Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpsons monoplanar methods / Avaliação da função atrial esquerda em cães assintomáticos com degeneração mixomatosa crônica de valva mitral: métodos ecocardiográficos bidimensional feature tracking e monoplanar de Simpson

The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson's monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p<0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson's monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p<0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson's monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.(AU)

O presente estudo avaliou o volume e a função atrial esquerda obtidos por meio da ecocardiografia bidimensional feature tracking (2D-FTI) e pelo método monoplanar de Simpson em cães saudáveis e cães com DMVD assintomáticos. Foram avaliados 80 cães distribuídos em três grupos: Grupo 1, 21 cães (classe A); Grupo 2, 30 cães (classe B1) e Grupo 3, 29 cães (classe B2). A variável strain (fase de contração) foi significativamente menor no Grupo 3 que no Grupo 1 (12,92±4,54 x 16,69±5,74, p=0,014) e para a variável índice de strain de contração (CSI), houve diferença estatística entre todos os grupos avaliados (1 = 46,82±8,10; 2 = 39,88±8,03; 3 = 35,25±5,64, p<0,0001). O índice de volume diastólico atrial (iVdA) mensurado por meio do 2D-FTI foi significativamente maior no Grupo 3 que no Grupo 1 (1,31±0,95 x 0,96±0,31, p=0,038), assim como para o índice cardíaco atrial (iCA) também foi maior no Grupo 3 (102,38±80,18 x 78,19±33,38, p=0,030). A função atrial avaliada pelo método monoplanar de Simpson demonstrou um aumento do volume atrial esquerdo e do volume sistólico do átrio esquerdo, enquanto que a função contrátil diminuiu com o aumento da gravidade da doença (Grupo 1 0,21±0,06; Grupo 2 0,25±0,06; Grupo 3 0,32±0,08; p<0,0001). A avaliação intraobservador e interobservador, demonstrou variabilidade baixa a moderada, uma vez que a maioria dos valores de coeficiente de variação se concentraram abaixo de 25% para as variáveis analisadas em ambos os métodos. Dessa forma, conclui-se que a DMVD causa alteração na função atrial, principalmente na fase de contração, mesmo em animais assintomáticos e que a ecocardiografia 2D-FTI e o método monoplanar de Simpson são métodos sensíveis e precoces na detecção da disfunção atrial esquerda.(AU)

Acute Aortic Regurgitation and Low Cardiac Output Syndrome due to Avulsion of the Aortic Valve Commissure: A Case Report / 日本心臓血管外科学会雑誌

A 73-year-old woman presented with epigastric discomfort and lightheadedness. She was admitted to another hospital with congestive heart failure due to severe aortic and mitral regurgitation. However, her heart failure was refractory to medical treatment, necessitating transfer to our hospital for surgical treatment. Emergency surgery was performed for worsening heart failure after admission to our hospital. Intraoperative findings showed aneurysms of the ascending aorta and aortic root and avulsion of the aortic valve commissure between the right coronary and non-coronary cusps. Replacement of the ascending aorta and aortic root replacement using the Florida sleeve method as well as double valve replacement (mitral and aortic) were performed with a favorable outcome. Histopathological examination showed myxomatous degeneration, which suggested that it could have contributed to avulsion of the aortic valve commissure.

Blood lactate increases with the progression of mitral valve disease in dogs / Aumento de lactato sanguíneo com progressão de valvopatia mitral em cães

In dogs with congestive heart failure, the upregulated sympathetic tone causes vasoconstriction that impairs peripheral blood supply, therefore causing the accumulation of lactate. In this prospective cross-sectional study with a longitudinal component, blood lactate was quantified in 10 healthy and 34 myxomatous mitral valve disease (MMVD) dogs to investigate its potential use as a diagnostic and prognostic biomarker. While there were no differences in lactate concentration between control animals and stages B1 (3.31±0.62mmol/L) and B2 (3.32±0.46mmol/L) dogs, significant differences were found between healthy (2.50±0.69mmol/L) and both C (3.99±0.47mmol/L) and D (6.97±1.23mmol/L) animals. When a cut-off of 3.35mmol/L was used, lactate was able to distinguish dogs with normal and remodeled hearts with a sensitivity of 78.2% and specificity of 63.6%. Also, significant correlations existed between lactate and indicators of cardiac remodeling. Finally, animals with blood lactate <3.5mmol/L carried a better prognosis when compared with dogs in which lactate was >5.0mmol/L. Our results suggest that the progression of MMVD results in accumulation of lactate within the bloodstream, which is likely attributable to the impaired peripheral tissue perfusion. In MMVD dogs, blood lactate may be used as a surrogate for cardiac remodeling, and an increased concentration is associated with a worse prognosis regarding the time to evolve into congestive heart failure.(AU)

Em cães com insuficiência cardíaca congestiva, o tônus simpático hiperregulado causa vasoconstrição e interfere com o suprimento sanguíneo periférico, resultando no acúmulo de lactato. Neste estudo prospectivo transversal com um componente longitudinal, o lactato sanguíneo foi quantificado em 10 cães saudáveis e 34 cães com doença mixomatosa da valva mitral (DMVM) para investigar seu potencial como biomarcador diagnóstico e prognóstico. Embora não tenham sido identificadas diferenças na concentração de lactato entre animais controle e cães com DMVM nos estágios B1 (3,31±0,62mmol/L) e B2 (3,32±0,46mmol/L), diferenças significativas foram constatadas entre os cães saudáveis (2,50±0,69mmol/L) e cães com DMVM estágio C (3,99±0,47mmol/L) ou D (6,97±1,23mmol/L). Quando utilizado o valor de corte de 3,35mmol/L, o lactato foi capaz de diferenciar cães com corações normais daqueles com corações remodelados com sensibilidade de 78,2% e especificidade de 63,6%. Além disso, correlações significativas foram encontradas entre o lactato e os indicadores de remodelamento cardíaco. Por fim, os animais com lactato sanguíneo <3,5mmol/L tiveram prognóstico melhor comparativamente aos cães com concentrações >5,0mmol/L. Nossos resultados sugerem que a progressão da DMVM resulta no acúmulo de lactato na corrente sanguínea, fato que é provavelmente atribuído à perfusão periférica prejudicada. Em cães com DMVM, o lactato sanguíneo pode ser utilizado como indicador de remodelamento cardíaco, cuja concentração elevada está associada com pior prognóstico relativo ao tempo para evoluir para insuficiência cardíaca congestiva.(AU)

Primary Pleural Inflammatory Pseudotumor in a Child

Background: Inflammatory pseudo tumor, a rare non-neoplastic lesion, commonlypresents as slow growing solid lesion in the lung, but many extra-pulmonary locations havebeen described. Case characteristics: A 4-year-old girl who presented with respiratorydistress due to massive pleural effusion. Computed tomography revealed large hypodensenon-enhancing lesion in the left hemi thorax. Surgical exploration revealed large semisolidpleural collection filled with gelatinous material with normal underlying lung. Outcome:Histopathology revealed spindle shaped cells with abundant myxoid stroma. Childrecovered after surgery and was asymptomatic at 5 years follow-up. Message: Primarypleural inflammatory pseudotumor may be a rare cause of pleural effusion in a child

Acute Aortic Regurgitation due to Rupture of an Aortic Valve Commissure / 日本心臓血管外科学会雑誌

Here, we report a patient who underwent surgery for acute aortic regurgitation (AR) due to rupture of an aortic valve commissure. The patient was a 51-year-old man who had undergone ascending aorta replacement for acute type A aortic dissection 6 years previously. He presented with a 2-day-history of headache and insomnia. Echocardiography showed only AR initially. However, 2 days later, a vegetation-like mass was noted at the aortic valve commissure on transesophageal echocardiography. We diagnosed AR associated with infective endocarditis, and decided to perform aortic valve replacement immediately. During surgery, we found that the cause of AR was rupture of the aortic valve commissure without infection. The cause of rupture in this case was suspected to be traumatic or myxomatous degeneration.

A Case of Recurrent Myxomatous Corneal Degeneration Treated by Interferon Alpha-2b

PURPOSE: To report a case of recurrent myxomatous corneal degeneration after pterygectomy. CASE SUMMARY: A 65-year-old man with a history of abdominal keloid was referred to our hospital for assessment of a well-circumscribed, gelatinous, whitish corneal mass on the nasal corneal area of the left eye that appeared one month prior. The patient had undergone pterygectomy on his left eye 2 years ago. The patient experienced mild foreign body sensation. The other anterior segment and fundus examination of the left eye were both normal. We diagnosed the case as keloid and we performed excisional biopsy of the corneal mass. Histologic findings revealed proliferation of myxoid-appearing material in the anterior corneal stroma. On immunohistochemical examination, sections were stained positive for actin and calretinin, and negative for S-100. We diagnosed the tumor as myxomatous corneal degeneration. After six months, a recurrent mass was found on the previously excised site. Re-excisional biopsy and topical interferon α-2b treatment were then performed in response. After re-excision, there was no recurrence or complications during one year follow-up. CONCLUSIONS: Myxomatous corneal degeneration should be considered during differential diagnosis of an elevated, whitish, gelatinous lesion of the cornea with previous history of trauma or operation, such as pterygectomy. An interferon α-2b topical treatment is useful for recurrent corneal myomatous degeneration.

Serum serotonin concentration in lean and obese dogs with myxomatous mitral valve disease

The aim of the present study is to investigate the potential influence of obesity as a factor in 5-hydroxytryptamine (5-HT) concentration in myxomatous mitral valve disease (MMVD) dogs. Fifty-five client-owned dogs were enrolled in a randomized trial. Dogs were classified by echocardiography into healthy (control), mild, and moderate to severe MMVD groups. Each group was subclassified by using a 9-point body condition score (BCS); lean (BCS 5–6/9) and obese groups (BCS 7.5–9/9). Dogs with moderate to severe MMVD had lower serotonin (5-HT) concentrations than the control group (p = 0.03). Dogs with moderate to severe MMVD (p = 0.017) had lower serum 5-HT concentrations than the control group in the obese group (BCS 7.5–9/9). Significant difference was found between the lean and obese groups (p = 0.015) which are not consider severe in the MMVD group. These results suggested that 5-HT concentration was decreased with the increasing severity of MMVD, and obesity might be taken into consideration when interpreting the serotonin concentration in MMVD dogs.

Familial mitral valve prolapse in a Maltese dog family / 동물의과학연구지

Mitral valvular prolapse (MVP) in dogs is characterized by myxomatous valvular degeneration, which is caused by abnormal valvular thickening and incomplete coaptation of the mitral valve leading to mitral regurgitation. Mitral regurgitation causes left atrial and left ventricular enlargement. Pathogenesis of the disease is unknown, although some studies have suggested the involvement of endothelin and systemic connective tissue diseases. Mitral valvular prolapse in dogs commonly occurs in aged small dog breeds, including Malteses and Shih Zhus. This case study investigated the clinical features of an affected Maltese family and performed pedigree analysis. To the best of the authors' knowledge, this is the first report of putative familial mitral valve prolapse and regurgitation in Maltese dogs. All family members in this study showed degenerative valvular changes and echocardiographic features of mitral valvular prolapse. Although disease progression differed, all dogs progressed to advanced heart failure stage within 2-3 years after diagnosis. Therefore, this is the first study to identify putative familial mitral valve prolapse in Maltese dogs. This finding suggests strong genetic etiology involved in the development of degenerative mitral valve disease in Maltese dogs. Furthermore, this finding could be a valuable resource for the identification of gene mutations in dogs with familial mitral valvular prolapse.

Clinical evaluation of enalapril maleate and furosemide usage in dogs with degenerative myxomatous mitral valve, CHF functional class Ib / Avaliação clínica da utilização do maleato de enalapril e furosemida em cães com doença degenerativa mixomatosa da válvula mitral, classe funcional Ib

Degenerative myxomatous mitral valve (DMMV) is a heart disease of high incidence in small animal clinical medicine, affecting mainly older dogs and small breeds. Thus, a scientific investigation was performed in order to evaluate the clinical use of the medicines furosemide and enalapril maleate in dogs with this disease in CHF functional class Ib before and after the treatment was established. For this purpose 16 dogs with the given valve disease were used, separated into two groups: the first received furosemide (n=8) and the second received enalapril maleate (n=8) throughout 56 days. The dogs were evaluated in four stages (T0, T14, T28 and T56 day) in relation to clinical signs, hematological, biochemical and serum assessment, which included serum angiotensin converting enzyme (ACE) and aldosterone, as well as radiography, electrocardiography, Doppler-echocardiography and blood pressure. The results regarding the clinical, hematological and serum chemistry evaluations revealed no significant changes in both groups, but significant reductions in the values of ACE and aldosterone in the group receiving enalapril maleate were verified. The radiographic examination revealed reductions of VHS values and variable Pms wave of the electrocardiogram in both groups, but no changes in blood pressure values were identified. The echocardiogram showed a significant decrease of the variables LVDd/s in the studied groups and the FS percent in animals that received only enalapril. Therefore, analysis of results showed that monotherapy based on enalapril maleate showed better efficiency of symptoms control in patients with CHF functional class Ib.

A doença degenerativa mixomatosa da válvula mitral (DDMVM) é uma cardiopatia de alta incidência na clínica médica de pequenos animais, acometendo mormente cães idosos e raças de pequeno porte. Desta forma, foi realizada uma investigação científica objetivando avaliar clinicamente a utilização dos fármacos maleato de enalapril e furosemida em cães com a referida enfermidade na classe funcional Ib da ICC, antes e após a terapêutica implantada. Para isso, utilizaram-se 16 cães portadores da valvulopatia supracitada, distribuídos em dois grupos; com o primeiro recebendo furosemida (n=8) e o segundo maleato de enalapril (n=8), durante 56 dias. Os cães foram avaliados em quatro momentos (T0, T14, T28 e T56 dias) quanto aos sinais clínicos e parâmetros hematológicos e bioquímico-séricos, que incluíram concentrações séricas da enzima conversora da angiotensina (ECA) e aldosterona, como também avaliações radiográficas, eletrocardiográficas, ecodopplercardiográficas e da pressão arterial. Os resultados quanto aos parâmetros clínicos, avaliações hematológicas e bioquímicas séricas não revelaram alterações significativas em ambos os grupos, mas reduções significativas nos valores de ECA e aldosterona no grupo que recebeu o maleato de enalapril foram identificadas. Ao exame radiográfico observou-se reduções nos valores de VHS e na variável onda Pms do eletrocardiograma em ambos os grupos, mas sem alterações nos valores da pressão arterial. Por sua vez, o ecodopplercardiograma evidenciou diminuição significativa das variáveis DIVEd/s nos grupos estudados e na FEC por cento nos cães que receberam somente enalapril. Portanto, a análise dos resultados encontrados indicou que a monoterapia fundamentada no maleato de enalapril apresentou melhor eficiência no controle do quadro clínico em pacientes da classe funcional Ib da ICC.

Oral focal mucinosis: report of two cases / Mucinose oral focal: relato de dois casos

Purpose: Oral focal mucinosis (OFM), an oral counterpart of cutaneous focal mucinosis, is a rare disease of unknown etiology. Its pathogenesis may be due to overproduction of hyaluronic acid by fibroblast at the expense of collagen production, resulting in focal myxoid degeneration of connective tissue primarily affecting the mucosa overlying bone. It has no distinctive clinical features, since the diagnosis is solely based on histopathological features. This paper reports two cases and discusses clinicopathological, immunohistochemical features and differential diagnosis of myxomatous lesions of the oral cavity. Case description: The two cases of OFM lesions were present in a 50 year-old patient on the hard palate and in a 26 year-old female patient in the mandible, which seem to be the first report in the Indian population. Conclusion: The histopathological and immunohistochemical analysis of Vimentin and S-100 protein may play a vital role in the correct diagnosis of OFM.

Objetivo: Mucinose oral focal (MOF), uma lesão equivalente à mucinose cutânea focal, é uma doença rara de etiologia desconhecida. Sua patogênese pode ser devido a superprodução de ácido hialurônico pelo fibroblasto às expensas de produção de colágeno, resultando em degeneração mixoide focal de tecido conjuntivo primariamente afetando a mucosa sobre o osso. Não tem características clínicas distintas e o diagnóstico é baseado somente em características histopatológicas. Este artigo relata dois casos e discute as características clinico-patológicas e imuno-histoquímicas, bem como o diagnóstico diferencial de lesões mixomatosas da cavidade bucal. Descrição dos casos: Os dois casos de lesões de MOF estavam presentes no palato duro de um paciente do sexo masculino, de 50 anos de idade, e na mandíbula de uma paciente do sexo feminino, de 26 anos. Estes parecem ser os primeiros casos relatados na população da India. Conclusão: A análise histopatológica e imuno-histoquímica de Vimentin e proteína S-100 podem ter um papel importante no correto diagnóstico de MOF.

Echocardiographic determination of the prevalence of primary cardiac valve myxomatous degeneration / 中华超声影像学杂志

Objective To determine the capability of echocardiography to identify primary cardiac valve myxomatous degeneration (PCVMD) compared to pathological findings and to determine the echo features of PCVMD. Methods Echocardiograms were retrospectively compared with pathological findings of 1080 patients who underwent surgery for moderate or severe valve regurgitation. PCVMD of the mitral,aortic and tricuspid valves was retrospectively identified, with a comparison of the echocardiography and pathology findings,to calculate the prevalence of PCVMD,and to summarize its echocardiography features.Results A total of 104 patients were diagnosed with PCVMD (prevalence of 9. 62%) with 117 lesions.Valvular regurgitation were confirmed by echocardiography in all patients( 100 % ). Valve morphology change including valve prolapsed, valve thickening and redundancy were confirmed by echocardiography in 101 lesions(86.3 % ), but suggestive diagnosis were done by echocardiography in only two patients. Conclusions In patients undergoing surgery for valvular regurgitation,a high prevalence of PCVMD was found. PCVMD had distinctive echocardiographic features,suggesting its preoperative diagnosis.

The Expression of Transforming Growth Factor-beta1 and alpha-Smooth Muscle Actin is Increased in the Human Myxomatous Valve

BACKGROUND: In vitro experimental studies have reported that transforming growth factor-beta1 (TGF-beta1) stimulates the production of alpha-smooth muscle actin (alpha-SMA) in porcine valves. However, the relation between TGF-beta1 and alpha-SMA in myxomatous valves has not been elucidated. METHODS: We classified 27 subjects into two groups: 1) myxomatous group (M:F=11:12, mean age=55+/-15 years) and 2) rheumatic group (M:F=3:1, mean age=41+/-17 years) according to preoperative echocardiographic and postoperative histologic findings. Twenty-seven valve specimens from the patients who underwent valve replacement were obtained. Tissue samples were analyzed by immunohistochemistry for TGF-beta1 and alpha-SMA. The positively stained areas were measured using an image analysis program (Image Pro-Plus 4.5), and then the TGF-beta1 volume fraction (TGF-VF) and alpha-SMA volume fraction (alpha-SMA-VF) were calculated. RESULTS: TGF-VF in myxomatous valves was higher than in rheumatic valves (2,759+/-2,294 vs 864+/-276, p=0.04). alpha-SMA-VF in myxomatous valves was higher than in rheumatic valves (4,122+/-2,275 vs 2,421+/-844, p=0.002). There was a significant correlation between TGF-beta1 and alpha-SMA in myxomatous valves (r=0.38, p=0.04). There was no significant correlation between TGF-beta1 and alpha-SMA in rheumatic valves (r=-0.50, p=0.67). CONCLUSIONS: TGF-beta1 and alpha-SMA may be related to the pathogenesis of myxomatous valves. The activation of TGF-beta1 might increase the expression of alpha-SMA in human myxomatous valves.

Clinical Characteristics of Surgically Corrected Mitral Regurgitation Due to Myxomatous Degeneration in Korea

BACKGROUND AND OBJECTIVES: Although the clinical significance of mitral regurgitation (MR) due to prolapse or chordae rupture with myxomatous degeneration (MD) is increasing significantly, clinical features of patients with MD in Korea are not characterized. MATERIALS AND METHODS: Retrospective analysis of clinical data of 90 patients who underwent surgical correction of significant MR due to MD was performed. Lesion sites of MD were confirmed during surgery; anterior (A) and posterior (P) mitral leaflets were divided into lateral (A1 & P1), middle (A2 & P2), and medial segments (A3 & P3). METHODS: Mean age was 5114 years and male / female ratio was 1; age distribution showed typical bimodal pattern with two peaks at the mid-thirties and the mid-fifties each. MD was confined to P leaflet in 36 (40%), A leaflet in 20 (22%), and both leaflets in 34 patients (38%). Forty-six patients (51%) showed MD in a single segment, and 37 (41%) in 2 segments; 7 patients (8%) showed MD in more than 2 segments. In 90 patients, pathologic MD was confirmed in 139 mitral segments; among them, P3 was the most commonly involved segment (30%), followed by A3 (17%), P2 (14%), A2 (14%), A1 (14%), and P1 (12%). Hypertension (HT) was more frequently observed in female patients (42%) than in male patients (16%) (p<0.05). Chordae rupture was observed in 71 patients (79%), which was associated with HT. Younger patients (age<45 years, N=31) showed lower prevalence of HT and higher incidence of MD involving multiple segments. Valve repair was successful in 83 patients (92%), which was not associated with lesion sites or numbers of MD. Three-year event free survival rate was 865% and independent on sites and numbers of MD. CONCLUSION: MD develops preferentially in the medial part of the mitral valve, and patterns of clinical presentation can change according to the age and existence of HT in these selected patients with significant MR. However, the morphologic characteristics of MD do not seem to affect the feasibility of repair and long-term prognosis.