Transesophageal monitoring of aortic blood flow during nonemergent canine surgeries

Objective: To establish baseline values for descending thoracic aortic blood flow parameters as determined with a transesophageal combined M‐mode and pulsed Doppler ultrasound‐based monitoring method. Design: Preliminary observational study. Setting: University small animal teaching hospital. Animals: The study population consisted of anesthetized canine patients undergoing nonemergent surgeries. Prospectively set criteria for inclusion were adequate body size for placement of the esophageal probe and a nonemergent reason for surgery. The criterion for exclusion was recent trauma. Interventions: Placement of the transesophageal probe. Measurements and main results: Data was collected during 15 surgeries. Data from three dogs was excluded from data analysis (two recently hit by motor vehicles, one recently having undergone a total hip replacement). Each parameter was stable across time within each individual dog. The ranges of the descending thoracic aortic parameters across the 12 nonemergent cases were as follows: blood flow, 0.038–0.085 L min^?1 kg^?1; blood flow per beat, 0.31–0.84 mL kg^?1; blood acceleration, 6–29 m s^2?1; blood peak velocity, 38–105 m s^?1; left ventricular ejection time interval 331–492 ms; and diameter, 0.30–0.93 mm kg^?1. Conclusions: The range of descending thoracic aortic blood flow parameters encountered in this small group of dogs during nonemergent surgeries was broad; however, each parameter was quite stable across time with little change occurring in any dog during monitoring.     

Application of Airway Pressure Therapy in Veterinary Critical Care: Part I: Respiratory Mechanics and Hypoxemia

Over the past several decades, recognition of acute respiratory failure as the cause of death in patients suffering from various clinical conditions has prompted aggressiv investigation into the area of respiratory physiology and supportive respiratory care. With the evolution of emergency medicine and critical care services in both human and veterinary medicine, many patients previously considered unsalvageable due to the severity of their underlying disease are now being resuscitated and successfully supported, creating a new population of critically ill patients. Where only a decade ago these patients would have succumbed to their underlying disease, they now survive long enough to manifest the complications of shock and tissue injury in the form of acute respiratory failure. Investigation into the pathophysiology and treatment of this acute respiratory distress syndrom (ARDS) has facilitated increased clinical application of respiratory theerapy and machanical ventilation.¹ The purpose of this paper is to provide a basic review of respiratory mechanics and the pathophysiology of hypoxemia as they relate to airway pressure therapy in veterinary patients and to review the use of airway pressure therapy in veterinary patients This paper is divided into two parts; part I reviews respiratory mechanics and hypoxemia as they apply to respiratory therapy, while part II deals specifically with airway pressure therapy andits use in clinical cases.     

TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION IN A FOAL

An 8-day-old Arabian-Morgan cross colt underwent cardiac evaluation. The foal was tachycardic, tachypneic, exercise intolerant and had a loud right-sided heart murmur and cyanotic mucous membranes. Total anomalous pulmonary venous connection was diagnosed with echocardiography and confirmed at postmortem examination. Total anomalous pulmonary venous connection is a very rare congenital cardiac abnormality that has not been reported before in the horse.     

Cardiac troponin I in canine patients with lymphoma and osteosarcoma receiving doxorubicin: comparison with clinical heart disease in a retrospective analysis

The cumulative cardiotoxicity that occurs as a result of doxorubicin chemotherapy is irreversible and can affect both quality and quantity of life for the cancer patient. Cardiac troponin I (cTnI) is a sensitive and specific marker of cardiomyocyte death. The purpose of this retrospective study was to evaluate serum concentrations of cTnI in dogs with lymphoma or osteosarcoma given doxorubicin chemotherapy, and with known cardiac outcome, based on a minimum assessment by physical examination and thoracic radiography. Serum samples were also available for cTnI measurement from seven healthy dogs given intracoronary doxorubicin. Serial serum samples obtained before, during and after doxorubicin chemotherapy showed increased cTnI concentrations in some clinical patients following chemotherapy (P = 0.0083 compared to baseline), but this did not correlate with clinical signs of cardiomyopathy. In dogs that subsequently developed cardiomyopathy however, serum cTnI concentrations were elevated before clinical signs became evident (confirmed with echocardiography).     

内毒素介导动物急性肾功能衰竭机理的试验研究

为了阐明内毒素介导急性肾功能衰竭的机理,观察了内毒素性肾功能衰竭家兔血液凝固性变化和肾脏的病理形态学变化。与对照组家兔比较,模型组家兔血小板计数和血浆纤维蛋白原含量极显著降低(P<0 01),出血时间、凝血时间、凝血酶原时间和白陶土部分凝血活酶生成时间显著或极显著延长(P<0 05,P<0 01)。另一方面,内毒素注射在全部模型组家兔导致了弥漫性血管内凝血,71.4%的肾小球中发现了微血栓,肾小球纤维素密度指数达60 6%。此外,96.2%的肾小管上皮细胞变性坏死,84.1%的肾小管中有管型形成。对照组家兔均未发现这些病理变化。上述试验结果揭示,内毒素引发了弥漫性血管内凝血,而肾小球毛细血管内广泛形成的微血栓阻断了肾小球毛细血管血流,从而导致肾小球滤过率降低,这是内毒素介导急性肾功能衰竭的首要机理。此外,肾小管上皮细胞的变性、坏死可损害其重吸收和分泌功能,管型形成可阻塞肾小管管腔并增大肾球囊内的压力,这些也都是在内毒素介导急性肾功能衰竭发生发展过程中起重要作用的因素。     

Retrospective Evaluation of the Effect of Heart Rate on Survival in Dogs with Atrial Fibrillation

Background

Atrial fibrillation (AF) usually is associated with a rapid ventricular rate. The optimal heart rate (HR) during AF is unknown.

Hypothesis/Objectives

Heart rate affects survival in dogs with chronic AF.

Animals

Forty‐six dogs with AF and 24‐hour ambulatory recordings were evaluated.

Methods

Retrospective study. Holter‐derived HR variables were analyzed as follows: mean HR (meanHR, 24‐hour average), minimum HR (minHR, 1‐minute average), maximum HR (maxHR, 1‐minute average). Survival times were recorded from the time of presumed adequate rate control. The primary endpoint was all‐cause mortality. Cox proportional hazards analysis identified variables independently associated with survival; Kaplan‐Meier survival analysis estimated the median survival time of dogs with meanHR <125 bpm versus ≥125 bpm.

Results

All 46 dogs had structural heart disease; 31 of 46 had congestive heart failure (CHF), 44 of 46 received antiarrhythmic drugs. Of 15 dogs with cardiac death, 14 had CHF. Median time to all‐cause death was 524 days (Interquartile range (IQR), 76–1,037 days). MeanHR was 125 bpm (range, 62–203 bpm), minHR was 82 bpm (range, 37–163 bpm), maxHR was 217 bpm (range, 126–307 bpm). These were significantly correlated with all‐cause and cardiac‐related mortality. For every 10 bpm increase in meanHR, the risk of all‐cause mortality increased by 35% (hazard ratio, 1.35; 95% CI, 1.17–1.55; P < 0.001). Median survival time of dogs with meanHR<125 bpm (n = 23) was significantly longer (1,037 days; range, 524‐open) than meanHR ≥125 bpm (n = 23; 105 days; range, 67–267 days; P = 0.0012). Mean HR was independently associated with all‐cause and cardiovascular mortality (P < 0.003).

Conclusions and Clinical Importance

Holter‐derived meanHR affects survival in dogs with AF. Dogs with meanHR <125 bpm lived longer than those with meanHR ≥ 125 bpm.     

Echocardiographic Estimates of Right Ventricular Systolic Function in Dogs with Myxomatous Mitral Valve Disease

Background

Right ventricular (RV) dysfunction independently predicts outcomes in human myxomatous mitral valve disease (MMVD). There is limited information regarding RV systolic function in dogs with MMVD.

Hypothesis

Right ventricular systolic function differs among stages of disease, decreasing in decompensated MMVD.

Animals

Thirty‐sixclient‐owned dogs with MMVD not receiving oral cardiovascular medications.

Methods

Prospective clinical study. Dogs were categorized according to disease severity as ACVIM Stage B1, B2, or C. Seven echocardiographic indices of RV systolic function were measured. Groups were compared by 1‐way ANOVA and Tukey's HSD test. Frequencies of cases with cardiac remodeling falling outside previously established reference intervals were compared using Fisher's exact test. Intra‐ and interobserver measurement variability was calculated for each RV function index.

Results

The indices TAPSE (P = 0.029), RV St_L (P = 0.012), and RV StR_L (P = 0.041) were significantly different between groups. A greater proportion of B2 dogs (7 of 12) had TAPSE values above reference intervals compared with B1 (2 of 12) or C (2 of 12) dogs (P = 0.027). Measurement variability of TAPSE, RV S', and RV St_G was clinically acceptable.

Conclusions and Clinical Importance

Right ventricular systolic function differs between stages of MMVD, increasing in stage B2, and declining in stage C. The prognostic importance of RV function indices, particularly TAPSE, might be worth evaluating in dogs with MMVD.     

Effects of remifentanil on monophasic action potential and transmural dispersion of repolarization in rabbit myocardium

AIM: To study the effect of remifentanil on monophasic action potential and transmural dispersion of repolarization (TDR) in the 3-layer myocardium of isolated rabbit hearts. METHODS: Adult rabbits (n=18, 2.0 ~ 2.5 kg) were used to isolate the hearts for preparing Langendorff perfusion model. The hearts were randomly divided into 3 groups after perfusion with K-H solution for 15 min: the perfusion in control group (C group) continued for 60 min; the hearts in remifentanil group (R group) were perfused with 12 μg/L remifentanil K-H solution for 60 min; the hearts in remifentanil+aminophylline group (RA group) were given 60-min perfusion of 12 μg/L K-H remifentanil+30 mg/L aminophylline. The HR and 3 layers of myocardial monophasic action potential (MAP) in the left ventricular anterior wall were recorded at time points after balanced infusion for 15 min (T₀), and continued perfusion for 15 min (T₁), 30 min (T₂) and 60 min (T₃). The monophasic action potential duration of repolarization at 90% (MAPD₉₀) and the transmural dispersion of repolarization (TDR) were calculated. The early afterdepolarization, delay afterdepolarization and arrhythmia were also observed. RESULTS: In R group, slower HR and prolonger MAPD₉₀ and TDR at T₁~T₃ were observed as compared with those at T₀ (P<0.05). R group showed slower HR and longer MAPD₉₀ and TDR than C group and RA group (P<0.05). CONCLUSION: Remifentanil slows the HR, extends the MAPD₉₀ and increases the TDR, thus being prone to induce reentry. Aminophylline makes HR faster and MAPD₉₀ shorter, thereby reducing the TDR.