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      Echocardiographic changes in the progress of reverse shunt and improvement to left‐to‐right shunt after medical treatment in dogs with bidirectional patent ductus arteriosus or ventricular septal defect: A report of two cases

      case-report

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          Abstract

          Two Maltese dogs were referred for evaluation of a congenital heart disease: one was diagnosed with patent ductus arteriosus and the other was diagnosed with a ventricular septal defect. The PDA patient was diagnosed with congenital heart disease 2 weeks ago and the VSD patient about 11 months ago at another hospital. Echocardiographic findings revealed a bidirectional shunt condition, and the dogs were treated with medical management using sildenafil and oxygen inhalation. After medical management, the dogs returned to clinically normal conditions, and echocardiographic findings revealed a return to left‐to‐right shunt tendency. These dogs had no clinical signs associated with heart disease 3 years after treatment. This case report describes changes in echocardiography findings according to the progression of the reverse shunt and the possibility of improvement to a left‐to‐right shunt after medical treatment.

          Abstract

          This report describe the clinical and echocardiographic changes observed during the progression of the reverse shunt (one with patent ductus arteriosus and one with ventricular septal defect) and its improvement to a left‐to‐right shunt after medical treatment. Furthermore, this report details the successful treatment of two dogs using sildenafil and oxygen inhalation.

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          Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group.

          WA Conway, EO Coates, PA Kvale (1980)
          At six centers, 203 patients with hypoxemic chronic obstructive lung disease were randomly allocated to either continuous oxygen (O2) therapy or 12-hour nocturnal O2 therapy and followed for at least 12 months (mean, 19.3 months). The two groups were initially well matched in terms of physiological and neuropsychological function. Compliance with each oxygen regimen was good. Overall mortality in the nocturnal O2 therapy group was 1.94 times that in the continuous O2 therapy group (P = 0.01). This trend was striking in patients with carbon dioxide retention and also present in patients with relatively poor lung function, low mean nocturnal oxygen saturation, more severe brain dysfunction, and prominent mood disturbances. Continuous O2 therapy also appeared to benefit patients with low mean pulmonary artery pressure and pulmonary vascular resistance and those with relatively well-preserved exercise capacity. We conclude that in hypoxemic chronic obstructive lung disease, continuous O2 therapy is associated with a lower mortality than is nocturnal O2 therapy. The reason for this difference is not clear.
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            Sildenafil for treatment of lung fibrosis and pulmonary hypertension: a randomised controlled trial.

            Horst Olschewski, Ralf T Schermuly, Falk Wiedemann … (2002)
            Lung fibrosis can be complicated by pulmonary hypertension, limiting exercise tolerance and life expectancy. Furthermore, vasodilators might cause deterioration in gas exchange. Our aim was to compare acute effects of sildenafil, nitric oxide, and epoprostenol in individuals with pulmonary hypertension secondary to lung fibrosis. We did a randomised controlled, open-label trial, in 16 individuals admitted to our hospital with pulmonary hypertension secondary to lung fibrosis. After inhalation of nitric oxide (10-20 ppm), we assigned patients to either maximum tolerated dose of intravenous epoprostenol (mean 8.0 ng/kg per min; n=8) or oral sildenafil (50 mg; n=8). Our primary objective was to assess pulmonary vasodilative potency (decrease in pulmonary vascular resistance index) of sildenafil by comparison with inhaled nitric oxide and infused epoprostenol. Analyses were by intention to treat. Pulmonary vascular resistance index was reduced by nitric oxide (-21.9%, 95% CI -14.1 to -36.2), epoprostenol (-36.9%, -24.4 to -59.6), and sildenafil (-32.5%, -10.2 to -54.1). However, ratio of pulmonary to systemic vascular resistance decreased only in individuals who received nitric oxide and sildenafil. Baseline measurement of multiple-inert-gas elimination showed right-to-left shunt flow (4.8%, 0.0-28.2) and little perfusion of low ventilation(V)/perfusion(Q) areas (0.1%, 0.0-13.0). Prostacyclin increased V/Q mismatch (shunt 16.8%, 10.8-35.9; low V/Q 3.8%, 0.0-13.0) and decreased arterial oxygenation. By contrast, nitric oxide (4.5%, 0.0-18.0; 0.0%, 0.0-17.3) and sildenafil (3.3%, 0.0-11.3; 0.0%, 0.0-12.4) maintained V/Q matching, with raised arterial partial pressure of oxygen (14.3 mm Hg, -1.7 to 31.3) noted for sildenafil. We recorded no adverse events. Sildenafil causes preferential pulmonary vasodilation and improves gas exchange in patients with severe lung fibrosis and secondary pulmonary hypertension.
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              Vertebral scale system to measure canine heart size in radiographs.

              Robert Buchanan, J Bucheler (1995)
              A method for measuring canine heart size in radiographs was developed on the basis that there is a good correlation between heart size and body length regardless of the conformation of the thorax. The lengths of the long and short axes of the heart of 100 clinically normal dogs were determined with calipers, and the dimensions were scaled against the length of vertebrae dorsal to the heart beginning with T4. The sum of the long and short axes of the heart expressed as vertebral heart size was 9.7 +/- 0.5 vertebrae. The differences between dogs with a wide or deep thorax, males and females, and right or left lateral recumbency were not significant. The caudal vena cava was 0.75 vertebrae +/- 0.13 in comparison to the length of the vertebra over the tracheal bifurcation.
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                Author and article information

                Contributors
                Hakyoung Yoon:
                ORCID: https://orcid.org/0000-0002-5051-5331
                knighttt7240@gmail.com
                Journal
                Journal ID (nlm-ta): Vet Med Sci
                Journal ID (iso-abbrev): Vet Med Sci
                Journal ID (doi): 10.1002/(ISSN)2053-1095
                Journal ID (publisher-id): VMS3
                Title: Veterinary Medicine and Science
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2053-1095
                Publication date (Electronic): 30 January 2023
                Publication date Collection: May 2023
                Volume: 9
                Issue: 3 ( doiID: 10.1002/vms3.v9.3 )
                Pages: 1044-1052
                Affiliations
                [ 1 ] Department of Veterinary Medical Imaging, College of Veterinary Medicine Jeonbuk National University Iksan South Korea
                [ 2 ] Bundang Leaders Animal Medical Center Seongnam South Korea
                [ 3 ] VIP Animal Medical Center Seoul South Korea
                Author notes
                [*] [* ] Correspondence

                Hakyoung Yoon, Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, 79 Gobong‐ro, Iksan‐si, Jeollabuk‐do 56443, Republic of Korea.

                Email: knighttt7240@ 123456gmail.com

                Author information
                https://orcid.org/0000-0002-5051-5331
                Article
                Publisher ID: VMS31081
                DOI: 10.1002/vms3.1081
                PMC ID: 10188055
                PubMed ID: 36716384
                SO-VID: 918fcaac-70cb-497f-bec1-5f6d2917cafa
                Copyright © © 2023 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Page count
                Figures: 5, Tables: 0, Pages: 9, Words: 6056
                Funding
                Funded by: The research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2019R1A6A1A03033084)
                Categories
                Subject: Case Report
                Subject: DOGS
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                cover-date May 2023
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.8 mode:remove_FC converted:16.05.2023

                Keywords: canine,congenital heart defect,echocardiography
                Data availability:
                Keywords: canine, congenital heart defect, echocardiography

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