Left atrial decompression as a palliative minimally invasive treatment for congestive heart failure caused by myxomatous mitral valve disease in dogs: 17 cases (2018-2019)

A Novel Technique of Left Atrial Decompression Using Intracardiac Echocardiography Guidance in 2 Dogs With Advanced Degenerative Mitral Valve Disease

Left atrial decompression (LAD) using transseptal puncture followed by balloon atrial septostomy recently has been described as a palliative minimally invasive procedure in dogs with advanced degenerative mitral valve disease (DMVD). We report herein the first use of intracardiac echocardiography (ICE) guidance combined with 3-dimensional transesophageal echocardiography (3D-TEE) to ensure the safety of the LAD procedure from a caudal approach, as performed in humans, in 2 American College of Veterinary Internal Medicine (ACVIM) stage C and D DMVD dogs (Jack Russell Terrier and Cavalier King Charles Spaniel) with recurrent episodes of acute pulmonary edema. Both LAD procedures were successful, as confirmed by markedly decreased systolic left atrial pressures (17 and 25 mmHg vs. 42 and 80 mmHg before LAD, respectively). Both dogs remained free of left-sided congestive heart failure signs for 8 and 10 months, respectively. The addition of ICE guidance to 3D-TEE is feasible and valuable in medium-sized dogs for safe LAD procedures.

Double Outlet Right Atrium in an American Domestic Shorthair Cat

•DORA should be considered in cases with radiographic evidence of LA enlargement. •TTE can diagnose DORA. •Cats with DORA may remain undiagnosed until adulthood.

Self-Reported Utilization of International (ACVIM Consensus) Guidelines and the Latest Clinical Trial Results on the Treatment of Dogs with Various Stages of Myxomatous Mitral Valve Degeneration: A Survey among Veterinary Practitioners

BACKGROUND

Myxomatous mitral valve degeneration is the most common canine heart disease. Several clinical trials have investigated various treatments. The latest recommendations are published in the ACVIM consensus guidelines (2019). Our study aimed to investigate how closely veterinary practitioners apply the treatment recommendations of these guidelines and the latest clinical trials.

METHODS

An online survey was sent to Dutch and Belgian veterinary practices via digital channels.

RESULTS

The data from 363 fully completed surveys were analyzed. For stage B1 disease, 93% recommended, correctly, no treatment. For stage B2 disease, 67% of the respondents recommended starting pimobendan as monotherapy. For chronic treatment of stage C disease, 16 different drug combinations were mentioned, but nobody recommended surgery. Only 48% of the respondents recommended the only evidence-based drug combination: a loop diuretic with pimobendan. A concerning finding was the simultaneous prescription of two loop diuretics, by 19% of the respondents.

CONCLUSIONS

Treatment recommendations showed an increasing variation with more advanced disease stages from B1 through B2 to C. This reflects the increasing disagreement among the panelists who prepared the ACVIM consensus guidelines. Practitioners of our study seem to practice more evidence-based medicine than veterinary cardiologists, as it was reported in a recent survey-based study.

Evaluation of two probes for transesophageal echocardiography in small dogs: imaging capabilities, image quality, and usability

INTRODUCTIONS

Patient size is a limiting factor for transesophageal echocardiography (TEE) in small dogs. The objective of this study was to describe imaging capabilities of two probes for TEE in small dogs.

ANIMALS, MATERIALS, AND METHODS

Prospective study in 10 client-owned dogs weighing <4 kg with congenital heart disease (CHD). Dogs had TEE performed with a microprobe (10T-D, GE Medical) and intracardiac echocardiography (ICE) catheter-based probe (AcuNav™, Biosense Webster) in the esophagus in alternating order. Ease of placement, ability to acquire images of the CHD, image quality, and probe limitations were recorded.

RESULTS

Median weight was 2.4 kg (range, 1.0-3.2). Congenital abnormalities included patent ductus arteriosus (n = 9) and pulmonary valve stenosis (n = 1). The 10T-D microprobe was easy to place (n = 8) or achievable with gentle manipulation (n = 2), and image quality of the CHD was optimal (n = 8), adequate (n = 1), or poor (n = 1). The ICE probe was difficult to place in the esophagus even with an external support system (n = 9) or could not be placed (n = 1), and image quality of the CHD was optimal (n = 2), adequate (n = 3), or poor (n = 5). Both probes provided images in a 1.0-kg dog. Probe limitations included lack of lateral motion (microprobe), the need for an external support system (ICE probe) and inability to consistently maintain contact with the esophagus (ICE probe).

CONCLUSION

The 10T-D microprobe provided high-quality TEE images more consistently than the ICE probe in the majority of dogs in this study; however, the lack of lateral motion can diminish its utility in some dogs.

Prospective evaluation of complications associated with transesophageal echocardiography in dogs with congenital heart disease

Background

Transesophageal echocardiography (TEE) is useful in the assessment and procedural monitoring of congenital heart disease (CHD) with a relatively low complication rate in humans.

Objectives

To evaluate the safety of TEE and report complications in dogs.

Animals

Forty client‐owned dogs with CHD.

Methods

Prospective observational study including gastroesophagoscopy before and after TEE imaging. TEE was planned with a GE 6VT‐D adult probe in dogs weighing ≥4 kg and a GE 10T‐D microprobe alternating with an intracardiac echocardiography probe placed in the esophagus in dogs <4 kg. Difficulties with probe placement, probe interference and TEE probe imaging times were recorded. Dogs were monitored in the recovery period after TEE using an established nausea scoring system.

Results

New gastroesophageal abnormalities were identified after TEE in 4 dogs including 4 areas of mucosal damage involving <25% of the lower esophageal sphincter (n = 4) and 1 lesion at the heart base (n = 1) and were not attributed to longer imaging times or a specific probe. Lesions identified before TEE in 4 dogs remained unchanged after TEE. The 6VT‐D probe could not be placed in 1 dog with enlarged tonsils, and it obstructed fluoroscopic views in 3 dogs. The probes did not compress any structures in dogs in which fluoroscopy was performed (n = 20). Four dogs had evidence to suggest nausea after the procedure.

Conclusions and Clinical Importance

While major complications remain possible, complications in this study were mild and few in number. Dog size and probe characteristics are factors to consider when performing TEE.