犬二尖瓣膜闭锁不全的诊断与治疗

[目的]为犬二尖瓣膜闭锁不全的预防、诊断、治疗提供借鉴。[方法]从流行病学、临床症状、心电图检查、X线检查、超声心动图检查和彩色多普勒超声显像等方面综述了该病的诊断方法。分析了该病的发病机理,介绍了该病保守治疗常用的药物以及手术治疗的手术方法、疾病护理要点和预防手段。[结果]犬二尖瓣膜闭锁不全的诊断可分为临床诊断和实验室诊断。犬二尖瓣膜闭锁不全的治疗可分为药物治疗和手术治疗。最后,对该病的日常护理和预防工作进行了阐述。[结论]今后还需要对二尖瓣膜的结构及其闭锁不全的致病机理进行深入研究。     

Use of the loop diuretic torsemide in three dogs with advanced heart failure

Diuretics are a mainstay of therapy in dogs with heart failure. In dogs with advanced heart failure, moderate to high doses of loop diuretics such as furosemide are used with diminishing effects as profound activation of neuroendocrine systems promote signs of congestive heart failure. The loop diuretic torsemide has several characteristics that make it suitable for treatment of advanced heart failure including longer half-life, increased potency of diuretic action, and anti-aldosterone effects. This case report details the administration of torsemide in 3 dogs with advanced heart failure and apparent furosemide resistance.     

Abnormal regurgitation in three cows caused by intrathoracic perioesophageal lesions

Background

Three Brown Swiss cows with abnormal regurgitation because of a perioesophageal disorder are described.

Case presentation

The cows were ill and had poor appetite, salivation and regurgitation of poorly-chewed feed. Collection of rumen juice was successful in one cow, and in another, the tube could be advanced to the level of the 7th intercostal space, and in the third, only saliva could be collected. In one cow, oesophagoscopy revealed a discoloured 10-cm mucosal area with fibrin deposits. Thoracic radiographs were normal. The cows were euthanased and examined postmortem. Cow 1 had a large perioesophageal abscess containing feed material at the level of the thoracic inlet, believed to be the result of a healed oesophageal injury. Cow 2 had an abscess between the oesophagus and trachea 25 cm caudal to the epiglottis with the same presumed aetiology as in cow 1. Cow 3 had a mediastinal carcinoma that enclosed and constricted the oesophagus.

Conclusions

Abnormal regurgitation in cattle is usually the result of an oesophageal disorder. Causes of oesophageal disorders vary widely and their identification can be difficult.     

Chordae tendineae rupture in dogs with degenerative mitral valve disease: prevalence, survival, and prognostic factors (114 cases, 2001-2006)

Background:Degenerative mitral valve disease (MVD) is the most common heart disease in small breed dogs, and chordae tendineae rupture (CTR) is a potential complication of this disease. The survival time and prognostic factors predictive of survival in dogs with CTR remain unknown.
Hypothesis:The prevalence and prognosis of CTR in dogs with MVD increases and decreases, respectively, with heart failure class.
Animals:This study used 706 dogs with MVD.
Methods:The diagnosis of CTR was based on a flail mitral leaflet with the tip pointing into the left atrium during systole, which was confirmed in several 2-dimension imaging planes using the left and right parasternal 4-chamber views.
Results:CTR was diagnosed in 114 of the 706 dogs with MVD (16.1%) and most of these (106/114, 93%) had severe mitral valve regurgitation as assessed by color Doppler mode. CTR prevalence increased with International Small Animal Cardiac Health Council (ISACHC) clinical class (i.e., 1.9, 20.8, 35.5, and 69.6% for ISACHC classes Ia, Ib, II, and III, respectively [ P < .05]). Long-term follow-up was available for 57 treated dogs (angiotensin-converting enzyme inhibitors and diuretics) and 58% of these (33/57) survived > 1 year after initial CTR diagnosis (median survival time, 425 days). Clinical class, the presence of ascites or acute dyspnea at the time of diagnosis, heart rate, plasma urea concentration, and left atrial size were predictors of survival.
Conclusions and Clinical Relevance: CTR is associated with a higher overall survival time than previously supposed. Its prognosis mostly depends on a combination of clinical and biochemical factors.     

Echocardiographic and radiographic findings in a cohort of healthy adult green iguanas (Iguana iguana)

ObjectivesTo describe characteristics of echocardiography and cranial coelomic radiography in a cohort of iguanas.AnimalsTwenty apparently healthy adult green iguanas (Iguana iguana) from a reptile sanctuary.MethodsPhysical examination, radiography, two-dimensional and color Doppler echocardiography were performed to assess cardiac structures and function, and any related normal or abnormal findings were recorded.ResultsEchocardiographic examination was possible without sedation and allowed visualization of the great vessels, atria, and ventricle. Some structures could not be evaluated in a minority of the iguanas due to individual differences in bony conformation and imaging quality. Suspected abnormal echocardiographic findings in 3 iguanas included pericardial effusion (n = 1) and enlarged caudal vena cava and/or sinus venosus (n = 2). Objective measurements were repeatable as assessed by within-subject coefficient of variation, and reliable as assessed by intra-observer intraclass correlation coefficient. Left atrial and ventricular measurements were significantly correlated with body weight. Valve regurgitation was common, with atrioventricular valve regurgitation present in 53% (9/17) and aortic or pulmonic valve regurgitation in 71% (12/17) of otherwise normal iguanas. A heart murmur was not appreciated during examination of any of the iguanas. Heart size cannot be measured radiographically due to superimposition and silhouetting of other coelomic structures. Echocardiographic or radiographic findings consistent with mineralization of the great vessels were present in 76% of iguanas (13/17).ConclusionsEchocardiography in iguanas is well tolerated without sedation and allowed both subjective evaluation and structural measurements. Valve regurgitation and great vessel mineralization were commonly observed in this cohort of apparently healthy adult iguanas.     

Distinguishing cardiac and noncardiac dyspnea in 48 dogs using plasma atrial natriuretic factor, B-type natriuretic factor, endothelin, and cardiac troponin-I

BACKGROUND: It is challenging to differentiate congestive heart failure (CHF) from noncardiac cause of dyspnea. HYPOTHESIS: Circulating concentrations of atrial natriuretic peptide (NT-proANP), B-type natriuretic peptide (BNP), endothelin-I (ET-1), and cardiac troponin-I (cTnI) can be used to help distinguish between cardiac and noncardiac causes of dyspnea in dogs. ANIMALS: Forty-eight client-owned dogs admitted to a veterinary teaching hospital for respiratory distress. METHODS: Blood samples from patients were prospectively obtained. The etiology of dyspnea was determined by using physical examination, thoracic radiographs, and echocardiography. RESULTS: CHF was diagnosed in 22 dogs, and dyspnea of noncardiac origin (noHD group) was diagnosed in 26 dogs. Analyses revealed significant difference between groups for NT-proANP (geometric mean, 95% confidence [CI]; no HD: 0.26 nmol/mL, 95% CI 0.17-1.09; CHF: 1.38 nmol/mL, 95% CI 1.09-1.74 nmol/mL; P < .0001), BNP (noHD: 12.18 pg/mL, 95% CI 10.91-16.17 pg/mL; CHF: 34.97 pg/mL, 95% CI 23.51-52.02 pg/mL; P < .0001), and ET-1 (noHD: 0.32 fmol/mL, 95% CI 0.23-0.46 fmol/mL; CHF: 1.26 fmol/mL, 95% CI 0.83-1.91 fmol/mL; P < .0001). Plasma cTnI concentrations were not significantly different between groups (noHD: 0.29 ng/mL, 95% CI 0.12-0.72 ng/mL; CHF: 0.42 ng/mL, 95% CI 0.18-0.97, P = .53). Receiver operating curves indicated areas under the curve for NT-proANP, BNP, and ET-1 of 0.946, 0.886, and 0.849, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Plasma NT-proANP, BNP, and ET-1, but not cTnI, appear useful for distinguishing between dogs with cardiac and noncardiac causes of dyspnea, with plasma NT-proANP having the highest sensitivity (95.5%) and specificity (84.6%).     

Incidence and characterization of esophagitis following esophageal foreign body removal in dogs: 60 cases (1999–2003)

Objective: To characterize the presence of esophagitis in dogs after esophagoscopy for diagnosis and treatment of esophageal foreign body and to relate the degree of esophageal injury to clinical signs and outcome. Design: Retrospective study. Animals, intervention, and measurements: Medical records of 60 dogs with esophageal foreign bodies diagnosed between January 1999 and December 2003 were reviewed. Information obtained from the medical records included age, breed, and sex; type and duration of clinical signs; physical examination, radiographic, and esophagoscopy findings; type and location of foreign body; surgical intervention; morbidity, and outcome. Animals were divided into 2 cohorts based upon the degree of esophageal injury detected during esophagoscopy: mild esophagitis or moderate‐to‐severe esophagitis. Data were then compared between the groups. Results: Dogs with moderate‐to‐severe esophagitis had a longer duration of clinical signs, were more likely to present for lethargy and regurgitation/vomiting, and had a longer time to recovery. This cohort had significantly greater morbidity including esophageal stricture, perforation, necrosis, and diverticulum formation, as well as aspiration pneumonia, pneumothorax, severe tracheal compression, and death. Dogs with mild esophagitis were more likely to present to the hospital for gagging. Conclusions: This study demonstrated a wide range of injury associated with esophageal foreign bodies. The degree of esophagitis appears to relate to the duration and severity of some of the clinical signs.