First reported long-term two- and three-dimensional echocardiographic follow-up with histopathological analysis of a transcatheter pulmonary valve implantation in a pet dog.

Transcatheter pulmonary valve implantation (TPVI) is indicated for use in the management of failing pulmonary valves in humans. We report here the long-term follow-up of the first documented transcatheter pulmonary valve implanted in a client-owned dog. A one-year-old Beagle dog with severe congenital type A valvular pulmonic stenosis first underwent percutaneous balloon pulmonary valvuloplasty, leading two years later to severe pulmonary regurgitation. A TPVI using a Melody™ bioprosthetic valve was then successfully performed, with normalization of the right heart cavities. Repeated two- and three-dimensional transthoracic echocardiographic examinations combined with Doppler modes confirmed the appropriate position and function of the valve for four years. Mitral myxomatous valvular degeneration led to refractory left-sided congestive heart failure, and the dog was humanely euthanized. After postmortem examination, X-ray imaging and histopathological evaluation of the stent and the valve were performed. Ex-vivo imaging of the implanted valve using a Faxitron® Path radiography system and microscopic evaluation of the implanted stent and bioprosthetic leaflets did not show any relevant leaflet or stent alterations. This case provides a proof of concept in interventional veterinary cardiology, showing that TPVI can be performed in dogs with subsequent long-term maintaining normal pulmonary valve function.

The variety of phenotypes behind 'double outlet right ventricle': clinical and imaging presentations in four dogs and a cat.

This report describes five cases of double outlet right ventricle (DORV) in four dogs (aged 3-18 months, two males and two females) and a domestic shorthair cat (aged 6 months, female) who presented with various clinical signs including tachypnea (n = 5), exercise intolerance (n = 5), mucous cyanosis (n = 3), delayed growth (n = 2), and/or lethargy (n = 2). The represented canine breeds were poodle, Yorkshire terrier, Samoyed, and Shetland sheepdog. For all animals, echocardiography revealed marked aortic dextroposition with both arterial trunks totally arising from the right ventricle, associated with a ventricular septal defect and various other congenital abnormalities, including subvalvular aortic stenosis (n = 2), minor aortic insufficiency (n = 5), subvalvular pulmonic stenosis with pulmonary trunk hypoplasia (n = 1), patent ductus arteriosus (n = 1), minor mitral and/or tricuspid dysplasia (n = 3). Subsequent cardiac remodeling was characterized by marked right ventricular hypertrophy for all patients, associated with right ventricular and right atrial dilation for most of them (4/5). Two dogs died soon after the initial DORV diagnosis (i.e. after 24 h and two months). A surgical correction attempted for another dog confirmed the presence of a DORV associated with patent ductus arteriosus, but the animal died during the procedure from sudden cardiac arrest. The fourth dog underwent a contrast-enhanced retrospective electrocardiogram-gated multidetector computed tomography angiography under general anesthesia, which confirmed the conotruncal malformation. Despite episodes of exercise intolerance, this dog is still alive, at the age of 53 months, as is the cat at the age of 21 months.

Successful transcatheter pulmonary valve implantation in a dog: first clinical report.

Transcatheter pulmonary valve (TPV) implantation is a therapeutic approach approved by the United States Food and Drug Administration for human patients with failing pulmonary conduits in 2010 and for failing bioprosthetic surgical pulmonary valves in 2017. We report here the first successful transcatheter implantation of a stented valve in a pulmonary position in a dog with congenital pulmonary valve disease. A 3-year-old, 10.9 kg, client-owned Beagle dog was referred for a follow-up visit after a percutaneous balloon valvuloplasty performed 22 months before for treatment of a severe type A valvular pulmonary stenosis. The Doppler-derived peak pressure gradient was 348 mmHg before the procedure and 66 mmHg 24 h after. The dog was lethargic. Echocardiography revealed a mild pulmonary stenosis (pressure gradient-43 mmHg), severe pulmonary regurgitation, and secondary severe right ventricular and right atrial dilation. Worsening of right heart dilation was observed 2 months later despite medical therapy. A TPV implantation was performed using a prestented Melody bovine jugular bioprosthetic valve. The dog recovered uneventfully and was discharged 10 days after the procedure. Right heart dilation resolved within 15 days. The dog was doing well 7 months after valve implantation. This case demonstrates that TPV implantation with a stented valve is technically feasible in dogs with severe pulmonary valve disease. Stringent postoperative care, with particular attention to thrombosis and infectious endocarditis, and appropriate sizing and positioning of the valve stent are keys to the success of this procedure.

Successful transcatheter retrieval of embolized Amplatz Canine Duct Occluders in two dogs.

Transcatheter occlusion of patent ductus arteriosus (PDA) using an Amplatz® Canine Duct Occluder (ACDO) is routinely performed in dogs. Pulmonary embolization of the device is a rarely reported complication of this procedure. We report here the first two cases of successful transcatheter retrieval of an embolized ACDO. An 8-month-old, 21-kg, German shepherd (case 1) was referred for pulmonary edema secondary to a large PDA with left-to-right shunting. After medical stabilization, an emergency procedure for PDA closure was recommended. An 8-mm ACDO was deployed under general anesthesia. The device was released after confirming its stability with a gentle tug test but migrated into the pulmonary trunk. A 10-mm ACDO was subsequently successfully deployed and released. Vascular access was then obtained from the right jugular vein so that a vascular snare could be used to capture the ACDO waist and pull it back toward the right ventricle and then the right atrium. It was then removed through the jugular vein. The dog recovered uneventfully and was discharged after confirmation of complete ductal occlusion. The same complication occurred in a second case (case 2, asymptomatic 6-month-old, 7.9-kg, cocker spaniel), and a similar procedure was used to successfully retrieve the embolized device. Both dogs are still doing well 9 and 21 months, respectively, after the procedure. These cases illustrate that transcatheter retrieval of ACDO devices embolized in the pulmonary artery using vascular snares is technically feasible in the dog.

Comparative anatomy and angiography of the cardiac coronary venous system in four species: human, ovine, porcine, and canine.

INTRODUCTION: The coronary arterial system has been the subject of greater investigation than its venous system due to the importance of human coronary artery disease. With the advent of new percutaneous treatments, the anatomy of the coronary venous system has increasing relevancy. We compared the organization of the coronary venous circulation in three species commonly used in research and compared these to normal humans using both macroscopic anatomic and angiographic studies. ANIMALS: The anatomy of five explanted hearts from healthy dogs, pigs, and sheep were studied macroscopically, and 10 explanted hearts per animal species and 10 clinically normal human were examined by angiography. METHODS: Animal hearts were injected with latex and dissected macroscopically. The coronary venous system of humans was evaluated from clinical angiographic studies. In the animal hearts, a retrograde angiographic study was performed via a Foley catheter in the coronary sinus. RESULTS: The general organization of the coronary venous circulation was similar among humans, dogs, sheep, and pigs. Despite overall similarities to humans, animal hearts demonstrated the absence of the oblique vein of the left atrium and differences in position and organization of venous valves; venous diameters; number of tributary veins; and presence of an anastomosis between the left and right (human anterior and posterior) venous tree. The left azygos of the pig and sheep joined the coronary sinus. CONCLUSIONS: Anatomical differences must be considered when planning biomedical and veterinary studies incorporating cardiac veins. This study provides baseline data regarding structure and organization of the cardiac venous system.

Intracardiac echocardiography: use during transcatheter device closure of a patent ductus arteriosus in a dog.

Intracardiac echocardiography (ICE) is used in humans for percutaneous interventional procedures, such as transcatheter device closures. Intracardiac echocardiography provides high-resolution imaging of cardiac structures with two-dimensional, M-mode, Doppler, and also three-dimensional modalities. The present report describes application of ICE during transcatheter occlusion of patent ductus arteriosus using a canine ductal occluder in a dog for which transesophageal echocardiography could not provide an optimal acoustic window.

Nanoporous hydroxyapatite/sodium titanate bilayer on titanium implants for improved osteointegration.

OBJECTIVE: The aim of this study was to improve the strength and quality of the titanium-hydroxyapatite interface in order to prevent long-term failure of the implanted devices originating from coating delamination and to test it in an in-vivo model. METHODS: Ti disks and dental commercial implants were etched in Kroll solution. Thermochemical treatments of the acid-etched titanium were combined with sol-gel hydroxyapatite (HA) coating processes to obtain a nanoporous hydroxyapatite/sodium titanate bilayer. The sodium titanate layer was created by incorporating sodium ions onto the Ti surface during a NaOH alkaline treatment and stabilized using a heat treatment. HA layer was added by dip-coating in a sol-gel solution. The bioactivity was assessed in vitro with murine MC3T3-E1 and human SaOs-2 cells. Functional and histopathological evaluations of the coated Ti implants were performed at 22, 34 and 60days of implantation in a dog lower mandible model. RESULTS: Nanoporous hydroxyapatite/sodium titanate bilayer on titanium implants was sensitive neither to crack propagation nor to layer delamination. The in vitro results on murine MC3T3-E1 and human SaOs-2 cells confirm the advantage of this coating regarding the capacity of cell growth and differentiation. Signs of progressive bone incorporation, such as cancellous bone formed in contact with the implant over the existing compact bone, were notable as early as day 22. Overall, osteoconduction and osteointegration mean scores were higher for test implants compared to the controls at 22 and 34 days. SIGNIFICANCE: Nanoporous hydroxyapatite/sodium titanate bilayer improves the in-vivo osteoconduction and osteointegration. It prevents the delamination during the screwing and it could increase HA-coated dental implant stability without adhesive failures. The combination of thermochemical treatments with dip coating is a low-cost strategy.

HIV-related risk-taking behaviour, knowledge and serostatus of intravenous drug users in Sydney.

This study was carried out in 1987 to investigate the relationships between human immunodeficiency virus (HIV)-related risk-taking behaviour, demographic characteristics and serostatus of 181 intravenous drug users in Sydney. Subjects were predominantly heterosexual men in their late twenties with limited secondary education. The majority (77%) had been injecting drugs for more than two years and were daily (91%) injectors of heroin (87%). Eighty per cent had shared injection equipment. Condom use was uncommon (15%) except during prostitution (72%). Sixty-nine per cent of all subjects were at risk of HIV infection due to either unsafe sexual practices or sharing of injection equipment. Thirty per cent of the sample had been in prison at some time since 1981 and half of these (15%) had used intravenous drugs and shared injection equipment while in custody. Thirteen per cent of men who had been imprisoned reported anal intercourse with other male prisoners. HIV antibody test results were available from 132 subjects of whom 12 (9%) (95% confidence intervals [CI], 4%-14%) were seropositive. The majority (67%) of seropositive subjects were homosexual/bisexual men but no other behavioural or demographic factor differentiated seropositive from seronegative subjects. The HIV seroprevalence (9%) found in this study of intravenous drug users in Sydney is significantly higher than a 1985 estimate of 0.5% (P less than 0.001). This finding and the level of risk-taking behaviour by this sample indicates that strategies introduced at the time may have been inadequate to prevent HIV infection among intravenous drug users in Sydney. Widespread HIV infection in Australian intravenous drug users may be imminent unless major changes in HIV-related risk-taking behaviour occur in the near future.

Effects of acute alcohol on penile tumescence in normal young men and dogs.

To determine the cause of the inhibition of sexual function observed in normal subjects with elevated blood alcohol concentrations (BAC), nocturnal penile tumescence (NPT) was monitored in 11 subjects over three consecutive nights. On the third night alcohol was administered (BAC = 0.154 g/100 mL). We observed no effect of alcohol on the size, duration, or number of erections. These results were confirmed in dogs. The latent period, magnitude, and duration of corpus cavernosal pressure changes produced by pelvic nerve stimulation were not affected by mean blood alcohol levels of 0.327 g/100 mL in three dogs. These results suggest that the inhibition of sexual response caused in conscious subjects by the ingestion of alcohol is not due to a suppression of the underlying spinal reflex but may be the result of its effect on perceptual or cognitive sexual mechanisms.

Intravenous drug users who present to the Albion Street (AIDS) Centre for diagnosis and management of human immunodeficiency virus infection.

Intravenous drug users who presented to the Albion Street (AIDS) Centre for human immunodeficiency virus (HIV) antibody screening during the period March 1, 1985 to January 31, 1989, were included in this study. Information on medical history and HIV risk-related behaviour was collected by means of a standardized, computer-coded medical record. Of the 1222 intravenous drug users in this study, 72.3% were men, 26.9% were women and 0.8% were transsexual, with 60.1% of the total claiming exclusive heterosexuality. Of the sample, 40.2% were current intravenous drug users, and 86.8% recorded having shared needles and syringes. Among this sample, the over-all prevalence of HIV seropositivity was 14.5%. Of subjects who were diagnosed as HIV seropositive, 43.8% were homosexual men, 13.1% were bisexual men and 5.3% were heterosexual men. Of all intravenous drug users, 49.9% had a history of at least one sexually-transmitted disease, with 21.8% reporting a history of more than one. Fifty-two per cent of the sample reported that they had been infected with hepatitis B previously. There was no over-all increase in the annual rate of HIV infection among this population of intravenous drug users. The sexual activity and prevalence of hepatitis and other sexually-transmitted diseases among this group are suggestive of widespread, continuing risk behaviour.

Syringe HIV seroprevalence and behavioural and demographic characteristics of intravenous drug users in Sydney, Australia, 1987.

The contents of needles and syringes returned by intravenous drug users to two Sydney needle and syringe exchange centres were analysed for HIV antibodies by the enzyme-linked immunosorbent assay (ELISA). Reactive and borderline samples were further tested by the Western blot method. Basic demographic and needle sharing data were also collected from the clients of the exchanges. Of a sample of 1544 returned syringes, 48 (3%) were confirmed as containing HIV-infected blood. The proportion of infected syringes at exchange 2 was 6% (33 out of 545), which was significantly greater (P less than 0.05) than the proportion of exchange 1 at 1.5% (15 out of 999). The difference in seroprevalence between the two centres may be related to the behavioural characteristics of the client populations that attended each of the exchanges. The maintenance of a low syringe HIV seroprevalence (1-1.5%) over a 7-month period at one exchange may indicate that the availability of sterile needles and syringes prevented transmission of HIV among the clients of that exchange. HIV antibody testing of the contents of used syringes is a potentially valuable method of monitoring HIV infection among intravenous drug users. In this study, syringe exchange schemes have proved to be suitable venues for investigating the demographic characteristics and risk-taking behaviours of this population.

The impact of the "grim reaper" national AIDS educational campaign on the Albion Street (AIDS) Centre and the AIDS Hotline.

The national educational programme on the acquired immunodeficiency syndrome (AIDS) caused a dramatic increase in the number of heterosexual persons who presented for human immunodeficiency virus (HIV) antibody testing at the Albion Street (AIDS) Centre. There was also a marked increase in the number of intravenous drugs abusers who presented, although the proportion of this high-risk group that has been tested remains low. There was no increase in the number of homosexual men who presented for testing. The increase in the number of telephone calls that were received by the Centre's AIDS Hotline was due to an interest in HIV-antibody testing, rather than an interest in information about safer sexual practices. The campaign was seen to have achieved its primary objective, namely, to alert sexually-active persons of the potential spread of the virus from the high-risk groups. However, it is clear that future educational campaigns need to target specific high-risk groups such as intravenous drug abusers.

PIP: The National Advisory Commission on AIDS (NACAIDS) launched a national educational program in April 1987 to educate the community about AIDS risk factors; it also initiated a market research study to determine the level of knowledge about AIDS. Data were also collected from random samples of the population and from clients of the Albion Street (AIDS) Centre in Sydney, including those who called the AIDS Hotline at the Centre. The educational campaign took the form of a television commercial featuring the "Grim Reaper" bowling over human "pins" in a bowling alley and was followed by large-format advertisements in newspapers. The market research survey showed that, although knowledge of the risk of AIDS among homosexuals and intravenous (IV) drug users was high, 36% of the respondents thought AIDS could be transmitted through casual contact, and there was a converse tendency to regard AIDS as a high risk only among homosexuals and IV drug users. The AIDS Hotline received 327% more calls during the 1st month of the campaign than in the 7 months preceding it. The number of female callers more than doubled, as did the number of callers requesting information about antibody testing. Clinic attendance also doubled, mainly due to a 127% increase in women and a 154% increase in the number of heterosexual men requesting antibody testing. The number of IV drug users and blood recipients also increased significantly. Between March 1985 and June 1987, 3556 heterosexual persons came to the Centre for HIV-antibody testing; 34 were seropositive, of whom only 6 belonged to high-risk groups. In summary, the AIDS educational campaign seems to have raised the anxiety level among low risk heterosexual persons, especially women.

Impotence--the team approach to investigation and surgical treatment.

A multidisciplinary study group was established to assess impotent patients. One hundred and forty-eight patients were fully assessed and 25 potent volunteers underwent measurement of nocturnal penile tumescence (NPT). This report describes the selection process and results of surgical implantation of the American Medical Systems (AMS) inflatable and the Jonas silver-silicone prostheses.