Annuloaortic ectasia in a four-month-old male Newfoundland dog: long-term follow-up and immunofluorescent study.

A 4 month-old, 14.8 kg, male Newfoundland dog was presented for cardiovascular evaluation following detection of a heart murmur. Echocardiography revealed enlargement of the sinuses of Valsalva and marked, diffuse dilation of the ascending aorta (annuloaortic ectasia, AAE), with mild/equivocal subaortic stenosis (SAS). The dog was monitored over the duration of its lifetime, with serial echocardiograms performed at 5, 6, and 8 months and 1, 2, 3, 4, 8, and 10 years demonstrating persistent, diffuse dilation of the ascending aorta. The dog lived until it was 10 years old and died of metastatic carcinoma. Postmortem examination confirmed AAE and mild SAS. Hematoxylin and eosin and Weigert van Gieson stains were used to compare the ascending aorta to the descending aorta and left subclavian artery, and to compare aortic samples to those of three control dogs. Histopathologic evaluation revealed mild medial degeneration in the ascending aorta of all four dogs. Immunofluorescent microscopy was used for determining the deposition of proteins known to play a role in aortic aneurysms in humans: fibrillin-1 (FBN1), latent transforming growth factor beta binding protein 4 (LTBP4) and fibronectin. The ascending aorta of the AAE case demonstrated reduced deposition of FBN1, indicating that its loss may have contributed to aortic dilation. Diffuse, primary ascending aortic dilation is uncommonly reported in dogs; when it is, it carries a poor prognosis. This case provides an important example of marked dilation of the ascending aorta in a dog that lived with no associated adverse effects for 10 years.

Balloon expandable aortic stent-graft for the treatment of aortic aneurysm and rupture in a dog.

OBJECTIVE: To describe the successful placement of an aortic stent graft in a dog suffering from aortic aneurysm and rupture. CASE SUMMARY: A 4-year-old neutered female mixed breed dog weighing 25 kg was presented with a chief complaint of acute onset of weakness and respiratory distress. On presentation, the dog was lateral and unresponsive, hypothermic, tachycardic, and tachypneic. Pleural effusion was identified in the right hemi-thorax on thoracic-focused sonographic scan for trauma. Thoracic radiographs showed a fluid/soft tissue opacity in the cranial mediastinum and pleural effusion on the right side. Thoracocentesis yielded noncoagulating blood. Hematology revealed normal PCV and total plasma protein that decreased within 24 hours to 20% and 50 g/L (20%/5.0 g/dL), respectively. The dog was treated with IV fluids, tranexamic acid, and fresh frozen plasma. An aortic aneurysm with irregular mineralization of the right ventrolateral aortic wall was identified on computed tomography examination, which also demonstrated a peri-aortic hematoma. A decision was made to attempt treatment with a stent graft. Under general anesthesia, a marker catheter was inserted into the esophagus. A 10-Fr sheath was inserted into the right femoral artery, and an angiography catheter was advanced over a wire. After angiography, a stent graft (12-mm × 50-mm) was placed over the guide wire and deployed under fluoroscopic guidance. The dog recovered uneventfully, with no evidence of recurrent bleeding, and was discharged 2 days after the procedure with antimicrobials, anthelmintic, and antithrombotic treatment. At 90-day follow-up, the dog was doing well, and stent position was radiographically confirmed. NEW OR UNIQUE INFORMATION PROVIDED: This report describes successful management of aortic aneurysm and dissection, an uncommon and challenging pathology in the veterinary practice with few available treatment options. Stent graft placement is a minimally invasive procedure in which a covered stent is placed over the lesion to prevent rupture.

Ascending aortic aneurysm associated with tetralogy of Fallot in an adult mare.

Congenital heart disease is relatively uncommon in horses. Only three reports exist that describe a tetralogy of Fallot in adult horses. Whereas in humans the presence of congenital heart disease constitutes a risk factor for developing aortic aneurysms, their association has never been reported in horses. Here, we present a case with a large ascending aortic aneurysm as a complication of a tetralogy of Fallot in an adult mare. The mare was referred with sustained tachycardia and a 5 days history of mild intermittent colic, depression, inappetence and weight loss. Echocardiography was used to characterize the cardiac abnormalities and aortic root dilation. Due to the poor prognosis, the mare was euthanized and post-mortem examination further characterized the abnormalities. At least four factors contributed in this case to the development of aortic haematoma: congenital disease, mucoid extracellular matrix accumulation vasa vasorum dysfunction and inflammatory/degenerative lesions in the aorta's intima. Although colic is primarily caused by gastrointestinal issues, cardiac disease should be suspected in cases with sustained tachycardia, even in absence of murmurs or arrhythmias. Despite the fact that congenital abnormalities are usually detected in foals, they may sometimes remain unnoticed for several years.

Aortopulmonary fistula in a Warmblood mare associated with an aortic aneurysm and supravalvular aortic stenosis.

This case report describes the clinical presentation, the necropsy findings, and genetic results of a 13-year-old Warmblood mare presented with colic and a bilaterally loud, holosystolic murmur. Echocardiographic examination revealed the presence of a thoracic aortic aneurysm, an aortic pseudoaneurysm, a periaortic hematoma (circumferential cuffing by perivascular hemorrhage), and aortopulmonary fistulation. A supravalvular aortic stenosis (SVAS) was visible during echocardiography. Necropsy confirmed that the thoracic aortic aneurysm had ruptured and connected to the pseudoaneurysm, which fistulated into the pulmonary artery. Histologically, the aneurysm wall revealed chronic lesions such as fibrosis, mucin depositions, mineralizations, and elastin fragmentation. The mid abdominal aorta showed lesions suggestive of a systemic elastin arteriopathy. Molecular analysis, however, could not attribute this disease to a variant in the elastin gene, the most common causative gene for SVAS. To the authors' knowledge, this case report describes a case of aortopulmonary fistulation in a Warmblood horse associated with the presence of SVAS and an aortic aneurysm.

Unruptured right sinus of Valsalva aneurysm in a Maltese dog: a case report.

A rare case of an unruptured sinus of Valsalva aneurysm (SVA) in a 2-month-old male Maltese terrier weighing 1.0 kg with a heart murmur is presented. A right SVA and a ventricular septal defect (VSD) were diagnosed by echocardiography and cardiac catheterization. The dog died due to a worsening of his condition. The necropsy revealed the sinus of Valsalva to have a diameter of 7 mm and a VSD hole was on the opposite surface. This report is the first to describe an unruptured SVA in the right coronary cusp of a small dog.

AORTIC ANEURYSM, DISSECTION, AND RUPTURE IN SIX BILE-FARMED BEARS.

Across China and Southeast Asia, over 17,000 bears are currently farmed for bile, predominantly for traditional Chinese medicines. Bears on farms in China are cage confined and undergo repeated daily bile extraction facilitated by surgically implanted catheters or gallbladder fistulas. Numerous health problems have been reported in bile-farmed bears including peritonitis, abdominal hernias, and extraction site abscessation. Between 2009 and 2014, five Asiatic black bears ( Ursus thibetanus) and one Asiatic black/Eurasian brown bear ( Ursus arctos arctos) hybrid, rescued from the bear bile industry in China, died from ruptured and/or dissecting aortic aneurysm. Medical records were reviewed and two bears exhibited no clinical signs prior to death. In four bears, clinical findings varied and included increased stereotypic behavior prior to death, epistaxis, retinal lesions, dysphagia, weight loss, and acute onset of hyporexia. On postmortem examination, hemopericardium with dissection and/or rupture of the ascending aorta and left ventricular wall hypertrophy were present in all cases. No evidence of infectious disease, connective tissue disorders, or congenital cardiac disease was identified. Based on these observations screening thoracic radiography was performed on all bears at the rescue center and aortic dilation was identified in 73 of 134 (54.5%) bile-extracted bears. To the authors' knowledge, aortic aneurysm, rupture, and/or dissection have not been previously reported in any bear species and the high prevalence in this population of bears suggests an association with bile-farming practices. Future studies are needed to investigate the etiopathogenesis of this condition to aid in early diagnosis and improved management of bears being rescued from bile farms across Asia.

Aortic dissecting aneurysm associated with systemic arterial hypertension in a cat.

INTRODUCTION: Aortic dissection is characterized by a tear in the aortic wall resulting in blood from the aortic lumen penetrating into the media, which causes dissection. When aortic dissection does not cause rupture, it provokes localized dilation of the aorta or aneurism, also called dissecting aortic aneurism (DAA). This case report describes a DAA in a cat associated with systemic arterial hypertension (SAHT). A 10-year-old male Domestic shorthair cat was presented for cardiac evaluation. Anamnestic clinical complaints were a syncope associated with paraparesis and weak femoral pules. Cardiomegaly had been found radiographically, and cardiogenic arterial thromboembolism had been suspected. Upon presentation physical abnormalities were tachycardia and a heart murmur. Measurement of systolic systemic arterial blood pressure (SABP) revealed severe SAHT. Echocardiographic images showed severe DAA, and marked aortic valve insufficiency. Palliative antihypertensive treatment resulted in fast clinical improvement and significant decrease in blood pressure. Four months later, acute severe respiratory distress due to cardiogenic pulmonary edema led to the cat's euthanasia. In human medicine, DAA is a well-reported complication of SAHT. This is the second case of DAA with congestive heart failure reported in a hypertensive cat.

Acute Occlusion of the Abdominal Aorta with Sudden Paraplegia in a Captive Mustached Tamarin (Saguinus mystax).

A wild-caught, research-naïve, adult male mustached tamarin (Saguinus mystax) experienced sudden onset of bilateral hindlimb paresis. Physical examination established the presence of paralysis and the lack of femoral pulses and deep pain in both legs. There were no signs of external trauma and, due to a poor prognosis, euthanasia was elected. Necropsy findings included pleural effusion, partial pulmonary atelectasis and congestion, dilatatory cardiomyopathy, a renal hemorrhagic infarct, and a thromboembolus located at the trifurcation of the distal abdominal aorta. The clinical and histologic findings were indicative of an aortic-iliac thrombosis.

Morte súbita causada por ruptura de aneurisma em aorta em ruminantes / Sudden death caused by aortic aneurysm rupture in ruminants

De um total de 2.088 ruminantes necropsiados no Laboratório de Patologia Animal da Universidade Federal de Campina Grande durante o período de janeiro de 2003 a dezembro de 2015, 803 (38,45%) eram bovinos, 651 (31,18%) ovinos e 634 (30,37%) caprinos. Desses, dois caprinos (0,31%), um ovino (0,15%) e um bovino (0,12%) foram diagnosticados com ruptura de artéria aorta devido à presença de aneurismas, correspondendo a 0,19% das causas de morte em ruminantes. O caso 1 ocorreu em um caprino que apresentava bom estado corporal e foi encontrado morto pelo proprietário; o caso 2, em um caprino com diagnóstico clínico presuntivo de linfadenite caseosa; o caso 3, em um ovino que foi encontrado morto pelo proprietário; e o caso 4, em um bovino com histórico de timpanismo recidivante. Em todos os casos, a morte ocorreu rapidamente por choque hipovolêmico. Os principais achados macroscópicos na necropsia foram hemotórax ou hemoperitônio e a ruptura na artéria aorta. Nos caprinos, abscessos foram visualizados microscopicamente e estavam associados à presença de bactérias, o que sugere infecção por Corynebacterium pseudotuberculosis. No ovino, não foram observadas lesões que pudessem elucidar a causa do aneurisma, por isso foi considerado de provável origem idiopática. No bovino, não foi possível estabelecer a causa, mas a presença do aneurisma dificultava a eructação dos gases da fermentação ruminal, caracterizando um quadro de timpanismo secundário. Aneurismas ocorrem de forma esporádica em caprinos, ovinos e bovinos e devem ser considerados como uma importante causa de morte súbita.(AU)

From a total of 2,088 necropsied ruminants in the Laboratory of Animal Pathology of Federal University of Campina Grande during the period from January 2003 to December 2015, 803 (38.45%) were cattle, 651 (31.18%) sheep, and 634 (30.37%) goats. Of these, two goats (0.31%), one sheep (0.15%) and one bovine (0.12%) were diagnosed with rupture of aorta due to the presence of aneurysms, corresponding to 0.19% of causes of death in ruminants. Case 1 occurred in a goat that had good body condition and was found dead by the owner, case 2 occurred in a goat that had clinical presumptive diagnosis of caseous lymphadenitis, case 3 occurred in a sheep who was found dead by the owner, and case 4 occurred in a cow with a history of recurrent bloating. In all cases, death occurred rapidly by hypovolemic shock. The macroscopic findings at necropsy were hemothorax or hemoperitoneum and the rupture in the aorta artery. In goats, abscesses were viewed microscopically and they were associated with the presence of bacteria, suggesting for Corynebacterium pseudotuberculosis infection. In the sheep, lesions that could explain the cause of the aneurysm were not observed, so we consider the aneurisma as idiopathic. In the cow, it was not possible to establish the cause, but the presence of the aneurysm hampered eructation of ruminal gases, causing secondary bloat. Aneurysms occur sporadically in goats, sheep and cattle and must be regarded as an important cause of sudden death.(AU)

Mycotic aneurysm caused by Graphium species in a dog.

A 10-year-old castrated male mixed-breed dog exhibited vomiting, lethargy and anorexia. An abdominal ultrasound examination revealed a focal dilation of the abdominal aorta. The dog died 2 days after examination, and necropsy revealed a ruptured aneurysm at the abdominal aorta between the kidneys. Histological examination revealed severe granulomatous and necrotizing pan-arteritis with fungal organisms. Graphium species was identified through DNA sequence analysis of the PCR product from formalin-fixed paraffin-embedded samples. To our knowledge, this is the first report of aortic aneurysm caused by Graphium species in a dog. Sequence was submitted to the DNA Data Bank of Japan with the accession number LC007972.

Sudden death, aortic rupture in horses, literature review, case studies reported and risk factors / Morte súbita por ruptura da aorta em cavalos, literatura, estudos de casos relatados e fatores de risco

Sudden deaths of horses in multiple equestrian disciplines have been attributed to acute and chronic respiratory and cardiovascular diseases. The aim of this study was to perform a review of aortic rupture in horses analyzing, case studies and assessing risk factors. The literature has reported a total of 137 cases of aortic rupture in horses for 28 years (1986-2014), with approximately five horses dying of aortic rupture per year. Histopathologically, there are observed discrete macroscopic degenerative changes in the intima layer only in the aorta. The histological evaluation in the beginning portion of the aorta of the heart evidenced degenerative changes with loss of continuity and distribution of elastic fibers. Risk factors for the rupture of the aorta are: spontaneous rupture associated with hypertension, preexisting vascular injury (aneurysm), dilated or hypertrophic cardiomyopathy, copper levels in the endothelium, genetic factors such as inbreeding, toxicology or pharmacological factors. Aortic rupture shows similarity with pulmonary hemorrhage induced by exercise especially under the locomotors induced trauma theory of exercise that can induce pulmonary hemorrhage. In conclusion, degenerative changes to discrete elastic fiber of the intima of the aorta in the emergence of the heart seem to predispose the aorta wall rupture at the time of maximum blood pressure during exercise and the consequent collapse and athletic horses death...

As mortes súbitas de cavalos em várias provas equestres têm sido atribuídas a doenças respiratórias e cardiovasculares agudas e crônicas. O objetivo deste estudo foi efetuar uma revisão de literatura da ruptura da aorta em cavalos analisando estudos de caso e estabelecendo os possíveis fatores de risco. Na revisão da literatura no período de 28 anos (1986-2014) foram localizados 137 casos de ruptura da aorta em cavalos com aproximadamente cinco cavalos morrendo por essa causa por ano. Histologicamente, são observadas alterações macroscópicas discretas degenerativas na camada íntima da aorta. A avaliação histológica na porção inicial da aorta do coração evidencia alterações degenerativas com perda de continuidade e distribuição das fibras elásticas. Fatores de risco para a ruptura da aorta dos cavalos são: ruptura espontânea associada com hipertensão, lesão vascular pré-existente (aneurisma), cardiomiopatia dilatada ou hipertrófica, níveis de cobre no endotélio, fatores genéticos, tais como a consanguinidade na criação, toxicologia e aspectos farmacológicos. A ruptura aórtica mostra semelhança com hemorragia pulmonar induzida pelo exercício. Em conclusão, alterações degenerativas discretas das fibras elásticas da íntima da aorta parecem predispor a ruptura da parede da aorta, no momento da pressão máxima de sangue durante o exercício determinando o consequente colapso e morte do cavalo atleta...

Imaging diagnosis-aortic aneurysm and ureteral obstruction secondary to umbilical artery abscessation in a 5-week-old foal.

A 5-week-old foal was evaluated for fever and hematuria of 3 days duration. Cystoscopy localized the blood to be originating from the left ureter. Abdominal ultrasonography revealed left hydronephrosis, hydroureter, and omphaloarteritis of the left umbilical artery with abscess formation that communicated with an arterial structure. Computed tomography (CT) revealed a large aortic aneurysm within the center of the abscess. An exploratory celiotomy was performed and the infection was nonresectable. The prognosis for life was grave; therefore the colt was euthanized. Necropsy findings confirmed the antemortem diagnosis. Ultrasound and CT imaging in this case provided an accurate antemortem diagnosis.

Distal aortic aneurysm presumed to be secondary to an infected umbilical artery in a foal.

CASE HISTORY: A 3-month-old female Warmblood foal was presented after displaying signs of colic with pyrexia for 5 days. CLINICAL AND PATHOLOGICAL FINDINGS: The foal continued to show signs of colic, frequently passed urine, and was pyrexic with an elevated white blood cell count. The umbilical stalk was thickened but there was no evidence of purulent material. Exploratory laparotomy revealed an enlarged left umbilical artery remnant tightly adhered to the bladder wall. The left umbilical artery continued to an aneurysm involving the distal aorta. The foal was subject to euthanasia and post-mortem examination confirmed a spherical aortic aneurysm, in the dorsal midline caudal to the kidneys that contained a large thrombus. Histopathological examination revealed inflammation and necrosis of the tunica intima and tunica media of the left umbilical artery with suppuration and bacterial colonies evident in the periarterial tissues. DIAGNOSIS: Infected aortic aneurysm presumably caused by an umbilical artery infection. CLINICAL RELEVANCE: A previously undetected umbilical infection appears to have resulted in an unusual delayed complication causing signs of colic in a foal. Veterinarians should be aware of this condition, and the possibility that it may be a cause of signs of colic in foals. Diagnosis based on ultrasonography should be possible, but may require sedation, visceral analgesia and careful examination.

Intracardiac thrombosis and aortic dissecting aneurysms in mustached tamarins (Saguinus mystax) with cardiomyopathy.

Spontaneous intracardiac thrombosis is rarely reported in animals, particularly nonhuman primates. The finding of 2 cases of intracardiac thrombi in mustached tamarins (Saguinus mystax) that died as a consequence of congestive heart failure prompted us to do a retrospective study to determine the frequency of this condition. Clinical records, necropsy reports, and tissues from 60 mustached tamarins that died or were euthanized between 1996 and 2009 were reviewed. Of the 60 monkeys whose cases were reviewed, 10 (16.6%) had intracardiac thrombi, and 4 (6.6%) had dissecting aortic aneurysms. Of the 10 animals with intracardiac thrombosis, 3 had left ventricular involvement alone; 4 monkeys had thrombi only in the right ventricle, and the remaining 3 animals exhibited thrombi in both ventricles. Myocardial fibrosis and chronic renal disease were common findings in affected animals. The causes of the intracardiac thrombosis in the tamarins in the present study are not known, but the clinical signs and gross and microscopic lesions suggest that congestive heart failure secondary to cardiomyopathy is the primary contributor. In addition, the cause of the aortic dissecting aneurysms in the tamarins in this study is not known. Further studies are required to determine whether factors including aortic curvature, genetic background, or hypertension-alone or in combination-play a role. To our knowledge, the current retrospective study is the first report of intracardiac thrombosis and aortic aneurysms in mustached tamarins.

Sinus of Valsalva aneurysm in a Göttingen minipig.

A 26.6-kg, intact, 9-mo-old female Göttingen minipig was presented for a coronary stent study. Angiography revealed a sinus of Valsalva aneurysm (SVA) in the aortic root that involved both the left and noncoronary sinuses of the heart. Gross histologic examination of the heart revealed 2 regions of aneurysmal formation: one at the ostium to the left main coronary artery, with aortic sinus involvement, and the other at the dorsal aspect of the aortic root involving the noncoronary aortic sinus. With no history of any infectious diseases, and the microscopic findings showing no evidence of necrosis, degeneration, or infection, confirmed that the aneurysmal-like dilation of the sinuses was most likely a congenital anomaly. This case illustrates the diagnosis and comparative findings of a rare cardiac anomaly found in only a few species to date. To our knowledge, antemortem diagnosis of unruptured SVA involving both the left and noncoronary aortic sinuses of the minipig heart has not been reported previously.

Imaging diagnosis--aortic thromboembolism associated with spirocercosis in a dog.

An 8-year-old neutered female Rhodesian Ridgeback developed acute, nonneurological right pelvic limb lameness. Femoral pulsation was poor, and oscillometric blood pressure measurements between the two pelvic limbs differed markedly. A caudal aortic right external iliac embolus was detected sonographically. Radiographically, there was a caudal esophageal mass and thoracic vertebral spondylitis typical of spirocercosis. Using CT-angiography, a caudal thoracic aortic aneurysm with a mural thrombus was detected. The dog recovered following heparin and aspirin therapy but signs recurred 7 months later. Subsequently, the patient improved on treatment and remains asymptomatic. This report illustrates the value of CT-angiography in detecting aortic thrombosis in dogs with spirocercosis.