Pre-procedural femoral vessel ultrasound in dogs with patent ductus arteriosus: diameter, image quality and relationship with arterial catheterization

INTRODUCTION

/Objectives: Patent ductus arteriosus (PDA) in dogs is often treated via minimally invasive transvascular occlusion using femoral artery access. This study compared ultrasound-derived diameter and image quality of the right femoral artery (RFA) and vein (RFV) in dogs with PDA using a linear ultrasound probe (L-P) and phased-array transthoracic echocardiography probe (TTE-P). The case outcome was assessed.

ANIMALS, MATERIALS & METHODS

Forty-five client-owned dogs with PDA were prospectively enrolled. Ultrasound-measured RFA and RFV diameters were obtained on images acquired with both probes pre-operatively and compared using Bland-Altman plots. The image quality of RFA and RFV was scored on L-P and TTE-P images.

RESULTS

Comparison of RFA and RFV diameter from L-P versus TTE-P images revealed: [Mean difference (limits of agreement): RFA = 0.009 mm (-0.78-0.79 mm), RFV = 0.523 mm (-1.75-2.79 mm)]. Image quality scores were significantly higher for L-P than TTE-P (P < 0.0001). In six small dogs, measurable images were unattainable with TTE-P. Dogs of similar body weight had variable RFA diameters. Twenty-seven dogs had RFA catheterization. In 21/27 dogs, RFA diameter exceeded the external diameter of the introducer used for catheterization, and in 6/27, it was smaller.

CONCLUSIONS

Pre-procedural ultrasound of the RFA in dogs with PDA is useful given variable RFA diameter relative to body weight. Despite poorer image quality, RFA diameters from TTE-P images were very similar to L-P images on average, suggesting TTE-Ps are suitable for pre-procedural planning in most dogs. Vasospasm, hypotension or differences in the location of ultrasound measurement versus catheterization might produce variation in pre-procedural versus intraoperative RFA size.

Prediction of clinically important acquired cardiac disease without an echocardiogram in large breed dogs using a combination of clinical, radiographic and electrocardiographic variables

INTRODUCTION

Large breed (LB) dogs develop dilated cardiomyopathy (DCM) and myxomatous mitral valve disease (MMVD). Echocardiography is required for a definitive diagnosis but is not always available. Our objective was to assess the clinical utility of thoracic radiographs alone and in combination with physical examination and electrocardiography findings for the prediction of clinically important DCM or MMVD in LB dogs.

ANIMALS

Four hundred fifty-five client-owned dogs ≥20 kg with concurrent thoracic radiographs and echocardiogram.

MATERIALS AND METHODS

Medical records were reviewed and stored thoracic radiographs and echocardiographic images were measured to classify dogs as normal heart size (NHS), preclinical DCM, clinical DCM, preclinical MMVD (with cardiomegaly), clinical MMVD, or equivocal. Dogs with preclinical MMVD, without cardiomegaly, were classified as NHS. Vertebral heart size (VHS) and vertebral left atrial size (VLAS) were measured. Receiver operating characteristic curves and prediction models were derived.

RESULTS

Prevalence of MMVD (39.3%) was higher than the prevalence of DCM (24.8%), though most MMVD dogs (67.0%) lacked cardiomegaly and were classified as NHS for analysis. The area under the curve for VHS to discriminate between NHS and clinical DCM/MMVD or preclinical DCM/MMVD was 0.861 and 0.712, respectively, while for VLAS, it was 0.891 and 0.722, respectively. Predictive models incorporating physical examination and electrocardiography findings in addition to VHS/VLAS increased area under the curve to 0.978 (NHS vs. clinical DCM/MMVD) and 0.829 (NHS vs. preclinical DCM/MMVD).

CONCLUSIONS

Thoracic radiographs were useful for predicting clinically important DCM or MMVD in LB dogs, with improved discriminatory ability when physical examination abnormalities and arrhythmias were accounted for.

Correlations between age, body size, sex, and conformation and ultrasound-measured femoral vessel diameter in the dog, with implications for transvascular procedural planning

Transvascular interventional radiology procedures have advanced in veterinary medicine, but basic knowledge about expected vascular size and vascular imaging requires further exploration. A prospective analytical study of 230 client-owned dogs was carried out to investigate correlations between ultrasound-measured femoral artery (FA) and femoral vein (FV) diameter and various morphometric and demographic dog variables, compare ultrasound-measured femoral vessel diameter to diameter predicted by body weight, compare right- and left-sided femoral vessel diameter, and assess measurement repeatability. Internal diameter of the FA and FV was measured with ultrasound bilaterally. Allometrically scaled body weight had the strongest correlation with FA and FV diameter (correlation coefficients: 0.92 and 0.80, respectively), although thigh circumference (FA: 0.89; FV:0.78) and withers height (FA: 0.84; FV: 0.76) were also strongly correlated. Within the entire population, males had a smaller FA (P = .005), but not FV (P = .278), than females and age was negatively associated with FA (P = .031) and FV (P < .001) diameter. Compared to ultrasound-derived measurements, body weight-predicted diameter overestimated by at least one French gauge in 32.6% and 35.2% of dogs for the FA and FV, respectively. Comparison of left and right FA and FV diameter revealed minimal mean differences, though limits of agreement could encompass multiple French gauge sizes: (Mean difference [limits of agreement]: FA = 0.00 mm [0.85-0.84 mm]; FV = 0.04 mm [1.92-1.99 mm]). Intra- and interoperator repeatability coefficients of variation were <9%. Femoral vessel diameter in dogs is influenced by multiple factors, with potential for clinically relevant differences between right- and left-sided vessels. Ultrasound measurement of femoral vessels could improve transvascular preprocedural planning.

Transesophageal Echocardiography–Guided Dirofilaria immitis Extraction from the Right Atrium in a Dog

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In Dirifilaria immitis infection, worms can migrate into the heart.

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Clinical signs are caused by hemolysis and and obstruction of blood flow.

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Transesophageal echocardiography guides removal of radiolucent foreign objects.

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TEE findings assisted in the extraction of intracardiac heartworms from a dog.

Artificial cardiac pacemaker placement in dogs with a cohort of myocarditis suspects and association of ultrasensitive cardiac troponin I with survival

INTRODUCTION

Artificial cardiac pacemakers (APs) are a common treatment for symptomatic bradyarrhythmias in dogs, some of which may be triggered by underlying myocarditis. Severely elevated cardiac troponin I (cTnI) concentrations support a diagnosis of myocarditis. The association of ultrasensitive-cTnI (US-cTnI) concentration with survival in a large cohort of dogs receiving APs is not described.

ANIMALS, MATERIALS, AND METHODS

The study included 110 dogs receiving APs over a 5-year period. Medical records were retrospectively reviewed to characterize the entire population receiving APs, with further analysis in dogs with preprocedural US-cTnI concentrations (n = 64) classified as normal/group 1 (n = 11), mildly to moderately elevated/group 2 (n = 27), and severely elevated/myocarditis suspects/group 3 (n = 26).

RESULTS

Median survival time was 1079 days for the entire population, 1167 days for group 2, 949 days for group 3, and not met in group 1. There was not a statistically significant difference in survival between group 2 and group 3. Overall, US-cTnI had a mild, negative association with survival. Age had a stronger negative association. Infectious etiologies were identified in a minority of group 3 cases. A possible association between severely elevated US-cTnI and a sudden death outcome was noted.

CONCLUSIONS

The negative association of US-cTnI with survival outcomes was mild, with age having a larger effect. Although a sudden death outcome may be seen more commonly in myocarditis suspects, group 3 survival time was similar to that of the entire canine population. Plausible infectious causes of myocarditis were infrequently identified.

The cognitive dismantling of Eye Movement Desensitization and Reprocessing (EMDR) treatment of Posttraumatic Stress Disorder (PTSD)

Twenty-seven subjects were exposed to standard Eye Movement Desensitization and Reprocessing (EMDR) treatment or a similar treatment without the explicit cognitive elements found in EMDR. Standardized psychometric assessments were administered (Structured Interview for Post Traumatic Stress Disorder, Impact of Event Scale, Revised Symptom Checklist-90) by independent assessors at pretest, posttest and two separate follow-up periods. Potential subjects met specific inclusion/exclusion criteria. Subjective measures including Subjective Units of Disturbance and Validity of Cognition assessments were also conducted. A two-factor repeated measures analysis of variance revealed that both treatments produced significant symptom reductions and were comparable on all dependent measures across assessment phases. The present findings are discussed in light of previous dismantling research that converges to suggest that several elements in the EMDR protocol may be superfluous in terms of the contribution to treatment outcome. These same elements have nevertheless entered unparsimoniously into consideration as possible explanatory variables.