Rare delayed cardiac tamponade in a pig after cardiac surgery.

OBJECTIVE: Delayed cardiac tamponade, a life-threatening complication of pericardial effusion in humans, has rarely been described in large animal models. We report here a pig with cardiac tamponade that developed 29 days after cardiac surgery. STUDY DESIGN: Case report. ANIMALS: One 45-kg domestic pig. METHODS: Open-chest surgery was performed on a pig to induce chronic heart failure. At 15 days after surgery, the pig's breathing appeared laboured; induced heart failure was considered the cause. Routine heart failure medications were administered. RESULTS: On day 28, the pig's status deteriorated. On day 29, echocardiography performed just before the pig's death showed a large pericardial effusion, mainly in the lateral and anterior walls of the right heart, with several fibre exudation bands. The right heart was severely compressed with an extremely small right ventricle. An emergency sternotomy was unsuccessful. Pathologic examination showed a severely thickened, fibrous pericardium. The pericardial sac was distended (up to 4.5 cm) and was full of dark brown, soft, friable material. Epicardial haemorrhage with a fresh, organised thrombus was noted in the pericardium. CONCLUSION: Delayed tamponade occurring at least 15 days after open-chest surgery is easy to misdiagnose or overlook in large animal models where attention is often focused on primary pathological model changes. To decrease mortality in animal models, researchers should be aware of potential complications and use the same level of follow-up monitoring of large animals as in clinical care.

Retrospective evaluation of clinical signs, clinical course, and prognosis between dogs with left atrial rupture secondary to myxomatous mitral valve disease and those with neoplastic cardiac tamponade (2015-2019): 70 cases.

OBJECTIVE: To describe the clinical signs, clinical course, and prognosis of suspected left atrial rupture (LAR) secondary to myxomatous mitral valve disease (MMVD) in dogs and to compare them with dogs with suspected neoplastic cardiac tamponade (NCT). DESIGN: Retrospective study from November 2015 to October 2019 SETTING: An out-of-hours Emergency Animal Hospital. ANIMALS: Twenty-three dogs with LAR secondary to MMVD (LAR group) and 47 dogs with NCT (NCT group). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The following were the characteristics of the study population (LAR group vs NCT groups) with P < 0.05 as the significance threshold: male sex, 83% vs 66%; median age, 11.9 vs 12.5 years; and median weight, 3.8 vs 6.4 kg (P < 0.001). Chihuahuas and Miniature Dachshunds were overrepresented in the LAR and NCT groups, respectively. Statistically different clinical findings between the 2 groups were as follows (LAR vs NCT): pulmonary edema, 43% vs 0%; pericardial thrombus, 70% vs 6% (P < 0.001); ineffectiveness of pericardiocentesis (whether aspiration of pericardial fluid was successful or not), 58% vs 2% (P < 0.001); mortality rate within 48 hours of visiting hospital, 35% vs 9% (P < 0.01). No significant difference was observed in survival time after discharge between the 2 groups. CONCLUSIONS: The proportion of dogs with a diagnosis of LAR secondary to MMVD in dogs with cardiac tamponade was higher than the previously reported rate. Furthermore, the frequency of pulmonary edema, ineffectiveness of pericardiocentesis, and short-term mortality rate was higher in the LAR group than in the NCT group.

Resolution of chylopericardium after balloon dilatation of tricuspid valve stenosis in a Labrador Retriever.

A 2-year-old 33 kg female castrated Labrador Retriever was referred for exercise intolerance, hyporexia, and abdominal distention. Point-of-care ultrasound revealed ascites, hepatic congestion, severe pericardial effusion, and cardiac tamponade. Pericardiocentesis was performed, and the chylous nature of the fluid was confirmed by cytology, triglyceride, and cholesterol measurements. Repeated pericardiocentesis was necessary within 24-h after admission, after which a pericardial stay-catheter was placed. Cardiac ultrasound revealed severe tricuspid valve stenosis. Balloon dilatation of the stenotic valve was performed, resulting in a significant drop in the mean diastolic trans-valvular Doppler gradient and long-term resolution of the chylopericardium. No other cause for the pericardial effusion could be identified, suggesting that this is the first described case of chylopericardium due to tricuspid valve stenosis.

Septic pericardial disease and mediastinal abscessation in a cat with an intrathoracic needle foreign body.

OBJECTIVE: To describe the successful management of a cat with an intrathoracic sewing needle foreign body and septic pericardial effusion. CASE SUMMARY: A 10-year-old neutered female domestic longhair cat was referred for an intrathoracic metallic foreign body identified via thoracic radiography. Two weeks prior, the cat may have ingested a sewing needle. She was presented hemodynamically unstable; point-of-care thoracic ultrasound identified pericardial effusion with right atrial tamponade. Pericardiocentesis stabilized hemodynamic parameters. The effusion was grossly purulent, and bacterial culture grew an Actinomyces sp. The cat underwent a median sternotomy to remove the foreign body, debride associated mediastinal abscesses, and perform a partial pericardiectomy. Over the next 10 days, the cat was managed in hospital with a left unilateral thoracostomy tube and intermittent lavage of the pleural cavity. The cat was discharged, and follow-up at 7 days showed no evidence of pericardial or pleural effusion. NEW OR UNIQUE INFORMATION PROVIDED: Contrary to previous reports, this case shows that extra-gastrointestinal, specifically intrathoracic, sewing needle foreign bodies can cause significant morbidity in cats. To the authors' knowledge, this report is the first to describe septic pericardial disease resulting from documented foreign body ingestion in the cat. It is also the first case report of successful surgical management of mediastinal abscessation in the cat.

Septic pericarditis caused by a migrating grass awn in a cat.

Septic pericarditis and cardiac tamponade associated with migrating grass awn foreign bodies is reported rarely in companion animals. We report such a case in a previously healthy, 9-year-old, neutered female, indoor-outdoor, domestic long-hair cat who presented for acute tachypnea. Large volume pericardial effusion and pericardial tamponade was identified by thoracic-focused assessment with sonography. Following removal of 108 mL of purulent pericardial effusion by pericardiocentesis, the cat improved. Cytologic examination of pericardial fluid demonstrated septic, suppurative inflammation, Pasteurella sp. was cultured from pericardial effusion, and antibiotics were administered. Subsequent echocardiographic examination revealed large volume pericardial effusion, pericardial thickening, and a linear foreign body within the pericardial space. Whole-body computed tomography confirmed pericardial thickening, pericardial, and pleural effusion. A 16-mm long grass awn was identified within the pericardial space during thoracic exploratory surgery performed through a median sternotomy. Successful foreign body removal and subtotal pericardiectomy was accomplished. Histopathology of pericardial tissue disclosed chronic pericarditis with lymphoplasmacytic-to-pyogranulomatous inflammation, and transmural presence of grass awn foreign body. The cat responded to supportive therapy and was discharged 4 days postoperatively. When examined 3 weeks later, the cat appeared healthy with normal appetite. The cat remained healthy as of this writing, 487 days following surgery. To the author's knowledge, this is the first report in the cat of septic pericarditis and cardiac tamponade resulting from a migrating grass awn foreign body.

Giant pericardial-occupying compressive primary cardiac hemangiosarcoma in a cat.

Hemangioarcoma in the cat is an infrequently diagnosed tumor, and cardiac involvement is rare. We report a previously healthy, 8-year-old, domestic shorthair cat with acute collapse associated with pericardial effusion and cardiac tamponade. Following pericardiocentesis and removal of 15 mL of fluid, the cat improved rapidly. A massive, space-occupying, intrapericardial tumor adhered to and compressing the right atrium and ventricle was detected by echocardiography. Approximately 5 weeks following initial presentation, bicavitary effusion and tachypnea developed, and the cat was euthanized. Necropsy revealed a giant intrapericardial mass adhered to and impinging upon the right heart. Histologic and immunohistochemical examination confirmed hemangiosarcoma with no gross or histologic evidence of metastasis. To the authors' knowledge, this is the first account of a pericardial-occupying, primary feline cardiac hemangiosarcoma resulting in compression of the right heart and cardiac tamponade, Further, this report describes novel clinicopathological relationships between radiographic and echocardiographic findings and gross and microscopic pathology.

Effects of Right Atrioventricular Expanded Polytetrafluoroethylene Path Graft Reconstruction on Arrhythmogenicity and Ventricular Function in Dogs.

Right atrioventricular pericardial autografts, including the coronary groove, may cause myocardial ischemia. Our aim was to explore the effects of this procedure using an expanded polytetrafluoroethylene (ePTFE) patch on arrhythmogenicity and right ventricular function. Four healthy beagles and one client-owned golden retriever with recurrent cardiac tamponade as a result of hemangiosarcoma were included. The four healthy dogs underwent right atrioventricular ePTFE patch graft reconstruction after complete resection of the right auricle. Right ventricular function and arrhythmia were evaluated using tricuspid annular plane systolic excursion and tissue Doppler imaging on echocardiography and Holter electrocardiography, respectively, before and after surgery. The golden retriever underwent right atrioventricular ePTFE patch graft reconstruction followed by resection of the cardiac mass. None of the echocardiographic values, not involving systolic function, changed after surgery in the four healthy dogs. Transient arrhythmias tended to increase 1 day after surgery. The dog with recurrent cardiac tamponade exhibited more severe arrhythmia and required transient antiarrhythmic treatment for 3 days and survived the cardiac tamponade for 434 days after surgery. We showed that an ePTFE patch can serve as a suitable alternative material for right atrioventricular patch graft reconstruction, although transient arrhythmias may occur following surgery.

Retrospective evaluation of pericardial catheter placement in the management of pericardial effusion in dogs (2007-2015):18 cases.

OBJECTIVE: To describe the use of pericardial catheters in dogs with pericardial effusion (PE), and detail any associated adverse events. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Eighteen client-owned dogs that had pericardial catheters placed for pericardial fluid drainage between May 2007 and January 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All pericardial catheters were placed within 5 hours of presentation, usually within 1 hour (median 72.5 min, range 45-300 min). Ten of 18 cases were sedated with butorphanol, and 4 with additional midazolam. Four had pericardial catheters positioned for single drainage only and were immediately removed. The other 14 pericardial catheters remained in situ for a median of 18 hours (range 2-88 h). Ten of the remaining 14 cases were redrained after pericardial catheter placement. The main adverse events reported were new arrhythmias in 6/18 cases, with 4 of these 6 patients being administered anti-arrhythmic therapy. No infectious or functional complications were reported. Ten patients were discharged, 1 died and 7 were euthanized. CONCLUSIONS: Thoracic drainage catheters inserted into the pericardial space via a modified-Seldinger technique can be positioned in dogs to aid management of PEs. The main associated adverse event is arrhythmia. Minimal sedation is required for placement, and dogs tend not to require postprocedural analgesia. Catheters can remain in situ for repeated drainage, potentially decreasing staffing time requirement and repeat sedation. Their use is associated with a rate of arrhythmia requiring treatment of 22%, compared to that of needle pericardiocentesis alone at 13%. They are easy to position using equipment available in many facilities.

Canine leishmaniasis associated with pericardial effusion in a 4-year-old dog.

A 4-year-old crossbreed dog presented with a two-day history of lethargy and abdominal effusion. Physical examination and echocardiography revealed pericardial effusion with cardiac tamponade. Pericardiocentesis was performed. Intracytoplasmic Leishmania amastigotes were found on cytological examination of the pericardial fluid. The animal was treated with N-methylglucamine antimoniate and allopurinol. After an initial favorable response, cardiac tamponade reoccurred one month later. The dog died during a pericardiectomy four months after the initial diagnosis. Histology confirmed the presence of chronic pericarditis. The presence of Leishmania amastigotes on cytological examination of pericardial effusion suggests a possible association between canine leishmaniasis and chronic pericarditis. This finding also supports the importance of cytological examination of pericardial fluid in areas endemic for canine leishmaniasis.

Plasma N-terminal pro-brain natriuretic peptide concentrations before and after pericardiocentesis in dogs with cardiac tamponade secondary to spontaneous pericardial effusion.

OBJECTIVE: To determine if concentrations of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) are increased in dogs with cardiac tamponade and if there is a significant increase in plasma NT-proBNP after pericardiocentesis. ANIMALS: Ten client-owned dogs with spontaneous cardiac tamponade. METHODS: Prospective clinical study. Cardiac tamponade was suspected from physical examination and confirmed with echocardiography. Blood was collected and plasma NT-proBNP concentrations were measured before and 30-60 min following pericardiocentesis and resolution of cardiac tamponade. Within-subject changes in plasma NT-proBNP were compared by the Wilcoxon signed-rank test. RESULTS: The plasma NT-proBNP concentrations measured within the reference interval in seven of 10 dogs before pericardiocentesis and in six of 10 dogs following pericardiocentesis. Following pericardiocentesis, there was a statistically significant increase in median NT-proBNP concentration (733 pmol/L, range 250-3,297) compared with the values measured before (643 pmol/L, range 250-3,210, P = 0.004). The NT-proBNP concentration increased in 90% of the dogs following pericardiocentesis. CONCLUSIONS: An upper reference limit of 900 pmol/L for plasma NT-proBNP is insensitive for the diagnosis of pericardial effusion and cardiac tamponade in dogs. Plasma NT-proBNP concentration commonly increases following pericardiocentesis, perhaps related to improved ventricular filling and stretch.

Evaluation of Pericardial Effusion in Dogs and Successful Treatment Using a Hemodialysis Fistula Needle: A Retrospective Study.

The aim of this retrospective study was to assess epidemiology and echocardiographic findings of pericardial effusion in canine patients and to determine the clinical usefulness and safety of a new pericardiocentesis technique, using a "fistula needle" for hemodialysis. A database of 5304 dogs of different breeds, age, gender, type, and severity of the cardiac disease, referred for a specialist cardiology and echocardiographic examination from 2009-2016, was reviewed. All the dogs were subjected to echocardiography; when possible and required, an echo-guided pericardiocentesis was performed by mean of a 17G "fistula needle" commonly used for hemodialysis. Complete echocardiography was repeated at the end of each pericardiocentesis. Pericardial effusion was identified by echocardiography in 91 dogs (1.71%), 20 were female (21.98%) and 71 were male (78.02%). PE caused cardiac tamponade in 38/91 cases (41.76%). A clear evidence of a neoplasm was found in 33 cases (36.26%). In 32 cases (35.16%) severe degenerative mitral and tricuspid valve disease was detected as the cause of the pericardial effusion. Echo-guided pericardiocentesis was performed in 28 cases (30.77%) with cardiac tamponade. No adverse effects were found in any of the patients during the 48 hours of follow up after pericardiocentesis. This study showed the high incidence of pericardial effusion due to severe bilateral degenerative valve disease in adult to elderly dogs of different breeds. Moreover, the use of a "fistula needle" for pericardiocentesis in dogs showed no adverse effects.

Focal intramural pericardial effusion and cardiac tamponade associated with necrotic adipose tissue in a dog.

CASE DESCRIPTION A 1-year-old castrated male German Shepherd Dog was examined because of an acute onset of lethargy, tachypnea, and inappetence. CLINICAL FINDINGS On initial physical examination, the dog was tachypneic with muffled heart sounds on thoracic auscultation and a palpable abdominal fluid wave. Transthoracic echocardiography revealed focal intramural pericardial effusion and cardiac tamponade. TREATMENT AND OUTCOME The patient underwent emergency therapeutic pericardiocentesis, followed by right lateral intercostal thoracotomy and subtotal pericardiectomy. A 3 × 5-cm mass located between the parietal and visceral layers of the pericardium was resected. The histologic diagnosis was necrotic adipose tissue with granulomatous inflammation and fibroplasia. The patient also underwent exploratory laparotomy and umbilical herniorrhaphy during the same anesthetic episode and recovered from surgery without apparent complications. There were no further clinical signs of cardiac disease. CLINICAL RELEVANCE The patient described in the present report underwent successful subtotal pericardiectomy for treatment of a benign focal lesion causing recurrent pericardial effusion and cardiac tamponade. Prompt diagnosis and intervention may have contributed to the positive outcome in this case.

Thoracic radiographic findings for dogs with cardiac tamponade attributable to pericardial effusion.

OBJECTIVE: To determine the prevalence of various radiographic findings for dogs with cardiac tamponade (CT) attributable to pericardial effusion (PE) and to determine the sensitivity and specificity of such findings for identification of affected dogs. DESIGN: Retrospective, randomized, blinded, controlled study. ANIMALS: 50 dogs with CT attributable to PE and 23 control dogs (10 healthy dogs and 13 dogs with cardiac diseases other than CT). PROCEDURES: Thoracic radiographic images of dogs were evaluated by an observer who was unaware of the dogs' medical histories. For each dog, a vertebral heart score, globoid appearance of the cardiac silhouette, and convexity of the dorsocaudal aspect of the cardiac silhouette were determined. RESULTS: The sensitivity and specificity of enlargement of the cardiac silhouette (vertebral heart score, ≥ 10.7) for identification of dogs with CT attributable to PE were 77.6% and 47.8%, respectively. The sensitivity and specificity of a globoid appearance of the cardiac silhouette for identification dogs with CT were 41.9% and 40.0%, respectively. The sensitivity and specificity of a convex appearance of the dorsocaudal aspect of the cardiac silhouette for identification of dogs with CT were 57.1% and 35.0%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicated none of the evaluated radiographic variables was highly (> 90%) sensitive or specific for identification of dogs with CT attributable to PE. Thoracic radiographic findings should not be considered reliable for identification of dogs with CT attributable to PE.

Echocardiographic findings and clinical signs in dairy cows with primary cardiac lymphoma: 7 cases (2007-2010).

OBJECTIVE: To describe echocardiographic and clinical findings in cattle with cardiac manifestation of lymphoma. DESIGN: Retrospective case series. ANIMALS: 7 adult Holstein dairy cows with cardiac lymphoma. PROCEDURES: Medical and necropsy records of all cows that underwent transthoracic echocardiography from January 2007 through April 2010 because of clinical signs of cardiac diseases or bovine lymphoma were reviewed. The diagnosis of cardiac manifestation of lymphoma was confirmed by necropsy examination or cytologic evaluation of pericardial fluid obtained by pericardiocentesis. RESULTS: Most commonly, cows had clinical signs of right-sided congestive heart failure secondary to cardiac tamponade with moderate to severe anechoic pericardial effusion (5/7 cows). In 2 cows, tachycardia was the only clinical sign in relation to cardiac disease and a heterogenic mass was observed protruding into the right atrium. CONCLUSIONS AND CLINICAL RELEVANCE: The use of transthoracic echocardiography aided in the diagnosis of primary cardiac lymphoma in cows. Transthoracic echocardiography may help to quantify the severity of pericardial effusion and to orient needle placement for pericardiocentesis to determine a final diagnosis. A mass within the right atrium was also suggestive of cardiac lymphoma and should be differentiated from mural bacterial endocarditis.

[Atrial rupture and pericardial effusion as a complication of chronic mitral valve endocardiosis]. / Komplikation der chronischen Mitralendokardiose: Vorhofruptur und Herzbeutelerguss.

A 9-year-old Labrador mixed breed dog, known to suffer from heart disease, was presented. It had recently collapsed on the street. Based on clinical findings and ultrasonography the tentative diagnosis of an atrial rupture with bleeding into the pericardial sac, resulting into a cardiac tamponade, was made. The dog's state of health improved under treatment, including infusion, sedation and analgesia. Therefore pericardiocentesis was unnecessary. The dog was released from hospital the next evening and the medical therapy of its heart disease was continued. The animal died 85 days later.

Repeated pericardiocentesis as palliative treatment for tamponade associated with cardiac lymphoma in a Holstein cow.

Maintaining a good quality of life for cows with cardiac manifestation of lymphoma may be valuable, especially in high-producing cows. This report describes the medical management of cardiac lymphoma in a cow by means of repeated pericardiocentesis. The cow survived for 34 days and was productive.