Evaluation of pacing site in dogs with naturally occurring complete heart block

Objective

To compare left ventricular synchronization and systolic performance with transvenous pacing of the right ventricular apex (RVA), left ventricular free wall (LVF) or simultaneous pacing of the RVA and LVF (BiV).

Animals, materials and methods

Seven canine patients with complete heart block. Prospective study evaluating effect of pacing site. Twenty four hours following implantation of transvenous BiV pacing systems, electrocardiograms and echocardiograms were assessed during pacing from the: (1) Right Atrial Appendage/RVA (RAA/RVA), (2) RAA/LVF, and (3) RAA/BiV.

Results

QRS duration was significantly shorter with BiV pacing versus LVF pacing (p < 0.001), or RVA pacing (p < 0.001). Echocardiographic indices of systolic performance fractional shortening (FS), ejection fraction (EF), cardiac output (CO) were significantly higher with BiV pacing than with pacing from the RVA (P = 0.023, 0.006, and 0.002 respectively). Cardiac output, measured by the biplane Simpson's method, was higher with LVF versus RVA pacing (P = 0.036). There was no difference in FS or EF when comparing LVF to RVA pacing. Tissue Doppler measurements of synchronization and systolic performance did not show any difference between pacing mode, but a significantly increased number of segments were seen to contract following aortic valve closure during LVF pacing (P = 0.0268) and RVA pacing (P = 0.0197) as compared to BiV pacing.

Conclusions

Findings suggest that BiV pacing improves cardiac output and systolic performance versus RVA pacing. This improvement however, is not reflected in tissue Doppler indices of synchronization and systolic performance.     

Oculocardiac reflex induced by zygomatic arch fracture in a crossbreed dog

A 3-year-old crossbreed male dog was presented with a history of blunt facial trauma. Skull radiographs showed right zygomatic arch fracture. An electrocardiogram revealed bradycardia, first-degree atrioventricular block and QT prolongation. Standard biochemical profile including electrolytes was normal. Atropine response test (0.04 mg/kg intravenously) restored normal sinus rhythm at a rate of 140 bpm with normal QT and PR intervals. This observation is consistent with oculocardiac reflex secondary to zygomatic arch fracture.     

Quantification of pulmonary to systemic flow ratio by a Doppler echocardiographic method in the normal dog: Repeatability, reproducibility, and reference ranges

Objective

To determine if the pulmonary to systemic flow ratio (Qp/Qs) could be assessed in healthy awake dogs using Doppler echocardiography.

Background

Qp/Qs could provide reliable information in assessing the severity of intracardiac shunts (ICS) by quantifying pulmonary overcirculation. Qp/Qs has been validated against electromagnetic flowmeter methods in experimental canine models. However, its clinical applicability in awake dogs has never been assessed.

Animals, materials and methods

Six healthy dogs were used to determine the repeatability and reproducibility of the technique (Study 1); Qp/Qs was then prospectively assessed in 50 healthy dogs (Study 2). In both studies Qp/Qs was calculated in awake animals using a standardized Doppler echocardiographic method.

Results

Within- and between-day coefficients of variation for Qp/Qs were <10% (Study 1). For Study 2, a relatively wide range of Qp/Qs was found (reference range = 0.71-1.29; mean ± SD = 1.00 ± 0.15).

Conclusions

Qp/Qs can be assessed with good repeatability and reproducibility in healthy dogs. However, the wide range of Qp/Qs obtained in the healthy population may suggest a limited usefulness of this variable for accurately assessing ICS severity in diseased animals. This needs to be assessed in further prospective and longitudinal studies including a large number of animals with ICS of various grades.     

Analysis of weight uniformity, content uniformity and 30-day stability in halves and quarters of routinely prescribed cardiovascular medications

Objectives

Congenital and acquired cardiac disorders are frequently diagnosed in small breed dogs and cats. In order to appropriately dose cardiovascular drugs for small patients, fractions of commercially available tablets must be prescribed. The aims of this study were to evaluate weight and content uniformity and 30-day chemical stability in halves and quarters of 11 drug formulations commonly prescribed to treat cardiovascular disorders in small breed dogs and cats.

Animals, materials and methods

Fifteen tablets from 11 drug formulations were obtained within the same lot. Tablets were split by a single operator using a commercially available pill splitter. Whole tablets, halves and quarters were weighed and stored in plastic containers. High-pressure liquid chromatography or liquid chromatography with mass spectrometry were utilized to determine drug content and repeated 30 days later to estimate chemical stability.

Results

Statistically significant weight variability, content non-uniformity and chemical degradation were found for some formulations. Digoxin showed a significant degradation that should be considered in clinical practice.

Conclusions

It appears that pill splitting is overall a relatively reliable practice; however tablets should not be split ahead of time but only immediately prior to intended usage.     

Surgical Treatment of Mineralized and Nonmineralized Supraspinatus Tendinopathy in Twenty-four Dogs

Objective— To report and compare the clinical diagnosis, surgical treatment, histopathologic changes, and outcomes of dogs with mineralized and nonmineralized supraspinatus tendinopathy (ST).
Study Design— Case series.
Animals— Dogs (n=24) with ST.
Methods— Medical records (1995–2006) of dogs with ST that had surgical treatment were reviewed. Results of clinical examination, diagnostic imaging, surgery, histopathology of resected tendon tissue, and outcome were compared between dogs with mineralized and nonmineralized ST.
Results— There were 15 dogs with mineralized ST and 9 with nonmineralized ST. Chronic, unilateral, intermittent or waxing-waning lameness, and pain elicited on palpation of the cranial aspect of the shoulder were the most consistent findings. On ultrasonographic or magnetic resonance imaging (MRI) of 35 shoulders, enlargement of the supraspinatus tendon (54%), increased fluid content (63%), and medial displacement of the biceps tendon (60%) were observed. Eleven of 12 dogs with bilateral abnormalities only had unilateral lameness. Surgery was performed in 30 shoulders. Resected tendon specimens had myxomatous degeneration and/or cartilaginous metaplasia in 11 of 13 dogs in the mineralized group and all 9 dogs in the nonmineralized group. Functional outcome after surgery was poor in 3 dogs and good-to-excellent in 16.
Conclusions— Mineralized and nonmineralized ST have many similarities. Although lameness is usually unilateral, the supraspinatus tendon may be affected bilaterally.
Clinical Relevance— Ultrasonography and MRI are good imaging techniques for detection of ST especially the nonmineralized form. Surgical treatment results in good recovery of limb function. Nonmineralized ST is a recently described disorder in dogs and evaluation of more cases is necessary to determine outcome after surgical or medical treatment.     

Laparoscopic Mesh Incisional Hernioplasty in Five Horses

Objective— To report a technique for incisional hernioplasty in horses using laparoscopic placement of a prosthetic mesh.
Study Design— Case series.
Animals— Horses (n=5) with ventral median abdominal incisional hernia.
Methods— A telescope and 2 instrument portals were established bilaterally, lateral to and distant from the hernia margins. After exposure of the internal rectus sheath by removal of retroperitoneal fat with endoscopic scissors and monopolar cautery, a prosthetic mesh was introduced into the abdomen and secured intraperitoneally using transfascial sutures with or without supplemental endoscopic hernia fixation devices.
Results— Successful placement of the prostheses was achieved without major intra- or postoperative complications. Repairs were intact in all horses (follow-up range: 6–23 months) without evidence of adhesion formation. Cosmetic results compared favorably with those typically achieved using conventional, open hernioplasty techniques.
Conclusion— Incisional hernia repair in horses can be successfully achieved with a laparoscopic intraperitoneal mesh onlay technique.
Clinical Relevance— Laparoscopic mesh hernioplasty has promise as a safe and effective method for repair of incisional hernias in horses.     

Biomechanical Comparison of Two Alternative Tibial Plateau Leveling Osteotomy Plates with the Original Standard in an Axially Loaded Gap Model: An In Vitro Study

Objective— To compare the axial compression stiffness of osteotomized canine tibiae stabilized with Slocum, Securos, or Synthes plates after a tibial plateau leveling osteotomy (TPLO) procedure. Study Design— In vitro, paired comparison of cadaveric tibial constructs subjected to mechanical testing under an axial load. Sample Population— Canine tibiae (n=16 pairs) from skeletally mature male and female dogs of various breeds (18–55 kg). Methods— Tibial pairs (n=16) were randomly assigned to 1 of 2 study cohorts (n=8 pairs/cohort): cohort 1, tibial osteotomy stabilization with a Slocum or a Securos plate, or cohort 2, tibial osteotomy stabilization with a Slocum or a Synthes plate. One tibia from each pair was stabilized with 1 of each plate design assigned to the cohort after TPLO. A 3.2 mm osteotomy gap was maintained during plate application in all constructs. Load and axial displacement were recorded while constructs were loaded to 2000 N in axial compression. Failure loads were not reported because no distinct yield point or failure point was evident within the load range for many specimens. Failure modes were recorded for each construct, and photographs of typical failures were obtained. Stiffness (N/mm) was calculated from load–displacement curves. Paired comparisons of mean stiffness were performed within study groups using a paired t‐test. Significance was set at P<.05. Results— The mean construct stiffnesses for the Slocum (383±183 N/mm) and Securos (258±64.1 N/mm) constructs were not significantly different (P=.164; power=0.566). The mean construct stiffness for the Synthes constructs (486±91.0 N/mm) was significantly greater than that of the Slocum constructs (400±117 N/mm); P=.0468. Modes of failure for the Slocum (16/16) and Securos (8/8) constructs included plastic deformation of the implant with valgus deformity combined with fibular luxation (2/16 Slocum; 1/8 Securos) or fibular fracture (2/16 Slocum; 4/8 Securos). Most Synthes constructs underwent elastic deformation (7/8). One Synthes construct fractured in the saggital plane through the tibial plateau depression at the point of load application. Conclusions— The Slocum and Securos plate/tibia construct have similar stiffness, whereas the Synthes/tibia constructs are significantly stiffer than the Slocum/tibia constructs. Modes of fixation failure observed in this model were consistent with TPLO fixation failures observed clinically. Clinical relevance— Construct stiffness in axial load varies with implant type. Implants that confer higher stiffness to the construct may result in greater fixation stability in tibial metaphyseal osteotomies.