Epidemiological, clinical, and echocardiographic features and survival times of dogs and cats with tetralogy of Fallot: 31 cases (2003-2014).

OBJECTIVE To characterize the epidemiological, clinical, and echocardiographic features of dogs and cats with tetralogy of Fallot (TOF) and determine their survival times. DESIGN Retrospective case series. ANIMALS 15 dogs and 16 cats with a diagnosis of TOF as determined via echocardiography. PROCEDURES Medical records of dogs and cats were reviewed to extract information on signalment, clinical status at the time of TOF diagnosis, echocardiographic findings, and any outcome data. RESULTS The most common canine breeds were terrier types (n = 7). Most animals (28/31 [90%]) had clinical signs of TOF at the time of diagnosis, including cyanosis (16/31 [52%]). Pulmonic stenosis was characterized by a variable systolic Doppler-derived pressure gradient (median [range], 108 mm Hg [26 to 255 mm Hg]). Most ventricular septal defects were large, with a median (range) ratio of the diameter of the ventricular septal defect to that of the aorta of 0.60 (0.18 to 1.15). Median age at cardiac-related death was 23.4 months, with no significant difference between dogs and cats. Median survival time from TOF diagnosis to cardiac-related death was briefer for animals with no or low-grade heart murmur (3.4 months) than for those with higher-grade heart murmur (16.4 months). After adjustment for age and sex, having a lack of or a low- to mild-grade systolic heart murmur was significantly associated with a briefer survival time. CONCLUSIONS AND CLINICAL RELEVANCE With a few exceptions, cardiac-related death occurred predominantly in young adult dogs and cats with TOF, and most animals had severe clinical signs at the time of TOF diagnosis.

Signalment, clinical features, echocardiographic findings, and outcome of dogs and cats with ventricular septal defects: 109 cases (1992-2013).

OBJECTIVE: To determine the signalment, clinical features, echocardiographic findings, and outcome of dogs and cats with ventricular septal defects (VSDs). DESIGN: Retrospective case series. ANIMALS: 56 dogs and 53 cats with VSDs. PROCEDURES: Medical records of dogs and cats with VSDs diagnosed by means of conventional and Doppler echocardiography were reviewed. Signalment, clinical status, echocardiographic findings, and outcome data were recorded. Variables of interest were analyzed for the study population and subgroups according to species and clinical status. RESULTS: VSDs were isolated (ie, solitary defects) in 53 of 109 (48.6%) patients. Most (82/109 [75.2%]) VSDs were membranous or perimembranous. Terriers and French Bulldogs were commonly represented canine breeds. Most isolated VSDs were subclinical (43/53 [81%]) and had a pulmonary-to-systemic flow ratio < 1. 5 (24/32 [75%]). The VSD diameter and VSD-to-aortic diameter ratio were significantly correlated with pulmonary-to-systemic flow ratio in dogs (r = 0.529 and r = 0.689, respectively) and in cats (r = 0.713 and r = 0.829, respectively). One dog underwent open surgical repair for an isolated VSD and was excluded from survival analysis. Of the remaining animals with isolated VSDs for which data were available (37/52 [71%]), no subclinically affected animals developed signs after initial diagnosis, and median age at death from all causes was 12 years. CONCLUSIONS AND CLINICAL RELEVANCE: Most dogs and cats with isolated VSDs had a long survival time; few had clinical signs at diagnosis, and none with follow-up developed clinical signs after diagnosis.

Basal plasma concentrations of routine variables and packed cell volume in clinically healthy adult small-sized dogs: effect of breed, body weight, age, and gender, and establishment of reference intervals.

BACKGROUND: Plasma variables may be affected by breed or body weight (BW). Small-sized dogs are very common, but no specific reference intervals (RI) are used. OBJECTIVES: The primary objective of this prospective study was to assess the potential effect of breed, BW, age, and sex on routine plasma analytes and packed cell volume (PCV) in small-sized dogs. A secondary objective was to establish RI in this small-sized population. METHODS: Blood was sampled under standardized conditions from healthy dogs. PCV and 15 routine plasma variables were measured at the same laboratory. Effects of breed, BW, age, and sex were tested using a general linear model. The procedure recommended by the Clinical and Laboratory Standards Institute was used to establish RI. RESULTS: In this study, 154 healthy dogs from 7 breeds were prospectively included. Although a significant effect of breed, BW, sex, or age was evidenced for most variables (except plasma sodium, phosphates, and triglycerides), it was considered as clinically irrelevant. More strikingly, the percentage of values in the reference sample group under the lower limit of the laboratory's RI ranged from 3.8% to 76.6% for 9 variables, and those higher than the upper limit of the laboratory's RI ranged from 4.5% to 9.7% for 7 variables. For example, the RI for creatinine in small-sized dogs was 45-90 µmol/L (vs 54-144 µmol/L for the general dog population). CONCLUSION: Specific RI should be considered for PCV and selected plasma variables in small-sized dogs.

Echocardiography and conventional Doppler examination in clinically healthy adult Cavalier King Charles Spaniels: effect of body weight, age, and gender, and establishment of reference intervals.

OBJECTIVES: The objectives of this study were (1) to assess the potential effect of body weight (BW), age, and gender on the most commonly used echocardiographic and conventional Doppler variables in a large population of healthy Cavalier King Charles Spaniels (CKCS), and (2) to establish the corresponding reference intervals (RI). ANIMALS: 134 healthy adult CKCS. METHODS: Ultrasound examinations were performed by trained observers in awake dogs. M-mode variables included left ventricular (LV) end-diastolic and end-systolic diameters, LV free wall and interventricular septal thicknesses at end-diastole and end-systole, and LV fractional shortening (FS%). The left atrium (LA) and aortic (Ao) diameters were measured using a 2D method, and the LA/Ao was calculated. Pulsed-wave Doppler variables included peak systolic aortic and pulmonary flow velocities, mitral E and A waves, and E/A ratio. Effects of BW, age, and gender on these 15 variables were tested using a general linear model, and RIs were determined by applying the statistical procedures recommended by the Clinical and Laboratory Standards Institute. RESULTS: A significant BW effect was observed for all variables, except LA/Ao, FS%, and mitral E/A ratio. A significant but negligible effect of gender and age was also observed for 5/15 and 4/15 of the tested variables, respectively. Only the BW effect on M-mode variables was considered as clinically relevant and the corresponding regression-based RIs were calculated. CONCLUSIONS: Body weight should be taken into account when interpreting echocardiographic values in CKCS, except for LA/Ao, FS%, and mitral E/A ratio.

Basal plasma concentrations of N-terminal pro-B-type natriuretic peptide in clinically healthy adult small size dogs: effect of body weight, age, gender and breed, and reference intervals.

Plasma NT-proBNP has previously been evaluated in dogs with degenerative mitral valve disease (DMVD). However, reference intervals (RI) established according to the Clinical Laboratory and Standards Institute (CLSI) recommendations have never been provided. The objectives of this prospective study were to assess effects of breed, body weight, age, and sex on plasma NT-proBNP, and to establish RI according to CLSI for this biomarker in a large population of dogs predisposed to DMVD. 183 Healthy small-sized dogs from 7 breeds were included. Assays were performed by ELISA. Effects of covariates were tested using a general linear model. Although a sex effect was demonstrated (P=0.01), no significant effect of breed, body weight or age was shown. The proposed RI was 157-2842 pmol/L. 7% of dogs had plasma NT-proBNP >2617 pmol/L, and were considered as outliers despite normal cardiovascular examination. In conclusion, plasma NT-proBNP may be high in a few healthy small-sized dogs.

Echoguided closed commissurotomy for mitral valve stenosis in a dog.

Surgical treatment of mitral stenosis (MS) usually consists of open mitral commissurotomy (MC) or percutaneous balloon MC, which require a cardiopulmonary bypass or transseptal approach, respectively. We describe here the first surgical management of congenital MS in a dog using a less invasive procedure, a surgical closed MC under direct echo guidance. A 5-year-old female Cairn terrier was referred for ascites, weakness, and marked exercise intolerance for 2 months, which was refractory to medical treatment. Diagnosis of severe MS associated with atrial fibrillation (AF) was confirmed by echo-Doppler examination and electrocardiography. Poor response to medical treatment suggested a corrective procedure on the valve was indicated. However, due to the cost and high mortality rate associated with cardiopulmonary bypass, a hybrid MC was recommended. A standard left intercostal thoracotomy was performed and three balloon valvuloplasty catheters of differing diameters were sequentially inserted through the left atrium under direct echo guidance. Transesophageal echocardiography revealed a 62% reduction in the pressure half-time compared to the pre-procedure. Thirteen months after surgery the dog is still doing well with resolution of ascites and a marked improvement of most echo-Doppler variables.

Successful treatment of a congenital pulmonic valvular stenosis in a snow leopard (Uncia uncia) by percutaneous balloon valvuloplasty.

A 3-yr-old intact female snow leopard (Uncia uncia) was evaluated for progressive apathy, lethargy, and decreased appetite. Cardiac auscultation revealed a left basal grade IV/VI systolic ejection murmur, and an echocardiogram confirmed a severe pulmonic valvular stenosis (pressure gradient of 98 mm Hg). The lesion was managed by balloon valvuloplasty, resulting in a marked pressure gradient reduction (30 mm Hg). The cat recovered well, and clinical signs resolved. This is the first description of a pulmonary valve stenosis and management with balloon valvuloplasty in a wild felid.

Double valvular insufficiency in a Burmese python (Python molurus bivittatus, Linnaeus, 1758) suffering from concomitant bacterial pneumonia.

Ultrasonography, and, to a lesser extent, echocardiography are now well-established, noninvasive, and painless diagnostic tools in herpetologic medicine. Various cardiac lesions have been previously described in reptiles, but valvulopathy is rarely documented in these animals and, consequently, is poorly understood. In this report, sinoatrial and atrioventricular insufficiencies were diagnosed in a 5-yr-old captive dyspneic Burmese python (Python molurus bivittatus) on the basis of echocardiographic and Doppler examination. This case report is the first to document Doppler assessment of valvular regurgitations in a reptile.