Left Atrial Mural Thrombosis and Hemopericardium in a Dog with Myxomatous Mitral Valve Disease

A 14-year-old mixed-breed dog with a 2-year history of myxomatous mitral valve disease was examined for collapse and lethargy. At the presentation, pale oral mucous membranes, rapid and weak femoral pulses, and muffled heart sounds with a moderate left apical systolic murmur were revealed. Echocardiographic examination showed pericardial effusion with organized echogenic material originating from the left atrial wall. Tamponade of the right atrium and severe left atrial enlargement were also observed. Multiple views of the left atrium and left auricle allowed to visualize a hyperechoic mass adherent to the endocardium of the left atrial wall. Contrast-enhanced ultrasonography study allowed to rule out active intrapericardial hemorrhages, and echo-guided pericardiocentesis was performed. No recurrence of pericardial effusion was observed, but the dog suddenly died after 10 days. The postmortem examination confirmed multifocal left atrial thrombosis attached to the endomyocardial tears

Prostatic Localization of a Migrating Grass Awn Foreign Body in a Dog

A 13-year-old male mixed-breed dog was examined because of hematuria and pyrexia. Ultrasonographic examination of the genitourinary tract showed the presence of a migrating grass awn in the right prostatic lobe. Laparotomy allowed, under ultrasonographic guidance, to remove entirely the migrating grass awn from the prostatic parenchyma. The recovery was uneventful and four months after the surgery the owner reported that the dog showed the complete resolution of the clinical signs and full return to normal activity. To our knowledge, this case report describes for the first time the clinical presentation, imaging findings, management and outcome for a dog with prostatic localization of a migrating grass awn

Heart rate and blood pressure variations after transvascular patent ductus arteriosus occlusion in dogs

The objective of the study was to retrospectively analyse the cardiovascular effects that occurs following the transvascular occlusion of patent ductus arteriosus in dogs. Sixteen anaesthesia records were included. Variables were recorded at the time of placing the arterial introducer, occlusion of the ductus, and from 5 to 60 min thereafter, including, among the other, heart rate, systolic, diastolic and mean arterial blood pressure. The maximal percentage variation of the aforementioned physiological parameters within 60 min of occlusion, compared with the values recorded at the introducer placing, was calculated. The time at which maximal variation occurred was also computed. Correlations between maximal percentage variation of physiological parameters and the diameter of the ductus and systolic and diastolic flow velocity through it were evaluated with linear regression analysis. Heart rate decreased after occlusion of the ductus with a mean maximal percentage variation of 41.0 ± 14.8% after 21.2 ± 13.7 min. Mean and diastolic arterial blood pressure increased after occlusion with a mean maximal percentage variation of 30.6 ± 18.1 and 55.4 ± 27.1% after 19.6 ± 12.1 and 15.7 ± 10.8 min, respectively. Mean arterial blood pressure variation had a significant and moderate inverse correlation with diastolic and systolic flow velocity through the ductus. Transvascular patent ductus arteriosus occlusion in anaesthetised dogs causes a significant reduction in heart rate and an increase in diastolic and mean blood arterial pressure within 20 min of closure of the ductus

Transesophageal echocardiography as the sole guidance for occlusion of patent ductus arteriosus using the Amplatz® Canine Ductal Occluder in dogs: a preliminary study.

Transesophageal echocardiography (TEE) has proven useful in evaluating patent ductus arteriosus (PDA) morphology thereby guiding appropriate device selection. Additionally, TEE, in combination with fluoroscopy, has been used to guide the transcatheter coil embolization and for deployment of Amplatz Canine Ductal Occluder (ACDO) in dogs. Recently, we described the use of transthoracic echocardiography (TTE) guidance during transcatether PDA occlusion with ACDO without the use of fluoroscopy, but observed problems of deployment in patients with sub-optimal acoustic windows. However, TEE, can overcome issues of sub-optimal TTE acoustic windows and provides higher image resolution of cardiac and vascular regions. Therefore, we hypothesized that TEE could be used to successfully visualize the vascular structures and interventional devices to safely perform PDA occlusion with ACDO without requiring fluoroscopy.We recruited 5 dogs with patent ductus arteriosus (PDA) for TEE-guided percutaneous ductal occlusion with an ACDO. Dogs were anesthetized, positioned in right lateral recumbency and the right femoral artery was accessed percutaneously (modified Seldinger technique). The TEE probe was advanced to a midesophageal position with minimal force to obtain a long axis 4-chamber view (transverse plane). The probe was then retroflexed and withdrawn to a cranial esophageal position until a cross section of the descending aorta was seen. To visualize PDA to the probe was slightly straightened and turned counterclockwise, and the ultrasonic beam was oriented between 60 and 120 degrees.In all dogs, the guide wire and a long introducer-sheath were guided from the aorta through the PDA into the main pulmonary artery by TEE monitoring. The ACDO was advanced through the introducer-sheath until the flat distal disk was visualized within the main pulmonary artery by TEE monitoring. The distal disk was positioned against the pulmonic ostium and the coupled proximal disk was deployed within the ductal ampulla while being monitored by TEE visualization.The guide wires, long introducer-sheath and ACDO appeared hyperechoic on TEE images and TEE guidance provided images of sufficient quality to clearly monitor the procedures in real-time. Real-time monitoring also allowed for immediate corrections to guide wire, catheter or device positioning. The procedures were successful and without complications in all patients.We have demonstrated that TEE monitoring, like TTE monitoring, can guide every step of transcatheter ACDO embolization procedures without requiring fluoroscopy, thereby avoiding radiation exposure, and provides an alternative to TTE-based guidance, especially when TTE visualization of the PDA is insufficient for safe and timely ACDO deployment

Transesophageal echocardiography as the sole guidance for occlusion of patent ductus arteriosus using the Amplatz® Canine Ductal Occluder in dogs: a preliminary study.

Transesophageal echocardiography (TEE) has proven useful in evaluating patent ductus arteriosus (PDA) morphology thereby guiding appropriate device selection. Additionally, TEE, in combination with fluoroscopy, has been used to guide the transcathete 2012 ECVIM Abstracts 1515 coil embolization and for deployment of Amplatz Canine Ductal Occluder (ACDO) in dogs. Recently, we described the use of transthoracic echocardiography (TTE) guidance during transcatether PDA occlusion with ACDO without the use of fluoroscopy, but observed problems of deployment in patients with sub-optimal acoustic windows. However, TEE, can overcome issues of suboptimal TTE acoustic windows and provides higher image resolution of cardiac and vascular regions. Therefore, we hypothesized that TEE could be used to successfully visualize the vascular structures and interventional devices to safely perform PDA occlusion with ACDO without requiring fluoroscopy.We recruited 5 dogs with patent ductus arteriosus (PDA) for TEE-guided percutaneous ductal occlusion with an ACDO. Dogs were anesthetized, positioned in right lateral recumbency and the right femoral artery was accessed percutaneously (modified Seldinger technique). The TEE probe was advanced to a midesophageal position with minimal force to obtain a long axis 4-chamber view (transverse plane). The probe was then retroflexed and withdrawn to a cranial esophageal position until a cross section of the descending aorta was seen. To visualize PDA to the probe was slightly straightened and turned counterclockwise, and the ultrasonic beam was oriented between 60 and 120 degrees.In all dogs, the guide wire and a long introducer-sheath were guided from the aorta through the PDA into the main pulmonary artery by TEE monitoring. The ACDO was advanced through the introducer-sheath until the flat distal disk was visualized within the main pulmonary artery by TEE monitoring. The distal disk was positioned against the pulmonic ostium and the coupled proximal disk was deployed within the ductal ampulla while being monitored by TEE visualization.The guide wires, long introducer-sheath and ACDO appeared hyperechoic on TEE images and TEE guidance provided images of sufficient quality to clearly monitor the procedures in real-time. Real-time monitoring also allowed for immediate corrections to guide wire, catheter or device positioning. The procedures were successful and without complications in all patients.We have demonstrated that TEE monitoring, like TTE monitoring, can guide every step of transcatheter ACDO embolization procedures without requiring fluoroscopy, thereby avoiding radiation exposure, and provides an alternative to TTE-based guidance, especially when TTE visualization of the PDA is insufficient for safe and timely ACDO deployment