Relationship between right heart echocardiographic parameters and invasive pulmonary artery pressures in canine models of chronic embolic pulmonary hypertension.

Basic information related to the association between right heart echocardiographic parameters and invasive pulmonary artery pressure (PAP) in dogs with pulmonary hypetension (PH) is scarce. The aim of this study was to examine the association between conventional right heart echocardiographic parameters and invasive PAP by right heart catheterization (RHC) before and after PH. Five female beagle dogs regarded as clinically healthy were used. Echocardiography and RHC were conducted before and after creating chronic embolic pulmonary hypertension (CEPH) models. The acceleration time to ejection time ratio in pulmonary artery flow profile (AT/ET), the ratio of the pulmonary artery and aortic diameter in diastole (PA/Ao), the right pulmonary artery distensibility index by M-mode method (RPAD M-mode), the normalized right ventricular internal diameter in diastole (RVIDdn), and the normalized tricuspid annular plane systolic excursion (TAPSEn) were correlated with the invasive systolic PAP (sPAP), mean PAP (mPAP) and diastolic PAP (dPAP). Multiple linear regression analysis identified AT/ET and RVIDdn as independent predictors of sPAP, PA/Ao and RVIDdn as independent predictors of mPAP, and PA/Ao and RPAD M-mode as independent predictors of dPAP. AT/ET and PA/Ao had high sensitivity and specificity for predicting CEPH. In conclusion, AT/ET, PA/Ao, RPAD M-mode, RVIDdn and TAPSEn were significantly correlated with invasive PAP and alterations in PA/Ao or AT/ET might enable clinicians to predict PH, even if tricuspid regurgitation is not observed.

Transvenous electrical cardioversion of equine atrial fibrillation: patient factors and clinical results in 72 treatment episodes.

BACKGROUND: Transvenous electrical cardioversion (TVEC) has been developed for treatment of atrial fibrillation (AF) in horses. The relationship among patient variables, treatment response, and outcome in a typical referral population has not been evaluated. HYPOTHESIS: Patient variables such as age, sex, weight, and duration of arrhythmia affect prognosis for response to treatment and the energy level at which cardioversion occurs. ANIMALS: TVEC was applied to 72 episodes of lone AF in 63 client-owned performance horses, with the majority (54) being Standardbred racehorses. METHODS: Catheterization of the right atrium (RA) and pulmonary artery (PA) through the jugular vein was used for electrode placement before horses were placed under general anesthesia. Biphasic, truncated exponential shock waves were delivered at incremental energy levels until cardioversion was achieved or a maximum single-energy level of 300 J was reached (cumulative energy 50-1,960 J). A multivariate model was constructed to evaluate influence of patient factors on cardioversion energy. RESULTS: Cardioversion was achieved in 71 of 72 episodes (62 of 63 horses) at a mean energy of 165.43 +/- 8.75 J. Cardioversion energy was higher for females than for males, and for interaction terms, weight was negatively related to energy in females and positively related in males. Age was positively related to cardioversion energy in females. No relationship was identified between duration of arrhythmia before treatment and prognosis for response or cardioversion energy. CONCLUSIONS AND CLINICAL IMPORTANCE: TVEC is highly effective in the treatment of lone AF in horses. Although age and sex influence cardioversion energy level, duration of arrhythmia does not.

Percutaneous extraction of a knotted pulmonary artery catheter and an entrapped tined pacing lead in two dogs.

Catheters and pacing leads may become entrapped within the heart necessitating the use of creative measures for extraction while preventing damage to cardiac structures. This report describes the percutaneous extraction of a knotted pulmonary artery catheter and an entrapped tined pacing lead in two dogs. In both cases, a long transseptal sheath was advanced over the catheter or pacing lead and used to facilitate removal of the entrapped devices without causing damage to the heart.

Comparison of three methods of temperature measurement in hypothermic, euthermic, and hyperthermic dogs.

OBJECTIVE: To assess the reliability and accuracy of a predictive rectal thermometer, an infrared auricular thermometer designed for veterinary use, and a subcutaneous temperature-sensing microchip for measurement of core body temperature over various temperature conditions in dogs. DESIGN: Prospective study. ANIMALS: 8 purpose-bred dogs. PROCEDURES: A minimum of 7 days prior to study commencement, a subcutaneous temperature-sensing microchip was implanted in 1 of 3 locations (interscapular, lateral aspect of shoulder, or sacral region) in each dog. For comparison with temperatures measured via rectal thermometer, infrared auricular thermometer, and microchip, core body temperature was measured via a thermistor-tipped pulmonary artery (TTPA) catheter. Hypothermia was induced during anesthesia at the time of TTPA catheter placement; on 3 occasions after placement of the catheter, hyperthermia was induced via administration of a low dose of endotoxin. Near-simultaneous duplicate temperature measurements were recorded from the TTPA catheter, the rectal thermometer, auricular thermometer, and subcutaneous microchips during hypothermia, euthermia, and hyperthermia. Reliability (variability) of temperature measurement for each device and agreement between each device measurement and core body temperature were assessed. RESULTS: Variability between duplicate near-simultaneous temperature measurements was greatest for the auricular thermometer and least for the TTPA catheter. Measurements obtained by use of the rectal thermometer were in closest agreement with core body temperature; for all other devices, temperature readings typically underestimated core body temperature. CONCLUSIONS AND CLINICAL RELEVANCE: Among the 3 methods of temperature measurement, rectal thermometry provided the most accurate estimation of core body temperature in dogs.

Echocardiographic estimation of mean left atrial pressure in a canine model of acute mitral valve insufficiency.

High mean left atrial pressure (MLAP) due to canine degenerative mitral valve disease is associated with clinically relevant morbidity and mortality. The ability to noninvasively measure MLAP would assist in the diagnosis and treatment of disease. Doppler echocardiography allows measurement of early transmitral blood flow (E) and the velocity of the mitral valve annulus (Ea). The ratio of early mitral inflow velocity to early mitral annular velocity (E: Ea) correlates well with MLAP in human subjects. We sought to determine the ability of E: Ea to predict MLAP in dogs with experimentally induced mitral regurgitation. Nine anesthetized purpose-bred dogs underwent placement of a Swan-Ganz catheter into the left atrium and recording of MLAP. Simultaneous transthoracic echocardiographic and hemodynamic studies were performed after acute chordae tendineae rupture and during IV infusion with nitroprusside (2.5-5.0 microg x kg(-1) x min(-1)) or hydralazine (1-1.5 mg/kg). Mitral regurgitant fraction, measured by single-plane angiography and thermodilution, ranged from 17% to 81%. MLAP increased from 5.4 +/- 2.5 mm Hg to 17.4 +/- 9.4 mm Hg after creation of mitral valve regurgitation (MR; P = .018). Forty sets of echocardiographic measurements were obtained from 7 dogs, and E, as well as E: Ea, were linearly related to MLAP. The R2 value for the linear regression equation containing E: Ea as the dependent variable (0.83) was greater than that for E (0.73). The 95% confidence intervals were calculated for predicting MLAP = 20 mm Hg from E:Ea, and E:Ea >9.1 or <6.0 indicated a 95% probability that MLAP was >20 mm Hg or <20 mm Hg, respectively. Echocardiography can be used to predict MLAP in isoflurane-anesthetized dogs with experimentally induced acute mitral valve insufficiency.

Cardiac output, wedge pressure, and oxygen delivery.

The primary goal of the intensive care clinician can be said to be to optimize global DO2. This approach is the primary means by which the greatest killers of the critically ill patient (sepsis, SIRS, multiple organ dysfunction syndrome) may be addressed at present. Optimizing DO2 means delivering just enough to meet the patient's needs, because therapeutic measures taken to increase DO2 are all associated with some degree of risk. When used correctly, the PAC can allow the clinician to determine if DO2 is optimal and, if not, what steps might be best suited to improve on it. Newer generations of PACs are becoming available and can provide valuable additional insights into a patient's cardiovascular status. Nearly all attempts to increase DO2 address one or more of a relatively short list of variables. The specific endpoints of therapy need to be tailored to the individual patient but include clinical, metabolic, organ function, and hemodynamic markers. As clinicians expand our understanding of the key elements found in survivors of critical illness, it is hoped that this knowledge translates into better outcomes.

[Oximetry in veterinary anesthesia: the continuous determination of mixed venous oxygen saturation in dogs and horses]. / Oxymetrie in der Veterinäranästhesie: Die kontinuierliche Bestimmung der gemischtvenösen Sauerstoffsättigung bei Hund und Pferd.

The continuous fiberoptical measurement of the mixed venous partial oxygen saturation is described. It is an enrichment of the diagnostical possibilities in veterinary medicine. In the horse it is of great interest, because disturbances of the pulmonary gas exchange and the myocardial function are common in the anaesthetised horse, and reliable methods of assessing the cardiac output are rare. Using this monitoring technique in nearly 100 equine high risk patients facilitated insight into the complex changes of the pulmonary, cardiac and circulatory function in the anaesthetised horse. The registered data are the basis of the presented case reports. Values measured "behind the tissue" are influenced by the oxygen supply and the oxygen consumption within the periphery. Changes of the mixed venous oxygen status can be caused by a disturbance of the arterial oxygen status, by a insufficient performance of the cardiovascular system or by a change in metabolic activity. Being a multifactorial influenced parameter the mixed venous oxygen saturation can only be interpreted in connection with other parameters. The mixed venous oxygen status gives global information about the whole organism, but it is not able to inform about the oxygen supply of single organs. From our own personal experience it reflects an aggravation of the patient very early and reliable.

Technical and methodological requirements for reliable haemodynamic measurements in the unsedated calf.

The purpose of this study was (1) to evaluate the technical and methodological problems associated with invasive haemodynamic measurements in unsedated cattle; (2) to assess the reproducibility of such measurements both within and between days; and (3) to compare the values with those previously reported. Twenty-one healthy calves, aged from 5.5 to 12 months, were studied. The central venous, the right ventricular, the pulmonary arterial, the pulmonary capillary wedge and the systemic arterial pressures were obtained by means of fluid-filled catheters, and the cardiac output was measured by the thermodilution technique. The heart rate, the stroke volume, the pulmonary and systemic vascular resistances and the pulmonary and systemic ventricular workloads were calculated. An adverse reaction, consisting of severe pulmonary hypertension, tachycardia, tachypnoea and transient weakness, occurred in 7 calves during the catheterization procedures. Such a reaction might be due to a local reflex induced by stimulation of mechano-receptors by the catheter tip. It should be avoided by reducing the manipulation of the catheter as much as possible and by inflating the tip of the balloon when moving it forwards. A comparison of the vascular pressures with those previously reported was difficult because of methodological or technical limitations, such as, for instance, a lack of standardization of the baseline. The reproducibility of the haemodynamic measurements obtained was satisfactory, in contrast to previous studies performed in conscious animals. This was attributed to our animals being better trained to the experimental conditions and emphasizes the importance of reducing mental stress in obtaining reliable haemodynamic measurements in unsedated and potentially uncooperative animals.

Use of conjunctival oxygen index for evaluation of cardiac output in dogs.

The relationship between the palpebral conjunctival oxygen (PcjO2) index, mixed venous oxygen tension (PvO2), and cardiac index were compared, using a canine hemorrhagic shock model. The cardiac output was reduced by reducing the blood volume in 5% increments until the initial cardiac output was reduced by one half. In each of 7 dogs, the PcjO2 index and PvO2 were found to have good correlation with cardiac index; however, the correlation coefficients were markedly reduced when the data from all of the dogs were combined. It was concluded that PcjO2 index provides an excellent means of assessing changes in cardiac index over time in the same dog; however, it cannot be used to estimate cardiac index in an individual dog with a degree of accuracy that would be clinically significant.