Left ventricular outflow tract to left atrial fistula associated with endocarditis in a dog

A one-year-old, intact male, 28-kg, mixed-breed dog developed neurological episodes consistent with emboli. An acquired III/VI holosystolic heart murmur was ausculted in the mitral area, and valvular endocarditis with pulmonic and aortic insufficiency were noted at echocardiographic examination. An abnormal communication (i.e., fistula) between the left ventricular outflow tract (LVOT) and the left atrium adjacent to the mitral valve annulus was noted with Doppler imaging and confirmed with angiography. Infective valvular endocarditis was confirmed based on two of three blood cultures being positive for Staphylococcus intermedius. In humans, a sequela to infective endocarditis of the aortic or mitral valve, or both, is rupture of the mitral-aortic intervalvular fibrosa, resulting in a communication between the LVOT and the left atrium. This is the first report of this sequela in the dog.     

Left coronary aneurysmal dilation and subaortic stenosis in a dog

A 6-month-old German shepherd dog was referred for evaluation of a cardiac murmur.Upon physical examination, the auscultated heart rate was 120 beats/min, and a grade IV/VI systolic heart murmur with a point of maximal intensity over the left heart base radiating up the neck was heard. The standard echocardiographic examination showed subaortic stenosis and an anechoic tubular structure extending from the sinus of Valsalva to the left ventricular posterior wall. Aneurysmal left coronary artery (CA) was confirmed by angiography. The dog was euthanized and post-mortem examination showed severe dilatation of the proximal left CA and confirmed the subaortic stenosis. Histopathology did not demonstrate abnormalities in the walls of the CA, aorta or pulmonary artery.The exact cause of the CA aneurysmal dilation remains unknown. Subaortic stenosis, elevated coronary vascular resistance or a congenital anomaly may have contributed to the dilation.To our knowledge, coronary aneurysmal dilation has never been described in dogs. Standard echocardiography provides reliable information on coronary anatomy.     

Acute aortic rupture in a dog with spirocercosis following the administration of medetomidine

Spirocercosis is an emerging disease in veterinary medicine. A strong suspicion of spirocercosis is usually evident after a thorough clinical examination and radiography of the chest has been performed. Lesions seen on radiography include an oesophageal mass, spondylitis and oesophageal air. Unfortunately, radiography is not diagnostic and additional diagnostic procedures are required to confirm the diagnosis. Endoscopy is commonly performed to diagnose the condition. The dog presented in this study had radiographic and clinical signs consistent with spirocercosis and definitive diagnosis was required. Shortly after sedation with medetomidine, the dog went into cardiac arrest and failed to respond to resuscitative measures. On post mortem, the diagnosis of spirocercosis was confirmed and the cause of death was identified as acute aortic rupture. Aortic aneurysms are not an uncommon finding and cause of acute death in dogs with spirocercosis. The acute rupture of the aorta in this case is most probably the result of cardiovascular changes associated with the administration of medetomidine. Medetomidine causes an acute rise in systemic vascular resistance with hypertension. The increase in shear stress across the weakened aortic wall resulted in rupture. Caution with the use of medetomidine in patients with spirocercosis is advised.     

Aortic rupture and aorto‐pulmonary fistulation in the Friesian horse: Characterisation of the clinical and gross post mortem findings in 24 cases

Reasons for performing study: In horses, aortic sinus of Valsalva aneurysms or tears in the aortic root are well‐recognised conditions in breeding stallions, often leading to sudden death. A more uncommon form of aortic rupture, located proximal to the ligamentum arteriosum has been reported in 3 Friesian horses. Objectives: The purpose of this study was to phenotypically characterise aortic rupture and aorto‐pulmonary fistulation in Friesian horses in terms of clinical and post mortem data based on 24 cases. Methods: Friesian horses that were diagnosed with aortic rupture and aorto‐pulmonary fistulation over a period of 13 years (1997–2010) at the Department of Equine Sciences of Utrecht University (n = 15) and Wolvega Equine Hospital (n = 9), were included in this study. Case history, results of clinical examination and gross post mortem findings were screened and analysed. Results: Some cases were found dead without prior symptoms, but in several cases signs such as recurrent colic, peripheral oedema and sustained tachycardia were present for several weeks prior to cardiac failure. Clinical examination during hospitalisation revealed increased rectal temperature, peripheral oedema and increased jugular pulse with a bounding arterial pulse. In the majority of horses an aortic rupture of the aortic arch near the ligamentum arteriosum, concurrent with a circumferential cuff of perivascular haemorrhage and aorto‐pulmonary fistulation, was found at post mortem examination. Conclusions: Aorto‐pulmonary fistulation in conjunction with aortic rupture is more common in Friesians than previously estimated. In some cases findings demonstrate a progressive pathology rather than acute cardiac failure and sudden death. An appropriate approach is necessary during post mortem examination of the heart in order not to overlook the diagnosis. Potential relevance: Equine practitioners should realise that in Friesian horses presented with a history of recurrent false colic, coughing, sustained tachycardia and/or peripheral oedema, aortic rupture and aorto‐pulmonary fistulation should be included in the differential diagnosis.     

Postoperative rupture of an aortic aneurysmal dilation associated with a patent ductus arteriosus in a dog

OBJECTIVE: To describe an unusual case of fatal aortic aneurysm rupture after standard ligation of a left-to-right shunting patent ductus arteriosus (PDA) and review the literature concerning the causes of aneurysm and applicable medical physics of blood flow that may contribute to mural failure. STUDY DESIGN: Clinical case report. SAMPLE POPULATION: An 11-month-old female Brittany spaniel. RESULTS: A PDA was diagnosed in the dog after referral for a grade IV/IV cardiac murmur. Diagnostic tests performed included a minimum database, thoracic radiography, and echocardiography. Conventional surgical ligation of the PDA was performed. The postoperative recovery from anesthesia was uneventful. Approximately 5 hours after surgery, the dog vocalized once and collapsed. All resuscitative efforts failed. Necropsy showed a large, spiral rupture of the cranial and dorsal wall of the aorta that extended from the left subclavian artery to 2 cm distal to the PDA-aorta junction. No evidence of intramural, perianeurysmal hemorrhage or inflammation was noted. Histopathologic examination of the ruptured aneurysm showed that the wall lacked a defined tunica intima and endothelial cell layer. A distinct separation of the thinned tunica media parallel to the elastic fibers was noted. CONCLUSIONS AND CLINICAL RELEVANCE: Dilatation of the aorta near the area of a PDA is one of the recognized abnormalities associated with the condition. Aneurysmal dilatation results from and contributes to abnormal blood flow dynamics and increased aortic wall tension, which promotes expansion. Although an unusual and previously unreported sequela, rupture of the aneurysm should be considered a possible complication when ligation of a PDA with a conspicuous aortic aneurysmal dilation is performed.     

AORTO-CARDIAC FISTULAS IN SEVEN HORSES

This report describes the history, clinical, electrocardiographic and echocardiographic findings, treatment, outcome, and post-mortem findings in seven horses with aorto-cardiac fistula. Affected horses included 5 stallions, one gelding and one mare; 2 each of the Thoroughbred, Arabian and Standardbred breeds and one Thoroughbred-cross with a mean ± s.d. age of 12 ± 4 years, range 6–18 years. The presenting sings were acute distress (four horses), exercise intolerance (two horses) and the lesion was detected during a routine examination in one horse. Five horses had monomorphic ventricular tachycardia on admission and one other had a history of this arrhythmia. Five horses had a characteristic continuous murmur loudes in the right fourth intercostal space. Echocardiography (six horuses) and/or post-mortem examination (four horses) revealed the horses had aorto-cardiac fistulas arising from the right aortic sinus in all five horses in which the site was recorded. Two horses had ruptured aneurysmall dilatations of the aortic wall at this site. Fistulas extended into the right ventricle in four horses; the right atrium in two horses, the left ventricle in one horse, and five horses had dissecting tracts in the septal myocardium. Horses survived for periods ranging from 24th to 4 years. Aorto-cardiac fistula should be considered in the differential diagnosis for horses presenting with acute distress, bounding arterial pulse, a right-sided continuous murmur and/or monomorphic ventricular tachycardia, particularly in middle-aged or older stallions. Echocardiography is the technique of choice for confirming the diagnosis and demonstrating accompanying cardiac changes.     

TWO-DIMENSIONAL ECHOCARDIOGRAPHIC ANATOMY OF THE SNAKE HEART (PYTHON MOLURUS BIVITTATUS)

Two-dimensional echocardiography was performed on Burmese pythons (Python molurus bivittatus) to determine an optimal echocardiographic imaging technique for snakes and to describe the echocardiographic anatomy of the snake heart. Five snakes immobilized with tiletamine/zolazepam and maintained on isoflurane in oxygen were imaged in dorsal recumbency. The portion of the snake's body containing the heart was submerged in warm water to reduce the artifact created by air trapped between and under the scales. Imaging in sagittal planes demonstrated the caudal vena cava, sinus venous valve, right atrium, various portions of the ventricle, horizontal septum, the left aortic arch, and pulmonary artery. Transverse imaging depicted the spatial relationship of the left and right aortic arches and pulmonary artery and the horizontal septum. Basic knowledge of cardiac blood flow in the reptile was necessary to understand the echocardiographic anatomy.     

AORTIC AND CARDIAC MINERALIZATION IN THE DOG

Aortic and cardiac mineralization was found in 21 of 3443 (0.61%) canine thoracic radiographs. In none of 786 feline thoracic radiographs reviewed were such lesions present. Mineralizations were superimposed on the ascending aorta (19 dogs) or on the caudal cardiac silhouette (2 dogs). In 2 of 4 dogs mineralization was identified echocardiographically dorsal to the aortic valve in close proximity to coronary arteries. Computed tomography confirmed mineralization of the aortic arch and root in 2 of 2 dogs. Necropsy and histopathologic examination in 1 dog revealed multiple nodular aortic tunica media calcifications with adjacent areas of degeneration. Lesions were significantly overrepresented in older dogs and in Rottweilers, and regarded as dystrophic calcification, caused either by age-related degenerative changes or chronic disease-related processes. There was no evidence of clinical significance attributed to the mineralization in any dog. Aortic and cardiac mineralization should be recognized as an incidental, non-significant finding in dogs of advanced age and differentiated from pleural and pulmonary structures.     

DILATED CORONARY SINUS IN A DOG WITH PERSISTENT LEFT CRANIAL VENA CAVA

This paper describes the electrocardiographic, echocardiographic (two-dimensional, M-mode, contrast and Doppler) and non-selective angiocardiographic features in a 3 year old female Beagle with dilated coronary sinus due to persistent left cranial vena cava. Negative P waves in leads III and aVR and a positive P wave in lead aVL were seen. Echocardiographically, a hipoechoic circular structure was seen between the left atrium and the pericardium in the area where the coronary sinus is located. A velocity pattern with two peaks was obtained, one systolic with velocity = 0.44 ± 0.05 m/sec and the other diastolic with velocity = 0.27 ± 0.01 m/sec. By M-mode echocardiography, at level of the aorta and the left atrium, a linear structure was identified between the left atrium and the pericardium; this structure was characterized by phasic movements of the anterior wall during the cardiac cycle. Following a left cephalic vein injection of saline, bubbles were seen within the coronary sinus; when saline was injected into the right cephalic vein, bubbles were also seen within the coronary sinus and right atrium and ventricle. Non-selective angiocardiography confirmed a dilated coronary sinus with persistent left cranial vena cava. The right cranial vena cava was absent. The dog was clinically normal and the unusual vessel was an incidental finding.     

Rupture of an aortic sinus aneurysm in a 15-year-old broodmare

A 15-year-old, Standardbred broodmare with an aortic sinus aneurysm developed rupture of the aneurysm with subsequent rupture of a tricuspid valve chorda tendinae, tricuspid regurgitation, acute right-sided congestive heart failure, and pulmonary thromboembolism. Shunting of blood from the aorta through the ruptured aneurysm into the right ventricle resulted in decreased renal perfusion and acute renal failure. Initially, treatment of the mare with analgesics, fluids, and digoxin resulted in clinical improvement, but the mare's condition deteriorated after 8 days and the mare was euthanatized due to unrelenting pain and a poor prognosis. Echocardiography was useful in diagnosis of the cardiac disease in the broodmare.     

Tricuspid atresia in a foal

An Arabian crossbred foal was examined because of a suspected congenital cardiac anomaly. There was a grade V/V crescendo-decresendo holosystolic murmur and thrill in the left 4th intercostal space. The foal was slightly cyanotic and polycythemic. Electrocardiography suggested left ventricular hypertrophy. Angiography and cardiac and vascular pressure recordings led to a diagnosis of pulmonic stenosis. The foal died after cardiac bypass and corrective surgery. Postmortem examination revealed an enlarged right atrium, atresia of the tricuspid orifice, a large, fenestrated patent foramen ovale, eccentric left ventricular hypertrophy, and a large interventricular septal defect. The right ventricle had a small lumen and a relatively thick wall. There was valvular and supravalvular pulmonic stenosis, with poststenotic dilatation of the pulmonary artery. A single coronary artery originated from the anterior sinus of the aorta.     

Aortic stenosis in the Dogue de Bordeaux

Objectives : To evaluate the occurrence of aortic stenosis and establish echocardiographic reference values in the Dogue de Bordeaux in Denmark. Methods : Fifty‐three dogs were auscultated for evidence of a cardiac murmur and a full echocardiographic examination was performed. The criterion for the diagnosis of aortic stenosis was a peak aortic velocity greater than 2·5 m/s from a subcostal transducer location. Results : A left‐basilar ejection murmur was detected in 38 (72 per cent) of the dogs. An aortic ejection velocity greater than 2·5 m/s was identified in 9 (17 per cent) of the dogs from a subcostal view. The aortic annulus in Dogue de Bordeaux was smaller than that considered normal in other breeds with comparable body size. Furthermore, a decreased aortoseptal angle was noticed in dogs with aortic stenosis. Clinical Significance : The Dogue de Bordeaux may be highly predisposed to aortic stenosis. The small aortic annulus noted in healthy and affected Dogue de Bordeaux and a decreased aortoseptal angle noted in affected dogs in this study might reflect key aetiological features in the development of aortic stenosis.     

Familial aortic aneurysm in Leonberg dogs

A thoracic aortic aneurysm was diagnosed in a 6-month-old male Leonberg dog by use of radiography, transthoracic and transesophageal echocardiography, and magnetic resonance imaging. The aneurysm was associated with a twisted ascending aorta and dilatation of several other thoracic arteries (pulmonary trunk, brachiocephalic trunk, and left subclavian artery). Histologic examination of the aorta revealed cystic medial necrosis, with disruption of the elastic network, collagen fibers, and the muscle glycoprotein fibrillin-1. The dam and sire of the dog and 8 littermates were examined by use of transthoracic echocardiography. The sire and 1 male littermate also had an aneurysm of the ascending aorta. To the authors' knowledge, this is the first report of familial aortic aneurysm in dogs.     

Complete interruption of the aortic arch in a dog

Complete interruption of the aortic arch was diagnosed by angiocardiography in a dog with exercise intolerance, a cardiac murmur, polycythemia, and cardiomegaly. The defect was accompanied by a patent ductus arteriosus, ventricular septal defect, and subaortic stenosis. The dog was euthanatized, and the clinical diagnosis was documented by gross dissection of the heart. The site of aortic interruption was between the left carotid and left subclavian arteries, which is the most common location in human beings. The similarity with the pathologic findings of interrupted aortic arch in human beings suggests a similar mechanism responsible for the abnormal cardiac morphogenesis. The defect may be confused with other cardiac anomalies that can result in exercise intolerance, polycythemia, and cardiac murmur. This defect is amenable to surgical treatment, which emphasizes the importance of a correct anatomic diagnosis in clinical patients.     

Mycotic aneurysm caused by Graphium species in a dog

A 10-year-old castrated male mixed-breed dog exhibited vomiting, lethargy and anorexia. An abdominal ultrasound examination revealed a focal dilation of the abdominal aorta. The dog died 2 days after examination, and necropsy revealed a ruptured aneurysm at the abdominal aorta between the kidneys. Histological examination revealed severe granulomatous and necrotizing pan-arteritis with fungal organisms. Graphium species was identified through DNA sequence analysis of the PCR product from formalin-fixed paraffin-embedded samples. To our knowledge, this is the first report of aortic aneurysm caused by Graphium species in a dog.     

Cardiac fibrosarcoma in a dog

A cardiac fibrosarcoma involving the right ventricular free wall, the interatrial septum, and proximal portion of the interventricular septum, with a 2-cm diameter protrusion into the right atrial lumen, was found at necropsy of a 2-year-old Miniature Schnauzer. Severe distortion of the tricuspid valve and narrowing of the aortic and pulmonic outflow tracts had caused the dog to develop right-sided cardiac failure and to have syncopal episodes. A tentative antemortem diagnosis of congenital pulmonic stenosis had been made on the basis of results of physical examination and diagnostic work-up. Evaluation of the case exemplifies the difficulty encountered in diagnosing cardiac tumors before the patient's death.     

Fatal aortic oesophageal fistula following oesophageal foreign body removal in a dog

An eight-month-old male Pomeranian was presented with hypovolaemic shock 7 days after successful oesophageal foreign body removal. On presentation the dog was anaemic and no coagulation abnormalities were detected. A fluid-filled oesophagus was visible on thoracic radiography and frank blood was aspirated from the oesophagus following oro-oesophageal intubation. Fluid resuscitation and blood transfusions were administered but attempts at stabilisation were unsuccessful and the dog died. At post-mortem examination, a 2-mm aortic oesophageal fistula was identified on the ventral aspect of the aorta at the level of heart base that communicated with the overlying oesophagus. Aortic oesophageal fistula has been reported in human medicine and occurs secondary to a number of conditions including oesophageal foreign bodies. These prove fatal without rapid stabilisation and surgery.     

Thoracic aortic rupture in horses

The aorta can rupture at the aortic root or aortic arch. In most breeds, the aortic root is the likely site and rupture leads to aortocardiac fistula with communication between the aorta and the right atrium, right ventricle and/or the interventricular septum. There is a high prevalence of aortic rupture in young Friesian horses and rupture occurs at the aortic arch with pseudoaneurysm and potentially aortopulmonary fistulation. Echocardiographic and post‐mortem techniques must be adapted to identify aortic arch rupture that is not generally identified with standard approaches. Given the narrow genetic base of the Friesian breed and the significant differences found in extracellular matrix composition and metabolism between Friesians and Warmbloods, genetic factors are likely to contribute to the condition in the Friesian breed.     

Surgical treatment of a double aortic arch in a dog

An 8-month-old spayed female Labrador retriever dog was evaluated for regurgitation 6 months after surgery for a suspected vascular ring anomaly. The dog had a history of regurgitation and slow development as a puppy. An initial left-sided exploratory thoracotomy was unsuccessful in identifying and treating a vascular ring anomaly. The dog was subsequently presented to the PennVet Emergency Service for regurgitation. Thoracic radiography showed cranial thoracic esophageal dilation and an esophageal foreign body that was then removed endoscopically. Subsequent computed tomographic (CT) angiography revealed a double aortic arch. A left 4th intercostal space thoracotomy was performed. The smaller left aortic arch and a left ligamentum arteriosum were ligated and transected. The dog recovered uneventfully and was healthy at the 1-month follow-up visit. This is the 5th reported successful surgical correction of a double aortic arch in a dog. Computed tomographic angiography was essential in diagnosis and surgical planning.Key clinical message:Although uncommon, double aortic arches can occur and present a diagnostic and surgical challenge when a persistent right aortic arch is suspected. Computed tomographic angiography provides an accurate preoperative diagnosis and allows for surgical planning.