Mitral valve repair in dogs using an ePTFE chordal implantation device: a pilot study

OBJECTIVE

Mitral valve (MV) regurgitation due to degenerative MV disease is the leading cause of cardiac death in dogs. We carried out preliminary experiments to determine the feasibility and short-term effects of beating-heart MV repair using an expanded polytetrafluorethylene (ePTFE) chordal implantation device (Harpoon TSD-5) in dogs.

ANIMALS

This study involved six healthy purpose-bred Beagles (weight range 8.9-11.4 kg).

MATERIAL AND METHODS

Following a mini-thoracotomy performed under general anesthesia, the TSD-5 was used to place 1 or 2 artificial ePTFE cords on the anterior MV leaflet or the posterior MV leaflet via a left-ventricular transapical approach. The procedure was guided and monitored by transesophageal echocardiography. Postoperative antithrombotic treatment consisted of clopidogrel or a combination of clopidogrel and apixaban. Dogs were serially evaluated by transthoracic echocardiography at day 1, 7, 14, 21, and 30. The hearts were then examined for evaluation of tissues reactions and to detect signs of endothelialization.

RESULTS

One or two chords were successfully implanted in five dogs. Four dogs completed the 30 days follow-up. One dog died intra-operatively because of aortic perforation. One dog died early post-operatively from a hemorrhagic pleural effusion attributed to overly aggressive antithrombotic treatment. One dog developed a thrombus surrounding both the knot and the synthetic cord. Postmortem exam confirmed secure placement of ePTFE knots in the mitral leaflets in all dogs and the presence of endothelialization of the knots and chords.

CONCLUSIONS

These preliminary results demonstrate the feasibility of artificial chordal placement using an ePTFE cordal implantation device in dogs.

Depletion of CD4 T lymphocytes at the time of infection with M. avium subsp. paratuberculosis does not accelerate disease progression

A calf model was used to determine if the depletion of CD4 T cells prior to inoculation of Mycobacterium avium subsp. paratuberculosis (Map) would delay development of an immune response to Map and accelerate disease progression. Ileal cannulas were surgically implanted in 5 bull calves at 2 months of age. Two calves were depleted of CD4 T cells by intravenous injection of anti-bovine CD4 antibody administered 24h prior to inoculation with Map. The two CD4-depleted calves and one non-depleted calf were inoculated via ileal cannula with 1 × 10(8)cfu live Map every 3 days for a total of 4 inoculations. Two additional calves served as non-depleted and uninfected controls. Injection with the anti-CD4 mAb reduced the frequency of CD4 T cells from a pre-depletion average of 15% to less than 1% in PBMC at 24h. However, a consistent proliferative response dominated by CD4 T cells, developed in both treated and untreated calves over the course of the 6-month study period. Recovery of Map from serial biopsies obtained from the CD4-depleted and non-depleted calves after Map infection did not differ. In addition, CD4 depletion did not increase the level of Map shed in the feces over the non-depleted animal.

Haemonchus contortus intestine: a prominent source of mucosal antigens

We sought to identify antigens from Haemonchus contortus, an abomasal nematode of small ruminants, that stimulate local (abomasal lymph node, ALN) CD4+ T lymphocyte responses during a primary infection. Results led to a focus on antigens from the parasite intestine. The H. contortus intestine proved to be a major source of antigens that stimulated ALN CD4+, CD25+ T lymphocyte responses during infections in lambs. When stimulated by intestinal antigens, ALN lymphocytes from these lambs expressed IL-4 and IL-13 transcripts, and, more variably, IFN-gamma. An immunoaffinity-purified fraction, enriched for H. contortus apical intestinal membrane proteins, stimulated similar ALN responses. On further fractionation, antigens from six size classes (ranging from 30 to 200 kDa) also stimulated proliferation of ALN lymphocytes. Mass spectrometry analysis of these size classes identified several known apical intestinal membrane proteins from H. contortus. The results show that H. contortus intestinal antigens warrant investigation in strategies to induce mucosal immunity against this parasite. The specific proteins identified have value for this purpose. The results are in contrast with the now generalized idea that H. contortus intestinal antigens are 'hidden' from the host immune system, and this issue is discussed. The approach also has potential application to other gastrointestinal nematode parasites.

Effect of moderate exercise on the severity of clinical signs associated with influenza virus infection in horses

The purpose of this experiment was to determine if exercising horses, infected with influenza virus, exacerbates the severity of clinical disease. Eight horses were trained on a treadmill for 42 days and then challenged with aerosolised influenza A/equine/Kentucky/91 (H3N8). Following challenge, 4 horses (exercise group) continued training for 28 days, while the other 4 horses (nonexercise group) were confined to their stalls. All horses developed clinical signs within 36 h of challenge (fever, coughing, and mucopurulent nasal discharge) and clinical scores were greater in the exercise group. Horses developed fever from Days 1-11 post challenge (PC) and were tachypnoeic and tachycardic from Days 1-14 PC. All horses lost weight within 4 days PC, but the exercise group lost an average of 20 kg more than the nonexercise group. All horses developed pneumonia, and ultrasonography revealed pulmonary consolidation and oedema by Day 7 PC that was resolving by Day 14 PC. Endoscopy and transtracheal aspirates showed airway inflammation for up to 21 days PC. While the exercise group exhibited more severe signs of clinical disease, resolution occurred for both groups on approximately Day 14 PC, and no adverse effects were noted at the end of the study. However, the potential long term effects of exercising horses acutely infected with influenza virus are unknown. Until further research is conducted in this area, it appears prudent not to exercise affected horses.