Assessment of survey radiography as a method for diagnosis of congenital cardiac disease in dogs.

In order to assess the diagnostic accuracy of survey radiography for canine congenital cardiac anomalies, thoracic radiographs of 57 dogs with congenital cardiac anomalies, 31 normal dogs and 27 dogs with acquired cardiac disease were mixed, and reviewed by two independent observers, who were blinded to any patient information. The congenital anomalies were aortic stenosis (n=25), pulmonic stenosis (n=10), patent ductus arteriosus (n=9), ventricular septal defect (n=8), tricuspid dysplasia (n=3) and mitral dysplasia (n=2). Both observers were moderately accurate at identifying dogs with cardiac disease. Their ability to distinguish dogs with congenital versus acquired cardiac disease was poorer and this assessment was probably influenced by the recognition of patients that were skeletally immature, which biased observers towards a diagnosis of congenital cardiac anomaly. The diagnosis rate for specific congenital anomalies was also poor (the differential list included a correct diagnosis in only 40 and 37 per cent of cases). Radiographic signs of specific cardiac chamber enlargement or pulmonary vascular abnormalities were recognised by both observers in only 20 per cent of instances in which they might be expected. They were, however, recognised more frequently in dogs with anomalies that imposed a volume load on the heart than in dogs with anomalies that induced a pressure load on the organ. It is concluded that survey radiography is an inaccurate method for diagnosis of canine congenital cardiac anomalies because of the difficulty of recognising radiographic signs, which are not present in many cases.     

Hereditary congenital heart defects in dogs

Congenital heart defects is probably the most common class of malformations found in dogs, occurring with a frequency approaching 1 per cent in animals presented to veterinary clinics. The frequency is significantly higher among purebred dogs than in dogs of mixed breeding and specific anatomic malformations occur with highest frequency in certain breeds. Genetic studies of patent ductus arteriosus, pulmonic stenosis, subaortic stenosis, ventricular septal defect, tetralogy of Fallot and persistent aortic arch have confirmed that these are specific heritable defects, the genes for which are concentrated in a number of different breeds. Each of these defects is inherited in a complex manner consistent with a polygenic basis. This paper will describe evidence supporting the view that the common forms of congenital heart disease in the dog are polygenic threshold traits. The general criteria for recognition of polygenic traits and methods for their control will be discussed.     

Partial atrioventricular canal defect in a dog

A case of a partial atrial canal defect is described in a nine-month-old female English setter. The patient had a large ostium primum atrial septal defect and a concurrent malformation of the mitral valve. Electrocardiographic and radiographic findings were suggestive of marked enlargement of the right heart and pulmonary overcirculation. Definitive diagnosis and assessment of the haemodynamic consequences were made using echocardiography. The magnitude of the left-to-right intracardiac shunt was estimated by measuring the pulmonary to systemic flow ratio (Qp/Qs) from Doppler-derived pulmonary and aortic blood flow. The results of this report suggest that dogs with a partial atrioventricular canal defect and concurrent mild mitral regurgitation may exhibit no clinical signs during the first years of life, even in cases with a Qp/Qs ratio of greater than 2.     

Dysplasia of the tricuspid valve in the dog and cat.

Dysplasia of the tricuspid valve in 14 dogs and 13 cats was studied. The clinical, electrocardiographic, radiographic, hemodynamic, angiocardiographic, and pathologic findings were reviewed in each species. Alterations of the tricuspid valve complex included long, thick septal leaflets adhered to the septum; absent or short, stout fused chordae tendineae; hypertrophic fused papillary muscles; insertion of papillary muscles directly into the lateral leaflets; incomplete development of the valvular tissue; and enlargement of the right atrium and ventricle. Additional intracardiac anomalies included malformation of the mitral valve complex (5 dogs and 3 cats), ventricular septal defect (3 dogs and 3 cats), pulmonary stenosis (1 dog and 1 cat), aortic stenosis (1 dog and 1 cat), and persistent left cranial vena cava (1 dog).     

Progression of aortic stenosis in the boxer

Thirty-five boxers that had been referred to the Royal (Dick) School of Veterinary Studies between 1989 and 1994 with left heart base murmurs and aortic velocities greater than 1.5 m/second on Doppler echocardiography were recalled for clinical examination and Doppler echocardiography between 1995 and 1996. Five dogs (14 per cent) showed an increase in murmur grade on repeat visit. Six dogs (17 per cent) showed an increase in aortic velocity of greater than 20 per cent. Eight dogs (23 per cent) had developed aortic valvular or subvalvular two-dimensional echocardiographic changes that had not been present at the initial visit. Seven dogs (20 per cent) had developed aortic regurgitation, and three dogs (8 per cent) mitral regurgitation.     

Review of left-to-right shunting patent ductus arteriosus and short term outcome in 98 dogs

The case records of 98 dogs with a left-to-right shunting patent ductus arteriosus (PDA) were reviewed. There were 35 breeds represented, with a female to male ratio of 3:1. Forty per cent of the dogs were older than one year at initial presentation and 31 per cent had clinical signs attributable to PDA. A left heart base continuous murmur of grade IV/VI or higher was noted in 90 per cent of the dogs. On electrocardiography, the most common abnormalities were tall R waves (63 per cent) and deep QII waves (62 per cent). The radiographic triad of dilation of the descending aorta with enlargement of the main pulmonary artery segment and left atrium, typical of PDA, was noted in only 26 per cent of cases. Two-dimensional (2D) and M-mode echocardiography detected left atrial enlargement (35 per cent) and an increased left ventricular diameter in diastole (82 per cent) and systole (84 per cent) as the most common abnormalities. Doppler echocardiography demonstrated increased aortic outflow velocities in 66 per cent of cases. The overall short-term successful outcome in this study was 95 per cent. There was no significant difference between surgical ductal ligation using a standard technique or the Jackson-Henderson technique in terms of survival, occurrence of haemorrhage or residual shunting. The number of interventional procedures used in this study was too low for statistical comparison, but there appeared to be a trend towards a higher rate of residual shunting and a lower fatality rate using a coil occlusion technique.     

Malformation of the canine mitral valve complex.

Twenty-nine dogs, including 13 Great Danes and 5 German Shepherd Dogs and averaging 7.3 months age, were diagnosed clinically and radiographically as having mitral regurgitation. Alterations of the mitral valve complex included enlarged anulus; short thick leaflets, with an occasional cleft; short and stout or long and thin chordae tendineae; upward malposition of atrophic or hypertrophic papillary muscles; insertion of one papillary muscle directly into one or both leaflets; and diffuse endocardial fibrosis, occasionally with jet lesions in te left atrium. Other cardiac anomalies included dysplasia of the tricuspid valve (5 dogs), patent ductus afteriosus (2 dogs), aortic stenosis (2 dogs), and ventricular septal defect (1 dog).     

Transcatheter closure of aneurysmal perimembranous ventricular septal defect with the canine duct occluder in two dogs

Congenital membranous ventricular septal aneurysm has been reported in dogs and can be associated with a perimembranous ventricular septal defect (VSD). The windsock-like ventricular septal aneurysm is formed by tissue of the membranous ventricular septum and portions of the septal leaflet of the tricuspid valve. We report two dogs that underwent transcatheter closure of perimembranous VSD associated with membranous ventricular septal aneurysm using a commercial device marketed for transcatheter closure of patent ductus arteriosus, the canine duct occluder. Partial closure was achieved in the first dog with reduction in left heart dimensions documented on echocardiography both at one day and nine months after procedure. In the second dog, three-dimensional transesophageal echocardiography, cardiac computed tomography, and a three-dimensionally printed whole heart model were used to evaluate feasibility for transcatheter device closure. Complete closure of the VSD was subsequently achieved. Both cases had good short- to medium-term outcomes, no perioperative complications were observed, and both dogs are apparently healthy and receiving no cardiac medications at 34 months and 17 months after procedure. Transcatheter attenuation of perimembranous VSD with membranous ventricular septal aneurysm is clinically feasible using the canine duct occluder, and multimodal cardiac imaging allows accurate assessment and planning prior to transcatheter intervention for structural heart disease in dogs.     

Ventricular septal defect with aortic valve insufficiency in a New Zealand White rabbit

A heart murmur was detected in a 10 mo old, female New Zealand White rabbit. Auscultation revealed cardiac murmurs both at the left and right hemithorax. Phonocardiography confirmed the systolic-diastolic nature of the left-sided and the systolic character of the right-sided murmur. Electrocardiography showed normal sinus rhythm; tall R waves and large T waves in lead II; and deep S waves in leads II, III, and aVF. Thoracic radiography demonstrated generalized cardiomegaly with prominent pulmonary vasculature. Echocardiography revealed a perimembraneous ventricular septal defect with aortic insufficiency. Signs of biventricular volume overload, relative pulmonic stenosis, and pulmonary valve insufficiency were also seen as consequences of the defect. Necropsy demonstrated a ventricular septal defect just below the aortic valve, a dilated pulmonary trunk, dilated and hypertrophied ventricles, dilated atria, and rightward displacement of the aortic root. Cardiac histopathology showed ventricular cardiomyocyte degeneration (swelling and hypereosinophilia of the cytoplasm with a loss of cross striation, and nuclear hyperchromasia), cartilaginous metaplasia of the aorta, and subendocardial fibrosis of the right ventricular flow tract.     

Congenital Quadricuspid Aortic Valve Anomaly in Two Dogs

A congenital quardricuspid aortic valve (QAV) was detected in two one year-old male dogs. This defect has not previously been reported in dogs. In both cases, the diagnosis was made by two-dimensional echocardiography performed to investigate the cause of a soft heart murmur. On the short-axis of a two-dimensional echocardiogram, the commissures of the QAV produced an “X” configuration of the valve during diastole in contrast to the “Y” configuration observed in dogs with a normal semilunar valve. Color flow Doppler studies indicated mild aortic regurgitation in both dogs, neither of which evidenced signs of disability. Subsequent necropsy of one of the dogs confirmed the presence of QAV.     

Transthoracic echocardiography in Estrela Mountain dogs: reference values for the breed

Of 100 Estrela Mountain dogs, 74 were examined to obtain echocardiographic reference values for the breed. The influence of bodyweight, age and sex on different echocardiographic parameters was studied using either analysis of variance or regression analysis. Statistically significant differences were found between sex and heart rate as well as interventricular septal thickness at end-systole and left ventricular internal dimension at end-diastole. A statistically significant linear correlation was also found between several parameters and (1) age (mean arterial pressure, left ventricular internal dimension at end-systole, fractional shortening, circularity index in systole, aortic valve velocity time integral, pulmonic valve velocity time integral and mitral valve E wave peak velocity), (2) weight (left ventricular posterior wall thickness at end-diastole and end-systole, end-diastolic volume index, left atrium diameter, aortic valve peak velocity and mitral valve E wave deceleration time), (3) sex and age (left ventricle end-diastolic volume), and (4) sex and weight (aortic root diameter and pulmonic valve peak velocity). Reference values for the breed are presented, as well as dispersion graphics for selected parameters, based on a regression equation.     

Epidemiological, clinical, haematological and biochemical characteristics of canine hypothyroidism

Hypothyroidism was diagnosed in 50 dogs and excluded in 86 dogs suspected of hypothyroidism, on the basis of the results of bovine thyrotropin response tests. Breed, pedigree, sex or neutering status did not significantly influence the likelihood of the dogs being hypothyroid. The hypothyroid dogs were significantly older than the non-hypothyroid dogs referred to the University of Glasgow during the same period. However, when dogs under two years of age were excluded from the statistical analyses there was no significant difference in age between the two groups. The most common clinical characteristics associated with hypothyroidism were metabolic signs (84 per cent of cases), particularly lethargy (76 per cent), obesity or weight gain (44 per cent), and exercise intolerance (24 per cent); and dermatological abnormalities (80 per cent), including alopecia (56 per cent), poor coat quality (30 per cent) and hyperpigmentation (20 per cent). When compared with the laboratory reference limits the most common biochemical and haematological abnormalities were increased concentrations of triglycerides (88 per cent), cholesterol (78 per cent), glucose (49 per cent), and fructosamine (43 per cent), and increased activities of creatine kinase (35 per cent), and decreased concentrations of inorganic phosphate (63 per cent), and a low red blood cell count (40 per cent). When compared with reference limits derived from the euthyroid dogs the most common abnormalities were increased concentrations of gamma-glutamyltransferase (21 per cent), cholesterol (18 per cent), and aspartate aminotransferase (15 per cent) and a decreased red blood cell count (29 per cent), and decreased neutrophils (18 per cent) and decreased activity of creatine kinase (15 per cent). Assessment of cholesterol, creatine kinase, aspartate aminotransferase, gamma-glutamyltransferase, and red blood cell and neutrophil counts may be particularly useful in distinguishing hypothyroid dogs from euthyroid animals with similar clinical signs.     

Quadricuspid aortic valve and associated abnormalities in a dog

An 11-month-old, female Scottish terrier was presented with a history of a heart murmur. The electrocardiogram showed signs of left ventricular enlargement, and radiography confirmed generalized cardiomegaly. Echocardiography revealed four equally sized aortic valve cusps. A ventricular septal defect, with systolic left-to-right shunting, and aortic regurgitation into both ventricles were also present. The dog was free of clinical signs 1 year after diagnosis.     

Cardiac conotruncal malformations in a family of beagle dogs

O bjectives : To study forms of congenital heart disease present in a family of beagle dogs with a strong prevalence of ventricular septal defect and to document the pathological findings associated with the ventricular septal defects and investigate the mode of transmission.
M ethods : The animals were investigated by physical examination, radiography, electrocardiography and ultrasonography to diagnose the presence of congenital heart disease. Some animals were diagnosed at post-mortem examination and the dead animals underwent post-mortem examination to verify the presence of ventricular septal defect. An analysis of pedigree was undertaken and two of the affected animals were mated to investigate the mode of transmission.
R esults : Among the 28 dogs evaluated clinically or by post-mortem examination, 14 cases of ventricular septal defect were identified. The post-mortem examination showed some abnormalities of the ventricular outflow region associated with malformation of conotruncal septum development. When two affected dogs were bred, congenital heart disease was present in all of the offspring.
C linical S ignificance : The congenital heart disease identified in this beagle family can be classified as conotruncal malformation, and an autosomal recessive mode of inheritance was suggested by pedigree analysis.     

Retrospective review of congenital heart disease in 976 dogs

Background: Knowledge of epidemiology is important for recognition of cardiovascular malformations. Objective: Review the incidence of congenital heart defects in dogs in Italy and assess breed and sex predispositions. Animals: Nine hundred and seventy‐six dogs diagnosed with congenital heart disease (CHD) of 4,480 dogs presented to Clinica Veterinaria Gran Sasso for cardiovascular examination from 1997 to 2010. Methods: A retrospective analysis of medical records regarding signalment, history, clinical examination, radiography, electrocardiography, echocardiography, angiography, and postmortem examination was performed. Breed and sex predisposition were assessed with the odds ratio test. Results: CHD was observed in 21.7% of cases. A total of 1,132 defects were observed with single defects in 832 cases (85%), 2 concurrent defects in 132 cases (14%), and 3 concurrent defects in 12 cases (1%). The most common defects were pulmonic stenosis (PS; 32.1%), subaortic stenosis (SAS; 21.3%), and patent ductus arteriosus (20.9%), followed by ventricular septal defect (VSD; 7.5%), valvular aortic stenosis (AS; 5.7%), and tricuspid dysplasia (3.1%). SAS, PS, and VSD frequently were associated with other defects. Several breed and sex predispositions were identified. Conclusions and Clinical Relevance: The results of this study are in accordance with previous studies, with slight differences. The breed and sex predilections identified may be of value for the diagnosis and screening of CHD in dogs. Additionally, the relatively high percentage of concurrent heart defects emphasizes the importance of accurate and complete examinations for identification. Because these data are from a cardiology referral center, a bias may exist.     

Serum protein electrophoresis in 147 dogs

Reference intervals for serum protein electrophoresis (SPE) were created from a group of 75 clinically healthy dogs and compared with SPE results obtained from clinical cases presented to the University of Bristol over an eight-and-a-half-year period. A total of 147 dogs, in which SPE had been performed, had complete case records available and thus met the inclusion criteria. Signalment and final diagnoses taken from the case records and SPE results were divided into normal and abnormal based on the newly established reference intervals. Cases were grouped according to the SPE protein fraction abnormalities and diagnosis using the DAMNITV classification system. Of the 147 cases, 140 (95.2 per cent) had abnormal SPE results. The most common protein fraction abnormality was decreased albumin (59.3 per cent) followed by a polyclonal increase in γ globulins (38.6 per cent). Decreased β-1 globulins and increased β-2 globulins were documented in 36.4 and 30.0 per cent of cases, respectively. The most common DAMNITV classification associated with abnormal SPE results was infectious/inflammatory disease, which was diagnosed in 79 of 140 cases (56.4 per cent). Monoclonal gammopathies were noted in eight dogs (5.7 per cent), and underlying lymphoproliferative disease was present in all cases where a diagnosis was achieved, including multiple myeloma (four dogs), splenic plasmacytoma (one dog), hepatic plasmacytoma (one dog) and lymphoma (one dog).     

Morbidity and mortality in 928 Dobermanns born in the Netherlands between 1993 and 1999

The morbidity and mortality among 928 dobermann dogs born between 1993 and 1999 were investigated by sending questionnaires to their owners; 340 (37 per cent) responded. Eighty-one of the dogs had died. Proportional mortality was high for heart failure (14.8 to 22.2 per cent), behavioural problems (19.8 per cent) and cancer (13.6 per cent), but low for hepatitis (3.7 per cent) and cervical spondylomyelopathy (2.5 per cent). Of the 259 surviving dogs, 132 were suffering from various disorders, with a high prevalence of skin problems (22.4 per cent) and urinary incontinence (15.8 per cent).     

Retrospective study of the epidemiological, clinical, haematological and biochemical findings in 109 dogs poisoned by Vipera xanthina palestinae.

One hundred and nine dogs were diagnosed as having been poisoned by viper (Vipera xanthina palestinae) venom between 1989 and 1996. Most of the cases occurred between April and September (86.2 per cent), with peaks in May (25.7 per cent) and July (20.2 per cent), and very few between November and February (3.6 per cent). Forty-two per cent of the dogs were poisoned in the evening (18.00 to 22.00), with a relative risk of 6.85, 17.4 per cent between 22.00 and 02.00, and 16.5 per cent between 14.00 and 18.00. The median age of the dogs was three years, and almost 80 per cent of them were from rural households. German shepherd dogs and rottweilers were over-represented (relative risk 1.98 and 1.87 respectively), and mongrel dogs and pinschers were under-represented (relative risk 0.41 and 0.53 respectively). Fifty-six per cent of the bites were on the head (excluding the mouth, lips and pinnae), 16.5 per cent on the front limbs, 9.7 per cent on the mouth and lips, 8 per cent on the hindlimbs, 4.4 per cent were submandibular and 5.4 per cent were at other sites. The main clinical signs were local swelling (98.2 per cent) and oedema (94.5 per cent), panting (45.7 per cent), tachypnoea (42.5 per cent), pain (34.9 per cent), tachycardia (29.8 per cent), lameness (25.7 per cent), and lymphadenomegaly (23.9 per cent). The mortality rate was 3.7 per cent. The most common haematological abnormalities were neutrophilia (67.6 per cent), leucocytosis (54.9 per cent), thrombocytopenia (51.9 per cent), increased haematocrit (47.6 per cent), and a left shift of neutrophils (37.8 per cent). Many biochemical abnormalities were observed, of which the most common were high activities of lactate dehydrogenase (84.6 per cent), creatine kinase (69 per cent), gamma-glutamyltransferase (40 per cent) and aspartate aminotransferase and high concentrations of globulin, phosphate and total bilirubin (33.3 per cent in each case).     

Assessment of balloon pulmonary valvuloplasty in six dogs

The effectiveness of balloon valvuloplasty was assessed, clinically and haemodynamically, in six dogs with moderate to severe pulmonic stenosis. The haemodynamic assessment was based on Doppler echocardiography, with colour flow mapping, in the conscious dog and by direct catheterisation in the anaesthetised dog, before and after balloon valve dilatation. Four of the six dogs were presented with exercise intolerance, of which two were in congestive heart failure. Balloon valvuloplasty resulted in improved exercise tolerance and resolution of congestive heart failure in these dogs. The average Doppler and catheter transvalvular pressure gradients were reduced to 43 per cent and 46 per cent of the preoperative gradient, respectively. The average pressure gradient obtained by catheter, in the anaesthetised dog, was 59 per cent of the pressure gradient obtained by spectral Doppler echocardiography in the conscious dog. Balloon valvuloplasty was considered successful in five out of the six dogs. Postoperative pulmonic regurgitation was not found to be a complication of balloon valvuloplasty.     

Trifoliate left atrioventricular valve with and without intact septal structures in four dogs: echocardiographic findings and surgical repair

Trifoliate left atrioventricular (AV) valve with common atrioventricular junction is considered part of the spectrum of atrioventricular septal defect. This valve morphology is typically associated with defects in the AV septum resulting in communication at the atrial or ventricular level, but has also been described as an isolated defect in the setting of a common AV junction without AV septal defect. Trifoliate left AV valve exhibits a line of apposition between the bridging leaflets that is directed toward the inlet interventricular septum, distinguishing it from isolated mitral valve cleft in which the orientation of the bridging leaflets are toward the left ventricular outflow tract. The echocardiographic findings of four dogs with trifoliate left AV valve are described; two with intact septal structures and two with large ostium primum defects. Three dogs underwent open surgical repair using different approaches depending on the presence or absence of a septal defect. One of these underwent concurrent surgical repair for right AV valve dysplasia. One dog with intact septal structures underwent interventional closure of a concurrent patent ductus arteriosus. Current terminology associated with trileaflet left AV valve malformations is reviewed.