Evaluation of transpulmonary ultrasound dilution cardiac output in piglets: accuracy,precision and trending ability with room temperature injectate

ObjectiveTranspulmonary ultrasound dilution (TPUD) is a minimally invasive technique to measure cardiac output (CO) using a 1 mL kg^–1 isotonic 37 °C saline injectate indicator. The objective was to evaluate the performance of TPUD using a room temperature saline injectate.Study designProspective experimental trial.AnimalsA total of seven anesthetized male Yorkshire piglets.MethodsPiglets aged 1 month and weighing 7.7–9.0 kg were anesthetized with detomidine–ketamine–hydromorphone–isoflurane and a pulmonary artery flow probe (PAFP) placed via a median sternotomy. The thoracic cavity remained open during measurement of CO by PAFP and TPUD. The TPUD indicators of 1 mL kg^–1 0.9% saline at 37 °C and 20 °C were compared during infusions of phenylephrine and dobutamine, blood withdrawal and replacement. Bias, limits of agreement (LoAs) and percentage error (PE) between each iteration of PAFP and TPUD were measured with Bland–Altman plots. Trending ability via concordance, angular bias and radial LoA were compared.ResultsBland–Altman plots showed negligible bias with varying LoAs. PEs of 22% and 38% were found for 37 °C and 20 °C saline injectates, respectively. In the four-quadrant plots, the concordance rate was 94% and 100% for measurements obtained with 37 °C and 20 °C saline injectates, respectively. Angular bias for both were < ±5 °, with radial LoA < ±7 °.ConclusionsTPUD was accurate when using 1 mL kg^–1 of isotonic saline at 37 °C in a range of CO within 0.2–0.8 L minute^–1, and it reliably tracked positive and negative changes in CO. Room temperature (20 °C) indicator was less accurate but equally able to track direction of changes in CO.Clinical relevanceThe use of room temperature injectates allows an easy, readily available clinical application of TPUD CO monitoring while preserving the trending ability of the monitor.     

TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF THE LEFT VENTRICULAR OUTFLOW TRACT, AORTIC VALVE AND ASCENDING AORTA IN BOXER DOGS WITH HEART MURMURS

The study was aimed at evaluating the anatomy of the left ventricular outflow tract, aortic valve, and ascending aorta by means of multiplane transesophageal echocardiography in Boxer dogs with left basilar heart murmurs and at comparing two-dimensional (2D) transthoracic to transesophageal echocardiography for the diagnosis of subaortic stenosis in this breed. Twenty-eight Boxers were included in the study and allocated to four groups according to physical and routine transthoracic 2D and Doppler echocardiography findings: group A--dogs with low grade (I-II/VI) heart murmurs without overt evidence of aortic stenosis (14 dogs); group B--dogs with type 1 subaortic stenosis (seven dogs); group C--dogs with type 2 subaortic stenosis (five dogs); group D--dogs with type 3 subaortic stenosis (two dogs). Anatomic lesions were not discovered by transesophageal echocardiography in dogs belonging to group A. Transesophageal imaging confirmed the type of subaortic stenosis, as graded by transthoracic echocardiography, in diseased animals (groups BCD). Morphologic information obtained by transesophageal echocardiography in Boxer dogs was similar to that obtained by transthoracic echocardiography.     

Oesophageal electrocardiography in healthy horses

Reasons for performing study: In human medicine, oesophageal electrocardiography (ECG) is a well‐established technique that magnifies P waves with respect to the QRS complex. Objectives: To investigate the feasibility of oesophageal ECG recording in horses and its ability to produce larger P waves compared with base‐apex and unipolar recordings. Methods: Bipolar and unipolar ECG were performed using oesophageal and surface electrodes. Oesophageal ECG was obtained from 6 different recording configurations at different oesophageal depths. Amplitudes of P, Q, R, S and T waves were measured from 3 different cardiac cycles for each recording configuration and depth. Results: Oesophageal ECG was feasible in all horses. For all oesophageal recording configurations, significantly larger P waves were recorded from a depth that equalled ‘height of the withers + 10 cm’ (HW₊₁₀) than from any other depth. P/QRS_magn, the ratio between the P wave and QRS complex magnitudes, was largest for intraoesophageal recordings with an interelectrode distance of 10 cm, at HW₊₁₀, where it was significantly larger than base‐apex and unipolar recordings. Base‐apex recording resulted in significantly smaller P waves than all other recording configurations and significantly smaller P/QRS_magn ratios than all other recording configurations except one combined oesophageal‐surface recording (E/S_low). Conclusions: Oesophageal ECG recording is feasible in horses and effective in magnifying P wave amplitude. Potential relevance: The procedure is promising for diagnosis of supraventricular tachydysrhythmias and might be used in electrophysiological studies and for cardiac pacing.     

Congestive Heart Failure Due to Endocardiosis of the Mitral Valves in an African Pygmy Hedgehog

A 2.5-year-old male African pygmy hedgehog (Atelerix albiventris) was presented with a 2-week history of lethargy, reduced appetite, and general weakness. Based on the clinical signs and heart valve abnormalities observed during an echocardiography examination, a provisional diagnosis of endocardiosis or endocarditis was made. Immediate therapeutic intervention consisted of furosemide, pimobendan, and amoxicillin/clavulanate. Despite medical treatment, 2 weeks following presentation, the hedgehog’s physical condition deteriorated to the point that euthanasia was recommended for the patient and agreed to by its owner. A postmortem examination was performed and tissue samples submitted for histopathology revealed a final diagnosis of valvular endocardiosis and wobbly hedgehog syndrome.     

Two‐dimensional speckle tracking for quantification of left ventricular circumferential and radial wall motion in horses

Reasons for performing study: The use of two‐dimensional speckle tracking (2DST) for quantification of left ventricular (LV) function has recently been described in horses using long‐axis images and short‐axis images at chordal but not at papillary muscle level. Objectives: To compare the feasibility and reliability of 2DST for quantification of circumferential and radial LV function in short‐axis images at papillary muscle and chordal level. Methods: Repeated echocardiographic examinations were performed on 10 healthy trotter horses by 2 observers from a right parasternal short‐axis view at papillary muscle and chordal level. Segmental and averaged peak values and timing of circumferential and radial strain and strain rate, radial displacement and rotation were measured in 6 LV wall segments in each imaging plane. Global peak values were calculated for circumferential strain and strain rate. The inter‐ and intraobserver within‐ and between‐day variability was assessed by calculating coefficients of variation for repeated measurements. Results: 2DST analysis was feasible in each cardiac cycle, although tracking was often inadequate during early diastole. Measurements of averaged systolic circumferential and radial strain and strain rate and radial displacement as well as global circumferential strain and strain rate could be determined with low variability. Early and late diastolic strain rate and systolic rotation showed a moderate variability. Radial segmental measurements were more reliable than circumferential measurements. The interventricular septum showed a higher circumferential and lower radial strain compared with the LV free wall. Peak timing was earlier at papillary muscle compared with chordal level. Conclusions: 2DST measurements of global and regional circumferential and radial LV wall motion are feasible both at papillary muscle and chordal level. Potential relevance: Several measurements had good reliability and should be used for evaluation of the technique in a clinical setting.