Claudio Bussadori

Retrospective Review of Congenital Heart Disease in 976 Dogs

BACKGROUND Knowledge of epidemiology is important for recognition of cardiovascular malformations. OBJECTIVE Review the incidence of congenital heart defects in dogs in Italy and assess breed and sex predispositions. ANIMALS Nine hundred and seventy-six dogs diagnosed with congenital heart disease (CHD) of 4,480 dogs presented to Clinica Veterinaria Gran Sasso for cardiovascular examination from 1997 to 2010. METHODS A retrospective analysis of medical records regarding signalment, history, clinical examination, radiography, electrocardiography, echocardiography, angiography, and postmortem examination was performed. Breed and sex predisposition were assessed with the odds ratio test. RESULTS CHD was observed in 21.7% of cases. A total of 1,132 defects were observed with single defects in 832 cases (85%), 2 concurrent defects in 132 cases (14%), and 3 concurrent defects in 12 cases (1%). The most common defects were pulmonic stenosis (PS; 32.1%), subaortic stenosis (SAS; 21.3%), and patent ductus arteriosus (20.9%), followed by ventricular septal defect (VSD; 7.5%), valvular aortic stenosis (AS; 5.7%), and tricuspid dysplasia (3.1%). SAS, PS, and VSD frequently were associated with other defects. Several breed and sex predispositions were identified. CONCLUSIONS AND CLINICAL RELEVANCE The results of this study are in accordance with previous studies, with slight differences. The breed and sex predilections identified may be of value for the diagnosis and screening of CHD in dogs. Additionally, the relatively high percentage of concurrent heart defects emphasizes the importance of accurate and complete examinations for identification. Because these data are from a cardiology referral center, a bias may exist.

Percutaneous versus surgical closure of secundum atrial septal defects: a systematic review and meta-analysis of currently available clinical evidence

AIMS To summarise data from studies comparing surgical (SC) versus percutaneous closure (PC) of atrial septal defects (ASDs). METHODS AND RESULTS Electronic databases, journals and major international conference proceedings were systematically searched for pertinent clinical studies comparing the two methods of closure (percutaneous and surgical) published up to December 2008, including only those reporting on more than 20 patients. Primary endpoints: occurrence of death and of total and major early complications. Thirteen original studies (3,082 patients) were included. All studies were non-randomised. One death was reported in the surgical group (0.08%; 95% C.I. 0-0.23%). Analysis of postprocedural complications showed a 31% rate (95% CI 21-41%) in SC patients and a 6.6% rate (95% CI 3.9-9.2%) in PC subjects. The adjusted OR for SC vs. PC total complications was 5.4 (95% CI 2.96-9.84; p<0.0001), significantly in favour of PC. The postprocedural major complication rate was 6.8% (95% CI 4-9.5%) in SC patients and 1.9% (95% CI 0.9-2.9%) in PC patients. The adjusted OR for SC vs. PC major complications was 3.81 (95% CI 2.7-5.36; p=0.006), again favouring PC. CONCLUSIONS The largest cohort to date of patients with secundum ASD shows that treatment by a percutaneous approach has a significantly lower rate of either total or major early postprocedural complications compared to surgery.

Clinical Efficacy of Pimobendan Versus Benazepril for the Treatment of Acquired Atrioventricular Valvular Disease in Dogs

Seventy-six dogs with clinical acquired atrioventricular valvular disease were evaluated to determine the efficacy of pimobendan (n=41) versus benazepril hydrochloride (n=35) in a randomized, positive-controlled, multicenter study. The study was divided into 56-day and long-term evaluation periods. In a subgroup of dogs with concurrent furosemide treatment (pimobendan [n=31], benazepril [n=25]), the Heart Insufficiency Score improved in favor of pimobendan (P=0.0011), equating to a superior overall efficacy rating (P<0.0001) at day 56. Long-term median survival (i.e., death or treatment failure) for dogs receiving pimobendan was 415 days versus 128 days for dogs not on pimobendan (P=0.0022).

Balloon Valvuloplasty in 30 Dogs with Pulmonic Stenosis: Effect of Valve Morphology and Annular Size on Initial and 1‐Year Outcome

Case records of 30 dogs in which valvular pulmonic stenosis (PS) was treated by balloon dilation were reviewed retrospectively. Physical examination, thoracic radiographs, 9-lead ECG, echocardiography, and Doppler studies were performed in all dogs. Two-dimensional and Doppler echocardiography were repeated after 24 h and 1 year after treatment. Dogs were divided into 2 groups based on their valvular anatomy on echocardiography and aortic:pulmonary ratio: 18 had type A PS with normal annulus diameter and aortic:pulmonary ratio < or = 1.2, and 12 had type B PS with pulmonary annulus hypoplasia and aortic:pulmonary ratio > 1.2. Most dogs in the type B group were brachycephalic and had no poststenotic dilatation on thoracic radiographs. Of the dogs with type A stenosis, 100% survived valvuloplasty with resolution of clinical signs. At 1-year follow-up, 94.4% were still alive and remained asymptomatic. Of those with type B stenosis, 66.6% had favorable outcome postvalvuloplasty. At 1-year follow-up, 66.6% of dogs were alive, and resolution of clinical signs was obtained in 50%. This study revealed the immediate and long-term efficacy of balloon valvuloplasty in dogs with PS.

Surgical ventricular restoration: left ventricular shape influence on cardiac function, clinical status, and survival.

BACKGROUND Myocardial infarction can result in a spectrum of left ventricular (LV) shape abnormalities. Surgical ventricular restoration (SVR) can be applied to any, but there are no data that relate its effectiveness to LV shape. Moreover, there is no consensus on the benefit of SVR in patients with a markedly dilated ventricle, without clear demarcation between scarred and normal tissue. This study describes postmyocardial infarction shape abnormalities and cardiac function, clinical status, and survival in patients undergoing SVR. METHODS Echo studies of 178 patients were retrospectively reviewed. Three types of LV shape abnormalities were identified: type 1 (true aneurysm), type 2 (nonaneurysmal lesions defined as intermediate cardiomyopathy), and type 3 (ischemic dilated cardiomyopathy). RESULTS SVR induced significant improvement in cardiac and clinical status in all patients, regardless LV shape types. Although not significant, mortality was higher in types 2 and 3. CONCLUSIONS Ischemic dilated cardiomyopathy and not just the true aneurysm can be successfully treated with SVR. Shape classification may be useful to improve patient selection and compare results from different institutions that are otherwise impossible to compare.

Transcatheter closure of congenital ventricular septal defects in adult : Mid-term results and complications

INTRODUCTION Transcatheter treatment of congenital heart defects in adult patients is dramatically changing the way in which this population is being treated. This report outlines mid-term follow-up results and complications in adult patients that underwent transcatheter VSD closure. METHODS The data of 40 adult patients who underwent transcatheter closure of a VSD at our institution were collected prospectively between January 2000 and June 2006. The inclusion criteria for this study were clinical and/or echocardiographic evidence of a significant left-to-right shunt through a muscular VSD (mVSD) or a perimembranous VSD (pVSD). A shunt was considered significant when the following were found: (i) left atrial enlargement, defined as a left atrial-to-aortic ratio >1.5; (ii) left ventricular enlargement (left ventricular overload), defined as a left ventricular end-diastolic diameter >+2 standard deviation (SD) above the mean for the patients age. Another inclusion criterion was a previous episode of endocarditis. RESULTS 41 procedures were carried out in 40 patients; a mVSD-O was used in 22 patients and a pVSD-O in 18 patients (1 patient had two devices inserted). No deaths occurred; no procedure was aborted. A total of 6 (14.6%) complications occurred. The most frequent complication was a rhythm abnormality (n=4). No device embolization occurred. The median follow-up duration was 36 months (range: 6-81 months). No deaths or cases of endocarditis occurred. One patient who had two devices implanted because of a residual defect after a tetralogy of Fallot repair, had to be operated again 3 months after the second device implantation because of a persistent significant residual leak. CONCLUSIONS Greater experience, possibly of multicentre trials and long-term follow-up are required to better assess the safety and effectiveness of this procedure as an alternative to surgical approaches in adult patients.

Doppler echocardiographic study of left ventriculardiastole in non-anaesthetized healthy cats

The current study: (1) describes the Doppler technique for the assessment of diastolic function in feline patients; (2) reports normal Doppler diastolic values; and (3) determines the effect of ageing on these parameters. Doppler echocardiography was performed on 20 non-anaesthetized healthy cats. Each diastolic parameter was correlated with age, body weight, body surface area and R-R interval. To assess the isovolumetric relaxation phase of diastole, isovolumetric relaxation time was measured. To assess the filling phase of diastole, we measured peak flow velocities of the E and A waves, diastolic filling time, acceleration and deceleration time of the E wave and the E/A ratio of transmitral flow, peak flow velocity of the S, D and the A retrograde waves, as well as the S/D ratio and the systolic fraction of pulmonary venous flow. We found a significant correlation between age and peak flow velocity of the A wave, normalized peak flow velocity of the A wave, the E/A ratio, the acceleration time of the E wave, the diastolic filling time, the velocity time integral of the E wave, the peak flow velocity of the S wave and the systolic fraction. It was concluded that Doppler echocardiographic analysis of diastole is possible in the cat and that age has most effect on filling parameters.

Covered stents in patients with congenital heart defects

Objectives: To evaluate the role of covered Cheatham‐Platinum stents in patients with congenital heart disease. Background: There are limited data in the literature about the use of covered stent in patients with congenital heart disease. Methods: Between January 2004 and September 2005, covered Cheatham‐Platinum stents were implanted into 18 patients with congenital heart defects (9 males, median age 19 years, range 8–45 years). Sixteen had aortic coarctation or recoarctation (8 with associated aneurysm, 1 with patent ductus arteriosus, 3 with an irregular wall, 4 with subatretic native aortic coarctation) (group 1). Two subjects with univentricular heart circulation were treated because of complex right‐to‐left shunting (Group 2). Results: Group 1: The stents used ranged from 34 to 45 mm in length. The mean fluoroscopy and procedure times were 12 ± 8 and 70 ± 15 minutes, respectively. After implantation, the gradient across the stenosis decreased significantly (prestent median value 37 mmHg) (range 20–50 mmHg) versus poststent: median value 0 mmHg (range 0–10 mmHg) (P < 0.0001). Vessel diameter increased from a median value of 6 mm (range 0–11) to a median value of 14 mm (range 10–23) (P < 0.0001). Stents were placed in the correct position in all subjects. No complications occurred and on angiographic control the stenoses had been relieved and the aneurysms completely excluded. Group 2: Implantation of the covered stents successfully abolished right‐to‐left shunting in both patients. Both had significant increases in oxygen saturation and no complications occurred. Follow‐up: During a median follow‐up of 7 months (1–19 months), the results were stable without any complications. Conclusion: Covered Cheatham‐Platinum stents are very useful tools for treating various congenital cardiovascular malformations.

Prevalence of Congenital Heart Disease in Boxers in Italy

OBJECTIVE To evaluate the prevalence of congenital heart disease in boxers in Italy by auscultation and echocardiography. METHODS This randomized study involved 500 boxers. The inclusion criteria were that the animals should be asymptomatic, older than 1 year and with a pedigree. Dogs with a heart murmur underwent a complete echo-Doppler examination. The criteria for the diagnosis of aortic or pulmonic stenosis were: heart murmur on cardiac auscultation; direct imaging of the obstructive lesions; turbulent aortic or pulmonic flow with peak velocity of >2 m/sec and > 1.5 m/sec, respectively. RESULTS 265 out of 500 dogs exhibited a heart murmur on cardiac auscultation. According to echo-Doppler examination, 89 (17.8%) dogs were affected with congenital heart disease. Subaortic stenosis and/or pulmonic stenosis accounted for all cases identified, although subaortic stenosis was more prevalent. Type I (63.75%) and Type II (21.25%) subaortic stenosis were the most common forms of the disease. Type A was the most prevalent type of pulmonic stenosis (74.2%). None of the dogs with a heart murmur of grade 1/6 or 2/6 complied with all the pre-selected criteria, and they were not considered to be affected with congenital heart disease. CONCLUSIONS The prevalence of congenital heart disease in boxers in Italy appears to be very high (17.8%). In this study, subaortic stenosis and pulmonic stenosis accounted for all identified heart diseases. These findings support a the suspicion of these diseases when a heart murmur is found in a boxer, but only Doppler echocardiography can differentiate between subaortic stenosis and pulmonic stenosis.

Percutaneous closure of multiple defects of the atrial septum: Procedural results and long‐term follow‐up

Background: The percutaneous closure of single atrial septal defect (ASD) is a valid alternative to surgery. Objectives: To assess the feasibility of percutaneous treatment of multiple ASDs. Methods: Between 1998 and 2007, 165 out of 1280 consecutive patients undergoing ASD percutaneous closure at our institution showed multiple defects that were classified in four categories: double atrial septal defects (d‐ASD), multifenestrated atrial septal defects (f‐ASD), multifenestrated defects with no signs of right heart overload (f‐PFO), and complex cases (c‐ASD). The following end points were taken into consideration: (1) immediate procedural success; (2) long term safety and efficacy. In this study, up to 81% of multiple ASDs were suitable for percutaneous closure. Results: Multiple device implantations were required in 47% of cases, especially in patients with d‐ASD and c‐ASD. Complication rate, residual shunt, and long term outcome were comparable among the four different categories. In particular, at long term follow‐up (6 ± 2 years) no patient required further surgical or percutaneous treatment and complete closure was confirmed in 99% of cases. Conclusions: Percutaneous closure of multiple ASDs is feasible and associated with a good outcome. A thorough identification and analysis of morphological aspects are mandatory in order to select the appropriate device and the optimal strategy.