôpital vétérinaire. La tomodensitométrie (CT) et la rhinoscopie nasopharyngée (postérieure) ont permis de diagnostiquer une atrésie choanale primaire membraneuse du côté droit. Les altératiins secondaires comprenaient une rhinite destructrice avec une progression vers le SNC avec empyème sous-dural et méningo-encéphalite. Des altérations de la rétine et une bronchopneumonie par aspiration étaient des complications supplémentaires présumées. Après guérison des infections secondaires, l'obstruction membraneuse a été perforée et dilatée à l'aide d'un ballonnet de valvuloplastie par une approche transnasale orthograde sous guidage endoscopique à partir d'une vue nasopharyngée rétrofléchie. Pour éviter une nouvelle sténose, une sonde de Foley a été placée comme stent transitoire pendant 6 jours. Le chat s'est rétabli sans incident et était asymptomatique après le retrait du stent. Le réexamen endoscopique effectué 5 mois plus tard a confirmé la persistance de l'ouverture et de la perméabilité de la voie choanale droite générée. Le chat reste asymptomatique 10 mois après l'intervention. La dilatation endoscopique transnasale par ballonnet et la pose d'une endoprothèse transitoire dans le cas d'une atrésie des choanes est une procédure peu invasive et relativement simple dont le succès peut être durable.

Comparison of the diagnostic value of a small, single channel, electrocardiogram monitoring patch with a standard 3-lead Holter system over 24 hours in dogs.

INTRODUCTION/OBJECTIVES: The aim of this study was to compare a novel small event recorder device, the Carnation Ambulatory Monitor (CAM), with a standard Holter. ANIMALS: Nineteen adult dogs. MATERIAL AND METHODS: Comparative and explorative study. The two devices were simultaneously applied for approximately 24 h. RESULTS: Analysis time (P=0.013) and percentage of artefacts (P<0.001) were greater for the CAM (110 min [40-264]; and 9% [0-34], respectively) compared to a standard Holter (30 min [18-270]; and 0.3% [0-9], respectively). The total number of beats (P=0.017) and maximum (P=0.02) and mean (P=0.037) heart rates were lower for the CAM (113,806 ± 23,619 beats; 227 ± 35 bpm; and 88 ± 22 bpm, respectively) compared to the standard Holter (131,640 ± 40,037 beats; 260 ± 64 bpm; and 92 ± 26 bpm, respectively). The minimal heart rate (P=0.725), number of pauses (P=0.078), duration of the longest pause (P=0.087), number of ventricular ectopic complexes (P=0.55), ventricular couplets (P=0.186), ventricular triplets (P=0.203), ventricular tachycardia (P=0.05), Lown grade (P=0.233), presence or absence of ventricular bigeminy, trigeminy, supraventricular tachycardia, and atrial fibrillation (P=0.98) did not differ. The CAM missed some relevant events, like complex ventricular arrhythmias, and the Lown grade did not match in 5/19 dogs when comparing the devices. CONCLUSIONS: Cardiac Ambulatory Monitor can be used to record ECG traces in dogs over a prolonged period, allowing to detect arrhythmias. Due to some clinically relevant limitations, including a higher percentage of artefacts, a longer reading time (which precludes quantitative counts of >300ventricular premature complexes), and underestimation of complex ventricular arrhythmias, the CAM appears not suitable for quantitative arrhythmia analysis in dogs.

Long-term palliation of right-sided congestive heart failure after stenting a recurrent cor triatriatum dexter in a 10½-year-old pug.

A 10½-year-old, male neutered, pug presented with increasing ascites over two months. Echocardiography revealed cor triatriatum dexter with no concurrent cardiovascular anomalies, subsequently confirmed by computed tomography angiography. Balloon dilation of the perforated intra-atrial membrane under fluoroscopic guidance resulted in the transient resolution of all clinical abnormalities, but six months later stenosis and ascites recurred. After repeated balloon dilation, a stent was placed across the membrane. The dog remains asymptomatic fourteen months after the second procedure. One noteworthy feature of this case is the onset of congestive heart failure due to a congenital defect only at more than 10 years of age.

Effect of a single dose of pimobendan on right ventricular and right atrial function in 11 healthy cats.

OBJECTIVES: The objective of this study was to investigate the effect of pimobendan on echocardiographic parameters of right ventricular and atrial function in healthy cats. ANIMALS: Eleven privately owned, healthy adult cats. MATERIAL AND METHODS: Each cat underwent five echocardiographic examinations: the first and second examinations were performed 1 h apart on day 0. On day 1, the third examination served as baseline, whereas the fourth and fifth examinations were performed one and 6 h after administration of a single oral dose of pimobendan (1.25 mg/cat), respectively. Parameters of right ventricular and atrial morphology and function were collected and compared among time points. RESULTS: Pimobendan administration produced a change in some echocardiographic variables. Specifically, heart rate, right ventricular fractional shortening and peak velocity of systolic lateral tricuspid annular motion increased (P = 0.032, P = 0.002 and P < 0.001, respectively), whereas right ventricular end-systolic internal diameter and right atrial maximum and minimum internal diameters decreased (P = 0.004, P = 0.025 and P = 0.01, respectively). Right ventricular fractional area change and tricuspid annular plane systolic excursion did not change. CONCLUSIONS: This novel study showed that pimobendan had positive effects on right ventricular and right atrial function in healthy cats. Further studies are needed to determine whether pimobendan has similar effects in cats with cardiac diseases.

Balloon valvuloplasty of valvular pulmonary stenosis in a neonatal foal.

In a 1-day old filly with a loud heart murmur, transthoracic echocardiography revealed right ventricular hypertrophy associated with severe pulmonary valvular stenosis and a transvalvular pressure gradient (between right ventricle and pulmonary artery) of 125 mmHg. Computed tomographic angiography confirmed the finding, with no evidence of other relevant concurrent abnormalities. Balloon valvuloplasty was performed using a single balloon technique. The foal recovered well from anaesthesia. Following the procedure, the right ventricle-pulmonary artery transvalvular gradient decreased to 38 mmHg. At follow up examinations after 1 month, 1 year and 2 years, the filly showed normal exercise capacity and echocardiography confirmed the persistent substantial improvement in the transvalvular outflow gradient.

Echocardiographic assessment of right ventricular systolic function in healthy Beagle dogs compared to high field cardiac magnetic resonance imaging.

Ten healthy Beagle dogs were used to compare selected echocardiographic parameters of right ventricular (RV) systolic function with high field cardiac magnetic resonance imaging (MRI). All dogs underwent complete transthoracic echocardiography before and during anesthesia, as well as cardiac MRI with determination of morphology-based ejection fraction, and phase contrast angiography-derived stroke volume. A correlation analysis was carried out between echocardiographic and MRI parameters. The values of fractional area change, tricuspid annular plane systolic excursion, tissue Doppler imaging derived peak velocity of the isovolumic contraction wave and systolic wave of the lateral tricuspid valve annulus showed lower values under general anesthesia. Of all echocardiographic parameters of RV systolic function, only fractional area change (r = 0.671, P = 0.034) and tissue Doppler imaging derived peak velocity of the systolic wave of the lateral tricuspid valve annulus (r = 0.768; P = 0.01), showed a significant correlation with MRI derived stroke volume. None of the echocardiographic parameters correlated with MRI derived ejection fraction. When evaluating the RV echocardiographically, fractional area change and peak velocity of the systolic wave of the lateral tricuspid valve annulus appear to be the most reliable predictors of RV systolic function when compared to MRI under anesthesia.

Endocardial fibroelastosis in a dog with congestive heart failure.

In a 6-month-old, intact female, Japanese spitz presenting with severe dyspnea, lung ultrasonography revealed confluent B lines associated with severe echocardiographic left sided volume overload and systolic dysfunction. A congenital shunt or valvular dysplasia was not demonstrable. On electrocardiogram, there was a constant sinus rhythm, respectively sinus tachycardia. Cardiac troponin I was normal. Within 2 days of admission, the dog died of heart failure. On macroscopic postmortem examination, the left ventricle and atrium were markedly dilated, and the left ventricular endocardium had a mild diffuse whitish appearance. Histopathology revealed moderate to severe thickening of the left ventricular endocardium, composed mostly of abundant elastic fibers and fewer collagen fibers, diagnostic for endocardial fibroelastosis. In addition, there were mild degenerative changes of the atrioventricular valves. Endocardial fibroelastosis is a rare congenital disease and should be considered in a young dog if more common causes of echocardiographic dilated cardiomyopathy phenotype are ruled out.

Closure of an unusual morphology patent ductus arteriosus with a covered stent in a dog.

Patent ductus arteriosus (PDA) with unusual morphology was diagnosed in a 3-year-old German shepherd presented for exercise intolerance. Two interventional PDA closure procedures with various Amplatzer devices and one surgical ligation were attempted to close the PDA. However, PDA closure failed with both methods due to the unusual morphology and the severe enlarged ductus ampulla. Therefore, the patient underwent an aortic covered stent placement, and successful closure of the PDA was achieved. Eight months after the procedure, the dog was free of clinical signs and no residual flow was identified through the PDA on transthoracic echocardiography. Moreover, computed tomography angiography demonstrated correct stent positioning, with no evidence of thrombus formation, damage to the stent, nor any aortic wall abnormalities. Aortic covered stent placement is a viable option in dogs with unusual PDA morphology.

[Diagnostic utility of creatine kinase elevation in the routine biochemical profile in cats]. / Diagnostischer Nutzen einer Kreatin­kinase Erhöhung im Routine­chemogramm bei Katzen.

INTRODUCTION: Creatine kinase (CK) is a muscle enzyme that is very sensitive to muscle damage. Therefore, serum CK is measured particularly to confirm suspected myopathy. Since 2013, this enzyme has been included in the routine chemistry profile in our hospital. Soon thereafter, the subjective impression developed that its elevation did not correlate to and was not explainable with the actual clinical problem. Therefore, the aim of this retrospective study was to investigate in which clinical cases the CK elevation was adequate and in which cases without clinical evidence of muscle damage the CK was so markedly elevated that it implied a clinically relevant muscle damage. For this purpose, we evaluated the CK values of 1641 cats presented in the years 2013/2014 at our university animal hospital. The CK was comprehensibly elevated in cats with trauma and various diseases with obvious and traceable muscle damage like thrombo-embolic damage or seizures. In addition, the CK was elevated in diseases where concomitant muscle damage is perceivable like in cats with hypertrophic cardiomyopathy. However, the CK also was commonly and sometimes dramatically elevated in cats of essentially any disease group without any comprehensible skeletal muscular lesion. These results confirm the hypothesis that the diagnostic value of this parameter is most questionable. A CK elevation does not allow any conclusion regarding its original diagnostic purpose, i.e. to confirm the presence of a clinically relevant myopathy.

INTRODUCTION: La créatine kinase (CK) est une enzyme musculaire très sensible lors de dommages musculaires. Par conséquent, la CK sérique est mesurée en particulier pour confirmer une myopathie suspectée. Depuis 2013, cette enzyme fait partie du chimiogramme de routine de notre hôpital. Après peu de temps, l'impression subjective s'est développée que son élévation n'était pas corrélée ni explicable avec le problème clinique réel. Par conséquent, le but de cette étude rétrospective était d'étudier dans quels cas cliniques l'élévation de la CK était adéquate et dans quels cas sans signe clinique de lésion musculaire, la CK était si nettement élevée qu'elle impliquait une lésion musculaire cliniquement pertinente. À cette fin, nous avons évalué les valeurs CK de 1641 chats présentés dans les années 2013/2014 à notre hôpital universitaire pour animaux. La CK était sensiblement élevée chez les chats souffrant de traumatismes et de diverses affections avec des lésions musculaires évidentes et traçables comme des dommages thrombo-emboliques ou des convulsions. De plus, la CK était élevée dans les maladies où des lésions musculaires concomitantes étaient décelables comme chez les chats atteints de cardiomyopathie hypertrophique. Cependant la CK était également couramment et parfois considérablement élevée chez les chats de pratiquement n'importe quel groupe de pathologies sans aucune lésion musculaire squelettique explicable. Ces résultats confirment l'hypothèse que la valeur diagnostique de ce paramètre est très discutable. Une élévation de la CK ne permet aucune conclusion concernant son objectif diagnostique d'origine, c'est-à-dire de confirmer la présence d'une myopathie cliniquement significative.

[Extraction invasive minimale de Dirofilaria immitis chez un chien souffrant d'un syndrome cave supérieur]. / Minimal invasive Extraktion von adulten Dirofilaria immitis bei einem Hund mit Kavalsyndrom.

INTRODUCTION: Caval syndrome due to infection with Dirofilaria (D.) immitis is a life-threatening situation, needing immediate therapeutic intervention. Severe pulmonary hypertension due to dirofilariosis was diagnosed echocardiographically in a 3.6 kg dog with heart failure and moderate hemolytic anemia. A ball of adult worms was visualized in the tricuspid valve area. Using a modified pigtail catheter, these worms were removed under fluoroscopic guidance by a transvenous approach. Already intraoperatively the hemodynamic condition improved. Subsequently, additional routine adulticide treatment was performed without complications. Over the following weeks the severe pulmonary hypertension normalized slowly but steadily. Manual extraction of adult D. immitis can be achieved with relatively simple tools and allows rapid stabilization of a critically sick patient.

INTRODUCTION: Le syndrome cave supérieur dû à une infestation à ­Dirofilaria (D.) immitis est une situation potentiellement mortelle nécessitant un traitement immédiat. Une hypertension pulmonaire sévère due à la dirofilariose a été diagnostiquée par échocardiographie chez un chien de 3,6 kg présentant une insuffisance cardiaque et une anémie hémolytique modérée. Une boule de vers adultes a été visualisée dans la région de la valvule tricuspide. En utilisant un cathéter queue de cochon modifié, ces vers ont été retirés sous guidage fluoroscopique par une approche transveineuse. Déjà durant l'opération, l'état hémodynamique s'est amélioré. Par la suite, un traitement adulticide de routine supplémentaire a été réalisé sans complications. Au cours des semaines suivantes, l'hypertension artérielle pulmonaire sévère s'est normalisée lentement mais régulièrement. L'extraction manuelle de D. immitis adultes peut être réalisée avec des outils relativement simples et permet la stabilisation rapide d'un patient gravement atteint.

Holter monitoring demonstrates that ventricular arrhythmias are common in cats with decompensated and compensated hypertrophic cardiomyopathy.

Arrhythmias can complicate cardiac disease in cats and are a potential cause of sudden death. The aim of this study was to evaluate the presence and nature of cardiac arrhythmias, and the potential correlation between plasma serum troponin I (cTnI) concentrations and the presence or severity of arrhythmias in cats with decompensated (dHCM) and compensated hypertrophic cardiomyopathy (cHCM). Forty one client-owned cats were studied: 16 with cHCM, 15 with dHCM and 10 healthy control cats. Physical examination, echocardiography, cTnI and 24-h Holter recordings were obtained in all cats and thoracic radiographs in cats with dHCM. Cats in both HCM groups were followed for 1 year after their initial Holter examination. The median (range) number of ventricular premature complexes (VPCs) over 24h was 867 (1-35,160) in cats with dHCM, 431 (0-18,919) in cats with cHCM and 2 (0-13) in healthy control cats. The median number of episodes of ventricular tachycardia (VTach) was 0 (0-1497) in dHCM and 0.5 (0-91) in cats with cHCM. The number of VPCs, VTach episodes and heart rate was not different between the HCM groups. Plasma serum troponin I was highest in the cats with dHCM, but there was no correlation between cTnI concentration and the number of arrhythmias. Thirteen of 31 cats with HCM died, but an association with the presence and complexity of ventricular arrhythmias was not observed. Compared to healthy cats, ventricular arrhythmias were common in cats with cHCM and dHCM, but neither presence nor complexity of arrhythmias could be linked to prognosis.

[Efficacy of the combination of glucocorticoids, mycophenolate-mofetil and human immunoglobulin for the therapy of immune mediated haemolytic anaemia in dogs]. / Wirksamkeitsstudie zur Kombinationstherapie von Glukokortikoid, Mycophenolat- Mofetil und humanem Immunglobulin zur Therapie von primärer immun vermittelter hämolytischer Anämie beim Hund.

INTRODUCTION: Idiopathic immune-mediated haemolytic anaemia (IMHA) is one of the most common immune-mediated diseases in dogs with a high mortality rate. In this retrospective study, we examined the effect of mycophenolate- mofetil (MMF) and human intravenous immunoglobulin (hIVIG) in combination with glucocorticoids on canine IMHA patients. Six dogs were treated with prednisolone and MMF (hIVIG-) and in 15 patients hIVIG was added (hIVIG+). There was no significant difference between the groups regarding age, weight, number of blood transfusions or hematocrit on the day of diagnosis. The hIVIG+ group showed a significantly faster recovery of the hematocrit, but this difference was only short-lived. The survival in the first year was similar in both groups and was with 71.5% somewhat higher than in other published studies. The addition of MMF to prednisolone for the treatment of dogs with acute IMHA was well tolerated and seemed to positively affect the course of the disease. Randomized studies are necessary to confirm this observation. Human immunoglobulin had only minimal clinical advantages and no effect on mortality.

INTRODUCTION: Une anémie hémolytique auto-immune idiopathique (IMHA) compte chez le chien au nombre des affections auto-immunes les plus fréquentes avec un taux de mortalité élevé. Dans le cadre de la présente étude rétrospective, nous avons examiné l'effet du mycophénolate mofétil (MMF) et des globulines humaines par voie intraveineuse (hIVIG) en combinaison avec des glucocorticoïdes sur des chiens souffrant d'IMHA. Six chiens ont été traités au moyen d'une combinaison prédnisolone/ MMF (hIVIG­) et chez 15 patients on a en plus utilisé des hlVIG (hIVIG+). Les deux groupes ne se différenciaient pas de façon significative en ce qui concerne l'âge, le poids, le nombre de transfusions sanguines ou l'hématocrite lors du diagnostic. Les patients du groupe hIVIG+ ont montré une normalisation significativement plus rapide mais de courte durée de l'hématocrite. Le taux de survie à une année était similaire dans les deux groupes avec 71,5%, ce qui est un peu plus élevé que dans d'autres études. L'ajout de MMF à la prédnisolone dans le traitement de chiens atteints d'IMHA est bien supporté et semble influencer le cours de la maladie de façon positive. Des études randomisées sont nécessaires pour confirmer ces observations. Les immunoglobulines humaines n'ont eu qu'un effet limité et pas d'influence sur la mortalité.

Transient Myocardial Thickening in Cats Associated with Heart Failure.

BACKGROUND: Cats with hypertrophic cardiomyopathy (HCM) and congestive heart failure (CHF) can have resolution of both left ventricular hypertrophy and CHF. OBJECTIVES: To describe the clinical characteristics of cats with transient myocardial thickening (TMT) and CHF compared with a control population of cats without resolution of HCM. ANIMALS: A total of 21 cats with TMT, 21 cats with HCM. METHODS: Retrospective study. Clinical records at 4 veterinary centers were searched for TMT cases and a control group of cats with HCM and CHF. TMT was defined as initial maximal left ventricular wall thickness (LVWT) ≥6 mm with left-sided CHF, with subsequent resolution of CHF, reduction in left atrium/aorta (LA/Ao), and LVWT<5.5 mm. HCM was defined as persistent LVWT ≥6 mm. RESULTS: Cats with TMT were younger (2 [0.4-11.4] years) than cats with HCM (8 [1.6-14] years) (P < 0.0001), and antecedent events were more common (15/21 versus 6/21, respectively) (P = 0.01). In cats with TMT, LVWT normalized from 6.8 [6.0-9.7] mm to 4.8 [2.8-5.3] mm and LA/Ao decreased from 1.8 [1.6-2.3] to 1.45 [1.2-1.7] after a mean interval of 3.3 (95% CI: 1.8-4.7) months. CHF recurred in 1 of 21 TMT and 15 of 21 cats with HCM. Cardiac treatment was discontinued in 20 of 21 cats with TMT and 0 of 21 HCM cats. All cats with TMT survived, whereas 8 of 19 cats with HCM died during the study period. CONCLUSIONS AND CLINICAL IMPORTANCE: TMT occurs in younger cats, and antecedent events are common. The prognosis is better in cats with CHF associated with TMT than HCM.

Cats with diabetes mellitus have diastolic dysfunction in the absence of structural heart disease.

Diabetes mellitus (DM) can result in cardiovascular dysfunction and heart failure characterized by diastolic dysfunction with or without the presence of systolic dysfunction in people and laboratory animals. The objective of this prospective study was to determine if cats with newly diagnosed DM had myocardial dysfunction and, if present, whether it would progress if appropriate antidiabetic therapy was commenced. Thirty-two diabetic cats were enrolled and received baseline echocardiographic examination; of these, 15 cats were re-examined after 6 months. Ten healthy age- and weight-matched cats served as controls. Diabetic cats at diagnosis showed decreased diastolic, but not systolic function, when compared to healthy controls, with lower mitral inflow E wave (E) and E/E' than controls. After 6 months, E and E/IVRT' decreased further in diabetic cats compared to the baseline evaluation. After excluding cats whose DM was in remission at 6 months, insulin-dependent diabetic cats had lower E, E/A and E' than controls. When classifying diastolic function according to E/A and E'/A', there was shift towards impaired relaxation patterns at 6 months. All insulin-dependent diabetic cats at 6 months had abnormal diastolic function. These results indicate that DM has similar effects on diastolic function in feline and human diabetics. The dysfunction seemed to progress rather than to normalize after 6 months, despite antidiabetic therapy. In cats with pre-existing heart disease, the development of DM could represent an important additional health risk.

Unexplained bleeding as primary clinical complaint in dogs infected with Angiostrongylus vasorum.

INTRODUCTION: Unexplained bleeding was the primary clinical complaint in 15 dogs diagnosed with A. vasorum and was observed in the mouth, as external bleeding, as large subcutaneous hematoma, as hemoptysis, in the brain, post ovariectomy, as epistaxis, in the anterior ocular chamber and on a tracheal intubation tube. In 8 dogs the cause of bleeding initially was suspected to be a minor trauma or a surgical complication, and various surgical approaches had been undertaken to eliminate the problem. In only 3 dogs respiratory signs were observed before the bleeding prompted referral. The median time elapsed between the first recognized clinical signs attributed to A. vasorum until diagnosis was 2 weeks (range1 day to 4 months). Four dogs died, 3 on the day of admission and 1 dog 4 days after admission. Suspected causes of death were respiratory failure and cerebral hemorrhage in 2 dogs each. Four dogs had been pre-treated with NSAIDs; of these, 2 dogs developed severe hemoptysis (1 died), 1 dog developed brain hemorrhage (and died), and 1 dog developed a large subcutaneous hematoma with marked anemia. Bleeding at various sites may be the only recognized abnormality in A. vasorum infection. Without a high index of suspicion, the diagnosis and appropriate therapy may be delayed to the point of a fatal outcome. Tests of coagulation were quite variable and the cause of bleeding likely multifactorial.

INTRODUCTION: Un saignement inexplicable a été le symptôme clinique primaire chez 15 chiens chez lesquels une infestation à A. vasorum a été diagnostiquée par la suite. Ces saignements ont été observés sous forme d'hémorragies dans la gueule, de saignements externes, de gros hématomes sous-cutanés, d'hémoptysie, de saignements cérébraux, de saignements abdominaux après ovariectomie, de saignements dans la chambre antérieure de l'oeil ou sur le trachéotube lors d'intubations. Chez 8 chiens, on a supposé que le saignement était initialement dû à un petit traumatisme ou à une complication opératoire et diverses mesures chirurgicales ont été prises pour résoudre le problème. Chez trois chiens, des symptômes respiratoires ont été observés avant que le saignement n'amène à l'envoi dans un centre de référence. Le temps moyen écoulé entre les premiers symptômes causés par A. vasorum et le diagnostic était de 2 semaines (1 jour à 4 mois). Quatre chiens sont décédés, 3 le jour de leur arrivée et un 4 jours plus tard. Les causes probables de la mort étaient dans deux cas une déficience respiratoire et dans deux une hémorragie cérébrale. Quatre chiens avaient été traités précédemment avec des AINS; deux d'entre eux ont développé une hémoptysie massive et un en est mort, un chien a présenté une hémorragie cérébrale fatale et le dernier a développé un volumineux hématome sous-cutané avec une anémie massive. Un saignement à un endroit quelconque peut être la seule anomalie constatée lors d'une infestation par A. vasorum. Si on n'a pas d'importants soupçons de cette affection, le diagnostic et le traitement adéquat peuvent être tellement retardés qu'une issue fatale survient. La cause pathophysiologique des hémorragies est vraisemblablement multifactorielle.

Hypovolemia induced systolic anterior motion of the mitral valve in two dogs.

Systolic anterior (septal) motion of the mitral valve (SAM) is a common secondary phenomenon in hypertrophic cardiomyopathy (HCM) in people and cats. In humans, it is increasingly recognized that SAM may be found in other cardiac and non-cardiac disease states. In small animal cardiology, SAM unassociated with HCM has been described in dogs with mitral valve dysplasia and right ventricular pressure overload. In this report, we describe two cases of dogs where transient SAM was caused by hypovolemia. When SAM was present both dogs showed pseudohypertrophy and tachycardia. Important factors in the genesis of SAM in this scenario are probably hypovolemia induced changes in left ventricular geometry affecting the orientation of the mitral valve apparatus combined with elevated catecholamine levels. SAM associated with increased wall thickness is not pathognomonic of HCM; this observation is of particular clinical importance when extrapolated to species where HCM is highly prevalent, e.g., cats. An echocardiographic diagnosis should always be evaluated together with full clinical assessment of history and physical examination.

Intrapulmonary arteriovenous anastomoses in dogs with severe Angiostrongylus vasorum infection: clinical, radiographic, and echocardiographic evaluation.

BACKGROUND: In both humans and dogs the pulmonary vasculature is able to recruit large-diameter anatomical intrapulmonary arteriovenous anastomoses (IPAVAs). In healthy people the opening of these anastomoses affects the degree of exercise-induced increase in pulmonary arterial pressure. The presence of these IPAVAs can be demonstrated using saline contrast echocardiography. OBJECTIVES: The aims of the present study were to characterize severely affected, naturally infected dogs with Angiostrongylus vasorum, to evaluate if these dogs can open IPAVAs, and to assess if the recruitment of such anastomoses affects the severity of pulmonary hypertension (PH). ANIMALS: Eight client-owned dogs with severe A. vasorum infection were recruited. METHODS: Dogs with A. vasorum infection that presented with severe dyspnea and/or syncope were prospectively screened by echocardiography for the presence of PH and IPAVAs. Only severely affected dogs, based on a combination of clinical, radiographic and echocardiographic abnormalities, were enrolled. RESULTS: Opening of IPAVAs could be demonstrated in three dogs with no to moderate PH, and could not be demonstrated in five dogs with severe PH. In two dogs thoracic radiographs showed only mild interstitial changes, while computer tomography and postmortem examination revealed severe pulmonary interstitial and vascular disease. CONCLUSIONS: These results suggest that dogs may open IPAVAs and that opening of such anastomoses may play a regulatory role in the development of PH. There may be a marked discrepancy between radiographic changes and disease severity in A. vasorum.

Intestinal epidermoid cyst in a cat.

A 3-year-old cat was presented with anorexia and vomiting. Palpation revealed a caudal abdominal mass. Ultrasound and explorative abdominal surgery revealed a cystic mass in the jejunum. Histopathologic findings were consistent with an epidermoid cyst. The cyst was likely of congenital origin, since the cat had not undergone previous abdominal surgery, and gradually grew to reach a size that caused intestinal obstruction. Extrapolating from findings in people, intestinal epidermoid cysts are considered benign with a good long-term prognosis when completely excised.

Clinical, laboratory and pathological findings in cats experimentally infected with Aelurostrongylus abstrusus.

Aelurostrongylus abstrusus parasitizes the respiratory tract and can heavily affect the breathing and general condition of cats. Experimental infections of six cats were initiated by intragastric administration with 100 or 800 third-stage larvae (L3) obtained from the terrestrial snail Helix aspersa. First-stage larvae were isolated from faecal samples after 35-41 days post infection (dpi) in five animals and until end of study (84 dpi) in two cats. Cough and respiratory sounds were observed starting from 28 to 41 dpi and dyspnoea and panting starting from 52 dpi. All cats had enlarged lymph nodes and, starting from 56 dpi, reduced body weight, and four cats showed intermittent reduced general condition with apathia and anorexia. Eosinophilia and leucocytosis partially with massive lymphocytosis, and occasional basophilia and monocytosis were observed. Mild anaemia was present in five cats, while alterations in coagulation parameters suggested stimulation of the coagulation cascade with increased consumption of coagulation factors (delayed PT, hypofibrinogenemia). Adult A. abstrusus specimens were isolated from the five patent cats at necropsy and all six cats showed pathological changes in the lungs, including disseminated inflammatory cell infiltrates, often associated with incorporated larvae and eggs. There was some degree of overlap between the severity and the inoculation doses. Infections starting from 100 L3 of A. abstrusus had an impact on the lung tissues and on the health of the cats, despite the presence of only mild haematological abnormalities. Due to the worldwide occurrence of feline lung worms, parasitic infections should be considered in the differential diagnosis of lung diseases regardless of the presence of clinical signs and larval excretion.