THORACIC RADIOGRAPHIC ABNORMALITIES IN 200 DOGS WITH SPONTANEOUS HEARTWORM INFESTATION

Thoracic radiographs of 200 dogs with spontaneously occurring heartworm disease were reviewed. Radiographs of 28 dogs (14%) were normal. In the remaining 172 dogs various combinations of cardiopulmonary abnormalties were found. The most frequently observed combination, noted in 61 of 200 dogs, was right ventricular, main pulmonary, and right cranial lobar pulmonary artery enlargemetn. Dogs with severe increse of one parameter generally had severe increase of the other two parameters also. One hundred five of the 200 dogs had a right cranial lobar pulmonary artery of normal size. Thus, right cranial lobar pulmonary artery size, when normal, is not a sensitive indicator of the absence of heartworm disease. There was a statistically significant positive relation between the size of the caudal vena cava and that of the right ventricle.     

RADIOGRAPHIC AND ANGIOGRAPHIC EVALUATIONS OF FERRETS EXPERIMENTALLY INFECTED WITH DIROFILARIA IMMITIS

Five ferrets of each sex were each inoculated with 15 third-stage infective larvae of Dirofilaria immitis to study radiographic and angiographic changes in the cardiopulmonary system following heartworm infection; 5 additional ferrets of each sex served as noninfected controls. Prior to inoculation and every 8 weeks thereafter until 40 weeks, the infected and noninfected ferrets were radiographed; angiographic examinations were done prior to necropsy. At necropsy, the worms in the heart, lungs, and associated vessels were counted, and lung histosections were prepared and examined for changes. Radiographic changes were seen in the right side of the heart and associated vessels of infected ferrets as compared with the noninfected ferrets, but changes were less prominent than those seen in heartworm-infected dogs and cats. The changes were primarily an increase in the size of the right side of the heart, especially the right atrium. Radiographically, no changes could be visualized in the pulmonary vascular system. Worms in the enlarged cranial vena cava, azygous vein, and left caudal lobar pulmonary artery of infected animals were delineated by angiography. Histologically, no changes were seen in the pulmonary vascular tissues.     

COMPUTED TOMOGRAPHY ANGIOGRAPHY FOR EVALUATION OF PULMONARY EMBOLISM IN AN EXPERIMENTAL MODEL AND HEARTWORM INFESTED DOGS

This study was performed to characterize pulmonary embolism with computed tomography pulmonary angiography in experimental pulmonary embolism and heartworm infected dogs. In the experimental group, there were pulmonary changes after pulmonary embolism induction as follows: hypoattenuating round filling defects in pulmonary arteries, arterial dilations with straight and abrupt cut‐off appearances in the pulmonary embolism regions, pulmonary infarctions, a cavity formation and spontaneous pneumothorax, and emboli migration. In the heartworm‐infected group, three out of eight dogs developed pulmonary embolism, especially in the right caudal arteries. Arterial dilations with typical tortuosity were also identified, mainly in the right caudal arteries in five dogs. Computed tomography pulmonary angiography can be an important imaging modality in the diagnosis of pulmonary embolism and the evaluation of pulmonary arterial and parenchymal changes in dogs.     

Pulmonary vascular response of dogs with heartworm disease.

Heartworm diseases in dogs is an infectious disease that produces pulmonary hypertension. Dogs with the early vascular changes of heartworm disease, but without the clinical cardiopulmonary signs and pulmonary hypertension, were studied. Dogs with early heartworm were identified that had an exaggerated hypertensive response to hypoxia and to postaglandin F2alpha as compared to those of normal dogs. The pulmonary hypertensive response of dogs with spontaneous heartworm disease varied widely between individuals.     

Investigation of Caval Syndrome in Dogs Experimentally Infected With Dirofilaria immitis

Nine of 16 dogs inoculated with 200 infective heartworm larvae developed caval syndrome (CS) of heartworm disease (HWD). There was no difference between dogs that did and did not develop CS with regard to total heartworm burden, burden relative to body weight, or female heartworm burden, indicating that factors other than worm mass are involved in the pathogenesis of CS. Male dogs were twice as frequently affected as females, although this finding was not statistically significant. Dogs afflicted with CS exhibited radiographic, pathologic, and hemodynamic evidence of chronic HWD. In a model of single heartworm exposure, these findings strongly support the theory that CS develops due to retrograde migration of adult worms from the pulmonary arteries and right ventricle to the right atrium and venae cavae. Pulmonary artery pressures were dramatically and significantly greater in dogs with CS (60 +/- 18 torr) as compared to non-CS (30 +/- 4 torr) dogs with equal worm burdens.     

MEASUREMENTS OF THE PULMONARY VASCULATURE ON THORACIC RADIOGRAPHS IN HEALTHY DOGS COMPARED TO DOGS WITH MITRAL REGURGITATION

This study reassessed the previously reported radiographic method of comparing pulmonary vessels versus rib diameter for differentiating healthy dogs and dogs with mitral regurgitation. The width of the right cranial pulmonary artery and vein at the fourth rib level, right caudal pulmonary artery and vein at the ninth rib level, and the diameters of the fourth rib and ninth rib were measured in prospectively recruited healthy dogs (n = 40) and retrospectively recruited dogs with mitral regurgitation (n = 58). In healthy dogs, the pulmonary arteries and accompanying veins were similar in size. The cranial lobar vessels were smaller than the fourth rib. However, 67.5% of right caudal pulmonary artery diameters and 65% of vein diameters were larger than the ninth rib in healthy dogs. The right caudal pulmonary vein diameter in dogs with mitral regurgitation, particularly those within moderate and severe grades, was significantly larger than that in healthy dogs (P < 0.001). The comparative method used to detect enlargement of the right caudal pulmonary vein relative to the accompanying pulmonary artery had the highest sensitivity (80.2%) and specificity (82.5%) for predicting mitral regurgitation. A cut‐off of 1.22 when applying the ninth rib criterion had better specificity (73%) than the most used value ≤ 1 (89.7% sensitivity and 63.8% specificity), although it has less sensitivity (73%). We recommend using the accompanying pulmonary artery and 1.22 × the diameter of the ninth rib as a radiographic criterion for assessing the size of the right caudal pulmonary vein and differentiating healthy dogs from those with mitral regurgitation.     

Pulmonic stenosis in the dog: 29 cases (1975-1984)

In a retrospective study of 29 dogs with congenital pulmonic stenosis, we evaluated the clinical, radiographic, angiocardiographic, and cardiac catheterization data. Eighteen dogs had no clinical signs of disease and were referred for evaluation of a previously detected cardiac murmur, 5 dogs had congestive right-sided heart failure, and 5 dogs were examined for exercise intolerance or syncope. Dogs with heart failure tended to be older than dogs without clinical signs of heart failure (19.3 months vs 12 months). All dogs had radiographic or electrocardiographic evidence of right ventricular enlargement. Poststenotic dilatation of the main pulmonary artery and apparent pulmonary undercirculation were observed frequently on survey radiographs. Isolated pulmonic valve dysplasia, representing a range of angiographic pulmonic valve abnormalities, was evident in 88% of the available 26 angiographic studies, whereas subvalvular stenosis was uncommon and observed in only 2 dogs. Muscular hypertrophy of the right ventricular infundibulum and supraventricular crest were observed in 96% and 25% of the angiocardiograms, respectively. Poststenotic dilatation of the main pulmonary artery was observed in every dog. A ratio between the width of the main pulmonary artery and the valve annulus was useful in identifying pulmonic stenosis and distinguishing this anomaly from other congenital malformations. The degree of poststenotic dilatation did not appear to be related to the severity of the systolic pressure gradient, which ranged from 20 to 228 mm of Hg (mean, 93 mm of Hg).(ABSTRACT TRUNCATED AT 250 WORDS)     

Scintigraphic evaluation of pulmonary perfusion in dogs experimentally infected with Dirofilaria immitis

Pulmonary arterial perfusion was evaluated by perfusion lung scans in ten dogs experimentally infected with heartworm. After larval inoculation, scans were done once a month for 11 months. In 8 of 10 dogs, pulmonary arterial perfusion deficits were detected. The perfusion deficits involved the left cranial, right cranial, and right caudal lung lobes. Generally, there was a poor correlation between vascular abnormalities detected on the survey thoracic radiographs and the perfusion deficits detected by lung scanning. The perfusion deficits did not produce clinical signs or pulmonary infarction.     

Two-dimensional echocardiography for diagnosis of dirofilariasis in nine dogs

Two-dimensional echocardiography (real-time ultrasonography) of the heart was used to detect adult Dirofilaria immitis in the right ventricle and atrium of a 2-year-old Labrador Retriever with occult heartworm disease and in 8 microfilaremic dogs. Adult worms were easily identified as parallel echogenic lines separated by a hypoechoic region. Images of worms fixed in formalin after recovery from dogs with experimentally induced heartworm infection had an identical appearance. The sensitivity of this imaging procedure was tested on the 8 dogs with naturally acquired infection, and worms were observed in the right ventricle of 7 of the dogs. Two-dimensional echocardiography appears to be a sensitive noninvasive procedure, which can be used in combination with thoracic radiography and serotests to improve accuracy of diagnosis of canine occult heartworm disease.     

Pulmonary Arteriography and Hemodynamics During Feline Heartworm Disease

The ability of aspirin to block arterial disease and thromboembolism of the pulmonary arteries was studied in heartworm-infected cats. Three groups of cats were transplanted with four heartworms per cat and studied. One group of eight cats (aspirin group) received aspirin (97.5 mg, twice a week) for the five-month infection and another group of eight cats served as the nontreated control group (nontreated group). Based upon the results of the first two groups, the third group (adjusted aspirin group) of six cats was studied in which the aspirin dosage was adjusted in order to maintain an inhibition of in vitro platelet aggregation. Cats were studied by nonselective pulmonary arteriograms before heartworm transplantation and by selective arteriograms, aortograms, and pulmonary hemodynamics five months after heartworm transplant. Pulmonary hypertension, (mean pulmonary artery pressures greater than 16 mmHg), was discovered in three cats with one cat in each group. There were no differences in the mean pulmonary artery pressure or vascular resistance between the groups. Many of the arterial diameters for the nontreated and aspirin groups were greater after the five-month infection than before heartworm infection. All of the postinfection caudal arteries were tortuous and had aneurysms. Some of the caudal lung lobes had perfused areas that appeared to have a hypervascular microvasculature. The proportion of obstructed right and left distal caudal pulmonary arteries and the resulting nonperfused area of the caudal lung lobe in the nontreated and aspirin treated groups were each greater than in the adjusted aspirin group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous heartworm removal from dogs with severe heart worm (Dirofilaria immitis) infestation

Canine heart worm disease is often life-threatening due to its various complications, including right side heart failure, caval syndrome and pulmonary eosinophilic granulomatosis. Several preventive medications and melarsomine have been developed and they are very effective to control heartworm infestation. However, in a case of severe infestation, melarsomine therapy often results in an unfavorable outcome because of the severe immune reaction caused by rapid killing of the adult worm. Surgical removal and an interventional method using flexible alligator forceps have been well described in the literature. Despite the usefulness of mechanical removal using flexible alligator forceps, the methodology still needs to be upgraded for increasing the applicability for treating dogs with severe infestation. We describe herein a newly developed percutaneous removal method for heartworms and this was successfully applied to 4 dogs with severe heartworm infestation. The follow-up studies also showed favorable outcomes with no complications.     

Congenital cardiac disease in dogs

Patent ductus arteriosus (PDA) is thought to be inherited and occurs twice as often in females as in males, most commonly in Poodles, Collies, Cocker Spaniels and Shetland Sheepdogs. About half of untreated dogs develop left-sided heart failure by 8 months of age. Clinical signs include coughing, decreased exercise tolerance, pulmonary edema, a "machinery" murmur in the pulmonic-aortic region, and a bounding pulse. An ECG may reveal an increased amplitude of the R wave and a lengthened P wave. Plain LAT films reveal loss of the cranial and caudal cardiac waists, increased sternal contact of the heart, increased width and straightened caudal border of the cardiac silhouette, elevated carina, and an enlarged left atrium. Changes on plain DV films include an elongated cardiac silhouette, enlarged right ventricle, and 3 bulges on the left side of the cardiac silhouette. Nonselective angiocardiography can be used for a definitive diagnosis and to demonstrate a reverse right-to-left PDA, in which the ascending aorta, brachiocephalic trunk and left subclavian artery are not opacified by contrast medium. Animals with a right-to-left shunt PDA are cyanotic in caudal body parts. Treatment of left-to-right shunt PDA involves ligation with 2 nonabsorbable sutures. A right-to-left shunt PDA should not be ligated but is treated by restricted exercise and periodic phlebotomy.     

Cardiopulmonary values in dogs with artificial model of caval syndrome in heartworm disease.

Cardiopulmonary values were determined in dogs with an artificial model of heartworm caval syndrome, which was produced by insertion of heartworm-like silicone tubes into the tricuspid valve orifice and right atrium. Fifteen to 25 tubes with some knots were inserted in 6 dogs (knot group), and 7 to 11 tubes (small-number group) or 29 to 37 tubes (large-number group) without a knot in 3 dogs, respectively. After tube insertion, angiographic contrast medium infused into the right ventricle regurgitated to the right atrium in all cases, and the regurgitation was the most severe in the large-number group. On electrocardiographic findings, the atrial and/or ventricular premature beat developed. The height of a- and v-wave of right atrial pressure curves elevated in all groups. The elevation in v-wave was obvious in the large-number group. The pulmonary arterial pressure tended to fall or to elevate slightly, and total pulmonary resistance increased in all groups. The right cardiac output decreased significantly in all cases. The right heart hemodynamics of the model might resemble those in spontaneous cases without disturbed pulmonary circulation.     

Aberrant migration and surgical removal of a heartworm (Dirofilaria immitis) from the femoral artery of a cat

A cat was evaluated for an acute‐onset of right pelvic limb paresis. Thoracic radiographs revealed normal cardiac size and tortuous pulmonary arteries. Abdominal ultrasound identified a heartworm (HW) extending from the caudal abdominal aorta into the right external iliac artery and right femoral artery. The cat was HW‐antigen positive. Echocardiography revealed a HW within the right branch of the main pulmonary artery and evidence of pulmonary hypertension. An agitated‐saline contrast echocardiogram revealed a small right to left intracardiac shunt at the level of the atria. Surgical removal of the HW was performed with no substantial postoperative complications. There was return of blood flow and improved motor function to the limb. The cat remains mildly paretic on the affected limb with no other clinical signs.     

Echocardiographic diagnosis of dirofilariasis in a ferret

Heartworm disease is described in a 14-month-old neutered female ferret (Mustela putorius furo) which had a three-week history of sneezing, anorexia and dyspnoea. Echocardiography revealed the presence of heartworms as hyperechoic densities within the right atrial and ventricular cavities. At necropsy, four Dirofilaria immitis parasites (three females, one male) were found in the right heart, the cranial vena cava and the caudal vena cava. Histopathological findings were similar to those reported in canine heartworm disease. Echocardiography may be a useful method of diagnosis of heartworm disease in the ferret.     

Use of computed tomography and silicon endocasts to identify pulmonary veins with echocardiography

The pulmonary veins were identified from the silicone endocast heart models of 19 dogs. Although variation in the number of the more peripheral veins on each specimen existed, all of the casts had a consistency with regards to the most proximal coalescence of the pulmonary veins as they entered the body of the left atrium. That is, the confluence of the veins formed three ostia at the atrial entry point that consisted of 1) right cranial and right middle pulmonary lobe veins; 2) right caudal, accessory, and left caudal pulmonary lobe veins; and 3) both the left cranial and left caudal pulmonary lobe veins of the left cranial lung lobe. The location of these structures identified by the 3-dimensional endocasts were then used to assist in the identification of the pulmonary veins using computed tomography of 2 dogs. Slices were made that approximated those commonly performed during echocardiographic examination. Understanding which pulmonary veins are seen by echocardiography in the different imaging planes will permit prospective evaluations of pulmonary vein size and abnormal flow patterns.     

Clinical and laboratory observations in 91 dogs infected with Dirofilaria immitis in northern Greece

The medical records of 91 dogs with heartworm (Dirofilaria immitis) infection were reviewed, and diagnoses were established by using parasitological and immunological methods. Twenty-one animals were asymptomatic (stage I), 57 had mild to moderate clinical signs (stage II), and 13 had the severe form of the disease including right congestive heart failure and the caval syndrome (stage III). Thoracic radiography revealed right ventricular enlargement in 38 of the dogs, pulmonary vascular enlargement in 43, and parenchymal lesions in 27. Only the cardiac and vascular changes were correlated positively with the clinical stages. D. immitis microfilaraemia was detected in 75 of 85 dogs. Occult infection occurred only in eight stage II and two stage III dogs. Thirty-two of the dogs were treated with thiacetarsamide and 39 were treated with melarsomine, and no differences were found in terms of drug efficacy or complication rate; nine stage II dogs suffered pulmonary thromboembolism and one suffered acute liver disease and there were six fatalities. The 50 treated dogs in stages II and III which were followed up for six months all recovered completely. The performance of 38 of 61 working dogs was completely restored, and the performance of another four was partially restored.     

A clinical study on velocity patterns of pulmonary venous flow in canine heartworm disease

In this study, we evaluated methods of determining the velocity patterns of pulmonary venous flow (PVF) in dogs and then investigated the relationship of the patterns to cardiac functions in heartworm disease (HD) by transthoracic echocardiography (TTE). The results revealed that there was a good correlation between PVF patterns determined by transesophageal echocardiography (TEE) and TTE in animals lying on their left sides. The measurement of S and D wave velocities (PVS and PVD) by TTE was shown to allow clinical determination of the velocity patterns of PVF in dogs. The HD groups showed significant increases in PVS and PVD, and S and D wave time-velocity integrals (S-TVI and D-TVI) of the right cranial lobe PVF, when compared with the normal group, as determined by TTE (P<0.05). In contrast, the HD groups produced significant decreases in PVD and D-TVI of the right caudal lobe PVF compared with the normal group (P<0.05), and a significant increase in the ratio of S-TVI to (S-TVI + D-TVI) (P<0.05). It is, therefore, suggested that measurement of the velocity patterns of the right cranial and caudal lobe PVF could be one method of assessing the stages of obstructive lesions in the pulmonary artery.     

CARDIAC AND PULMONARY ARTERY MENSURATION IN FELINE HEARTWORM DISEASE

A retrospective study was undertaken to quantify thoracic radiographic changes in cats with heartworm diseases, ( Dirofilaria immitis ). Using a blinded study format, the cardiac silhouette, thoracic cavity and pulmonary arteries were measured from thoracic radiographs of 21 cats with feline heartworm disease and 30 cats without known cardiac or pulmonary vessel pathology. Measured data were normalized to the thoracic cavity or bony structures within the radiographic field of view. The measurements were compared between the two groups of cats using an unpaired, two-tailed Student's t -test, with a p value of < 0.05 being considered significant. Cats with feline heartworm disease had enlargement of the craniocaudal aspect of the cardiac silhouette and normalized cardiac:thoracic ratio (p < 0.05) on the lateral view. Also, there was significant enlargement of the central and peripheral caudal lobar pulmonary arteries and their normalized ratios (p < 0.05) in the heartworm infected cats as visualized on the ventrodorsal projection. Tortuosity of the pulmonary arteries was seen in three of the 21 infected cats. Eleven of the 21 cats with feline heartworm disease had pulmonary parenchymal changes. Based on the present study, central and peripheral pulmonary artery enlargement as viewed on the ventrodorsal radiograph was the single best radiographic indicator of feline heartworm disease.