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We sought to determine the feasibility, measurement variability, and within-day repeatability of tricuspid annular plane systolic excursion (TAPSE) measured by two-dimensional echocardiography (2D TAPSE), generate reference intervals for 2D TAPSE, assess agreement and correlation between 2D TAPSE and the conventional TAPSE measured by M-mode echocardiography (MM TAPSE), and to assess the ability of 2D TAPSE to track a drug-induced decrease in right ventricular (RV) function compared with MM TAPSE.Seventy healthy privately owned dogs of varying bodyweight.All dogs underwent a single echocardiogram to quantify RV function by both TAPSE methods. Ten dogs underwent a second echocardiogram 2-3 h after the first to assess within-day repeatability, and 20 different dogs underwent a second echocardiogram 3-h after atenolol (1 mg/kg per os (PO)). Intraobserver and interobserver measurement variabilities were assessed in 12 randomly selected studies using coefficients of variation. Statistical relationships between 2D TAPSE and bodyweight, gender, heart rate, and age were explored.2D TAPSE could be measured in all dogs. Coefficients of variation for repeatability and measurement variability were low (≤12%). Bodyweight-dependent reference intervals for 2D TAPSE were generated using allometric scaling. TAPSE methods were strongly correlated (r = 0.72; p0.0001) but 2D TAPSE measured consistently less than MM TAPSE (-1.6 [2.2] mm) when analyzed by Bland-Altman's method. Both TAPSE methods were significantly (p≤0.014) reduced after atenolol but percent decrease in 2D TAPSE (-16.2 [9.3]%) was significantly greater (p=0.03) than MM TAPSE (-7.5 [13.8]%).Two-dimensional echocardiography TAPSE appears well suited for clinical assessment of RV function. The TAPSE methods should not be used interchangeably.

Objectives We aimed to evaluate safety and efficacy of high-pressure balloon valvuloplasty (HPBVP) for treatment of canine severe pulmonary valve stenosis (PS). A secondary aim was to provide pre-procedure predictors of success. Animals Twenty-five dogs. Methods Prospective observational study. Dogs with severe PS (echocardiographically derived trans-pulmonary peak/maximum pressure gradient (EDPG) ≥80 mmHg) were recruited. All dogs underwent echocardiography before and 20–24hrs after HPBVP using a high-pressure balloon with rated burst pressures ranging from 12 to 18 ATM. Procedural success was defined as a post-HPBVP EDPG reduction of ≥50% or reduction into at least the moderate category of PS (50–79 mmHg). Optimal result was defined as a post-procedural EDPG ≤30 mmHg. Results Initial median (IQR) EDPG for all dogs was 96 (88, 127) mmHg with a post-operative median of 48 (36, 65) mmHg. The median EDPG reduction provided by HPBVP was 63% (39, 68); procedural success rate was 92% (23 dogs). Optimal results were achieved in 56% (14 dogs). There were no significant correlations between EDPG reduction and valve morphology (Type A and Type B) or severity of right ventricular hypertrophy. Pulmonary valve annulus diameter was the only echocardiographic variable that was significantly correlated to EDPG reduction (p = 0.02; r = −0.46). No dog experienced any anesthetic or surgical complications, and all patients survived the procedure. Conclusions In this cohort of 25 dogs with severe PS, HPBVP was safe and effective. The procedural success rate and high number of optimal results achieved with HPBVP suggest future randomized controlled trials comparing HPBVP to conventional valvuloplasty are warranted.

Functional assessment of the right ventricle (RV) is challenging and has been understudied compared with the left ventricle. However, advances in echocardiographic assessment of RV function permit the quantitative assessment of RV performance via numerous modalities. Many RV function indices have now been studied in large samples of healthy dogs, and studies suggest a clinical benefit to echocardiographic RV function assessment in dogs and cats. This article reviews relevant RV anatomy and physiology and highlights numerous indices of RV function assessment for dogs and cats. Imaging techniques, advantages and disadvantages, and clinical impact of these indices are discussed.

A coronary artery anomaly characterized by the presence of a single left coronary ostium with absence of the right coronary ostium and an anomalous prepulmonic right coronary artery course was observed in two dogs with concurrent congenital pulmonary valve stenosis. This unique coronary artery anatomy is similar to the previously described single right coronary ostium with anomalous prepulmonic left coronary artery, the so-called type R2A anomaly, in that an anomalous coronary artery encircles the pulmonary valve annulus. Both dogs of this report, a boxer and an English bulldog, were of breeds known to be at risk for the type R2A anomaly. As such, veterinarians should be aware that the echocardiographic presence of a left coronary ostium in a dog with pulmonary valve stenosis does not exclude the possibility of a prepulmonic coronary artery anomaly that may enhance the risk of complications during balloon pulmonary valvuloplasty. A descriptive naming convention for coronary artery anomalies in dogs is also presented, which may be preferable to the older coding classification scheme.

Objective To report signalment, history, indications, complications and outcome for 28 dogs and 5 cats in which 34 permanent epicardial pacing leads were surgically placed by transdiaphragmatic approach (32) or intercostal thoracotomy (2). Methods Medical records (2005–2010) were reviewed. Signalment, age, species, gender, clinical signs, presence of structural heart disease and/or congestive heart failure, ECG diagnosis, body weight ( 10 kg), and overall survival rate were recorded. Statistical correlations were made between these variables and major and minor complications rates. Results Except for body weight, no statistical differences were identified in prevalence of major (life threatening or requiring replacement of the pacemaker system) or minor (self-limiting) complications; dogs weighing >10 kg had significantly more major complications (P = .03). There was a trend (P = .051) for lower survival in animals that had major complications. Conclusions Larger dogs (>10 kg) may be predisposed to more major complications with epicardial pacemaker (EP) implantation. Major complication rate and survival time are similar to those reported for transvenous pacing and therefore implantation of EPs remains a suitable alternative.

Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine. Background: Studies evaluating right ventricular (RV) structural and functional abnormalities in feline hypertrophic cardiomyopathy (HCM) are limited. Hypothesis: Right ventricular structural and functional abnormalities are present in cats with HCM and are associated with clinical severity. Animals: Eighty-one client-owned cats. Methods: Retrospective 2-dimensional (2D) echocardiographic study. Right atrial diameter (RAD), RV free wall thickness (RVFWd), RV internal dimension (RVIDd), RV fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) were measured in control cats (n = 26), cats with subclinical HCM (subclinical HCM; n = 31), and cats with HCM and congestive heart failure (HCM + CHF; n = 24). Results: Right heart size (RAD, RVFWd, and RVIDd) and RV function (FAC and TAPSE) significantly (all P

© 2016 American College of Veterinary Internal Medicine. Background: Echocardiographic assessment of diastolic function is challenging in cats, partially because of transmitral flow pattern fusion associated with high heart rates. With heart rate (HR) reduction, transmitral flow waveforms separate, allowing identification of diastolic dysfunction. Timolol, an ophthalmic, nonselective beta-blocker used in glaucoma is safe and transiently decreases HR in clinical trials. Hypothesis: Administration of timolol ophthalmic solution decreases HR and facilitates echocardiographic assessment of diastolic function in cats without inducing clinically relevant adverse effects. Animals: Twenty-five apparently healthy cats. Methods: Electrocardiograms and echocardiograms including transmitral flow patterns were evaluated before and 20 minutes after ocular administration of 1 drop of timolol 0.5% solution. Twenty cats underwent treatment with timolol, and 5 different cats served as untreated controls to evaluate the effects of acclimation to the hospital environment on HR. Results: Acclimation to the hospital had no effect on HR in control cats. After timolol administration, a significant median HR reduction of 25 bpm was observed (P < .0001). Timolol had no effect on E/A ratio in cats without E/A fusion (7/20, P = .44). Of the 13 cats with E and A waves that were fused before timolol application, separation of these waves was identified in 8 cats (62%) after timolol treatment. No bradyarrhythmias were noted after timolol administration, but 2 cats had first-degree atrioventricular block. Timolol resulted in resolution of dynamic outflow tract obstruction in 6 of 6 cats. Conclusions and clinical importance: Ocular administration of timolol safely decreases HR in cats and could facilitate assessment of diastolic function.

Objective—To examine effects of an autologous platelet-rich fibrin (PRF) membrane for enhancing healing of a defect of the patellar tendon (PT) in dogs. Animals—8 adult dogs. Procedures—Defects were created in the central third of the PT in both hind limbs of each dog. An autologous PRF membrane was implanted in 1 defect/dog, and the contralateral defect was left empty. Dogs (n = 4/time period) were euthanized at 4 and 8 weeks after surgery, and tendon healing was assessed grossly and histologically via a semiquantitative scoring system. Cross-sectional area of the PTs was also compared. Results—Both treated and control defects were filled with repair tissue by 4 weeks. There was no significant difference in the histologic quality of the repair tissue between control and PRF membrane—treated defects at either time point. At both time points, the cross-sectional area of PRF membrane—treated tendons was significantly greater (at least 2.5-fold as great), compared with that of sham-treated tendons. At 4 weeks, the repair tissue consisted of disorganized proliferative fibrovascular tissue originating predominantly from the fat pad. By 8 weeks, the tissue was less cellular and slightly more organized in both groups. Conclusions and Clinical Relevance—A PRF membrane did not enhance the rate or quality of tendon healing in PT defects. However, it did increase the amount of repair tissue within and surrounding the defect. These results suggested that a PRF membrane may not be indicated for augmenting the repair of acutely injured tendons that are otherwise healthy.

Objective: To compare the concentration of a representative growth factor (transforming growth factor-beta [TGF-β]1) eluted from a platelet-rich fibrin matrix (PRFMatrix), a platelet-rich fibrin membrane (PRFMembrane), and a whole blood clot (BC) over time, and to compare the mitogenic effect of the eluents from each construct. Study Design: In vitro study. Sample Population: PRFMatrix, PRFMembrane, and BC (n=4/construct/time point). Methods: Each construct was placed in tissue culture wells containing media for 7 days. The media was collected and replenished on days 1, 3, 5, and 7 and the concentration of eluted TGF-β1 was measured by enzyme-linked immunosorbent assay. Canine tendon cells were subjected to additional aliquots of the conditioned media and the amount of cell proliferation compared. Results: The media from both PRFM (PRFMatrix and PRFMembrane) constructs contained significantly more (P≤.026) TGF-β1 at days 1 and 3 and produced a significant increase (P≤.044) in cell proliferation at all time points compared with the BC. The PRFMembrane media contained significantly more (P≤.05) TGF-β1 at days 1 and 3 and produced a significant increase (P≤.002) in cell proliferation at all time points compared with the PRFMatrix. Conclusions: Both PRFM constructs are comprised of a dense fibrin scaffold that contains increased concentrations of TGF-β1 and are capable of increasing tendon cell proliferation over time when compared with a BC. Clinical Relevance: The sustained increase in growth factor availability in PRFM constructs may be beneficial in the healing of biologically compromised tissues.

© 2015 Elsevier B.V. Objective: To quantify drug-induced changes in right ventricular (RV) systolic function after administration of pimobendan and atenolol. Animals: 80 healthy privately-owned dogs. Methods: Using a prospective, blinded, fully-crossed study design with randomized drug administration, RV systolic function was determined twice at two time periods; before and 3h after administration of pimobendan (0.25mg/kg PO) or atenolol (1mg/kg PO). Indices of RV systolic function included tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulsed-wave tissue Doppler-derived systolic myocardial velocity of the lateral tricuspid annulus (S'), and speckle-tracking-derived global longitudinal RV free wall strain and strain rate. The effect of treatment on percent change from baseline RV function was analyzed with a linear mixed model including the covariates heart rate, body weight, age, gender, drug sequence, and time period. Results: All indices showed a significant (p < 0.0001) increase and decrease from baseline following pimobendan and atenolol, respectively. Significant differences from baseline were attributed to drug treatment (p < 0.0001); whereas, effects of other covariates were not significant. The greatest percent changes, but also highest variability, were observed for S' and strain rate (p < 0.0001). Post-atenolol, a significantly greater proportion of dogs exceeded the repeatability coefficient of variation for FAC and S' compared to TAPSE (p≤0.007). Conclusions: Echocardiographic indices in healthy dogs tracked expected changes in RV systolic function following pimobendan and atenolol and warrant study in dogs with cardiovascular disease.

© 2016 American College of Veterinary Internal Medicine. Background: Noninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure. Hypothesis/Objectives: To determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler-derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs. Animals: Sixty-nine client-owned dogs with TR. Methods: Prospective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG 75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog. Results: Right pulmonary artery distensibility index demonstrated the strongest correlation (r = -0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = -0.69; P < .0001) and AT:ET (r = -0.68; P < .0001). RPAD index possessed the most accurate cutoff (50 mmHg compared to AT (1.04; Sn 0.94, Sp 0.74). All intra- and interobserver measurement variabilities exhibited coefficients of variation ≤13%. Conclusions and Clinical Importance: Right pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

Objectives To describe a series of dogs with pulmonary artery dissection and patent ductus arteriosus (PDA). Animals Eight dogs. Methods Retrospective case series. Results Pulmonary artery dissection was diagnosed in 8 dogs, 3 were Weimaraners. Four dogs presented in left-sided congestive heart failure, 4 presented for murmur evaluation and without clinical signs, and 1 presented in right-sided congestive heart failure. In 7 dogs the dissection was first documented concurrent with a diagnosis of uncorrected PDA. In the other dog, with pulmonary valve stenosis and PDA, the dissection was observed on autopsy examination 17 months after balloon pulmonary valvuloplasty and ductal closure. Median age at presentation for the 7 dogs with antemortem diagnosis of pulmonary artery dissection was 3.5 years (range, 1.5–4 years). Three dogs had the PDA surgically ligated, 2 dogs did not undergo PDA closure, 1 dog failed transcatheter occlusion of the PDA with subsequent surgical ligation, 1 dog underwent successful transcatheter device occlusion of the PDA, and 1 dog had the PDA closed by transcatheter coil delivery 17 months prior to the diagnosis of pulmonary artery dissection. The 2 dogs that did not have the PDA closed died 1 and 3 years after diagnosis due to heart failure. Conclusions Pulmonary artery dissection is a potential complication of PDA in dogs, the Weimaraner breed may be at increased risk, presentation is often in mature dogs, and closure of the PDA can be performed and appears to improve outcome.

A bicuspid aortic valve (BAV) demonstrating moderate valvular stenosis and mild insufficiency was identified in an asymptomatic 1-year-old male cryptorchid English bulldog by transthoracic and transesophageal echocardiography. The BAV was most consistent with type 3 morphology, based upon human classification. Pulmonary valve dysplasia with mild pulmonary stenosis and a suspected persistent left cranial vena cava were also identified. Although BAV is the most common congenital cardiac malformation in humans, it is rare in the dog.

To report signalment, history, indications, complications and outcome for 28 dogs and 5 cats in which 34 permanent epicardial pacing leads were surgically placed by transdiaphragmatic approach (32) or intercostal thoracotomy (2).Medical records (2005-2010) were reviewed. Signalment, age, species, gender, clinical signs, presence of structural heart disease and/or congestive heart failure, ECG diagnosis, body weight (10 or10 kg), and overall survival rate were recorded. Statistical correlations were made between these variables and major and minor complications rates.Except for body weight, no statistical differences were identified in prevalence of major (life threatening or requiring replacement of the pacemaker system) or minor (self-limiting) complications; dogs weighing10 kg had significantly more major complications (P = .03). There was a trend (P = .051) for lower survival in animals that had major complications.Larger dogs (10 kg) may be predisposed to more major complications with epicardial pacemaker (EP) implantation. Major complication rate and survival time are similar to those reported for transvenous pacing and therefore implantation of EPs remains a suitable alternative.

To compare the concentration of a representative growth factor (transforming growth factor-beta [TGF-β]1) eluted from a platelet-rich fibrin matrix (PRFMatrix), a platelet-rich fibrin membrane (PRFMembrane), and a whole blood clot (BC) over time, and to compare the mitogenic effect of the eluents from each construct.In vitro study.PRFMatrix, PRFMembrane, and BC (n=4/construct/time point).Each construct was placed in tissue culture wells containing media for 7 days. The media was collected and replenished on days 1, 3, 5, and 7 and the concentration of eluted TGF-β1 was measured by enzyme-linked immunosorbent assay. Canine tendon cells were subjected to additional aliquots of the conditioned media and the amount of cell proliferation compared.The media from both PRFM (PRFMatrix and PRFMembrane) constructs contained significantly more (P≤.026) TGF-β1 at days 1 and 3 and produced a significant increase (P≤.044) in cell proliferation at all time points compared with the BC. The PRFMembrane media contained significantly more (P≤.05) TGF-β1 at days 1 and 3 and produced a significant increase (P≤.002) in cell proliferation at all time points compared with the PRFMatrix.Both PRFM constructs are comprised of a dense fibrin scaffold that contains increased concentrations of TGF-β1 and are capable of increasing tendon cell proliferation over time when compared with a BC.The sustained increase in growth factor availability in PRFM constructs may be beneficial in the healing of biologically compromised tissues.

Numerous scaffolds have been proposed for use in connective tissue engineering. Although these scaffolds direct cell migration and attachment, many are biologically inert and thus lack the physiological stimulus to attract cells and induce mitogenesis and matrix synthesis. In the current study, a bioactive scaffold was created by combining a synthetic scaffold with growth factor-rich plasma (GFRP), an autologous concentration of growth factors derived from a platelet-rich plasma preparation. In vitro tendon cell proliferation and matrix synthesis on autologous GFRP-enriched scaffolds, autologous serum-enriched scaffolds, and scaffolds alone were compared. The GFRP preparation was found to have a 4.7-fold greater concentration of a sentinel growth factor (transforming growth factor-beta1) compared with serum. When combined with media containing calcium, the GFRP produced a thin fibrin matrix over and within the GFRP-enriched scaffolds. Cell proliferation assays demonstrated that GFRP-enriched scaffolds significantly enhanced cell proliferation over autologous serum and control groups at both 48 and 72 h. Analysis of the scaffolds at 14, 21, and 28 days revealed that GFRP-enriched scaffolds significantly increased the deposition of a collagen-rich extracellular matrix when compared with the other groups. These results indicate that GFRP can be used to enhance in vitro cellular population and matrix deposition of tissue-engineered scaffolds.