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      Pre- and post-operative cardiac evaluation of dogs undergoing lobectomy and pneumonectomy

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          Abstract

          This study aimed to assess the influence of lobectomy and pneumonectomy on cardiac rhythm and on the dimensions and function of the right-side of the heart. Twelve dogs undergoing lobectomy and eight dogs undergoing pneumonectomy were evaluated preoperatively and one month postoperatively with electrocardiography and Doppler echocardiography at rest. Pulmonary artery systolic pressure (PASP) was estimated by the tricuspid regurgitation jet (TRJ) via the pulse wave Doppler velocity method. Systemic inflammatory response syndrome criteria (SIRS) were also evaluated based on the clinical and hematological findings in response to lobectomy and pneumonectomy. Following lobectomy and pneumonectomy, we predominantly detected atrial fibrillation and varying degrees of atrioventricular block (AVB). Dogs that died within seven days of the lobectomy (n = 2) or pneumonectomy (n = 1) had complete AVB. Preoperative right atrial, right ventricular, and pulmonary artery dimensions increased gradually during the 30 days ( p<0.05) following pneumonectomy, but did not undergo significant changes during that same period after lobectomy. Mean PASP was 56.0 ± 4.5 mmHg in dogs having significant TRJ after pneumonectomy. Pneumonectomy, but not lobectomy, could lead to increases ( p<0.01) in the SIRS score within the first day post-surgery. In brief, it is important to conduct pre- and postoperative cardiac evaluation of dogs undergoing lung resections because cardiac problems are a common postoperative complication after such surgeries. In particular, complete AVB should be considered a life-threatening complication after pneumonectomy and lobectomy. In addition, pneumonectomy appears to increase the likelihood of pulmonary hypertension development in dogs.

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          Most cited references 41

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          Clinical characteristics of 53 dogs with Doppler-derived evidence of pulmonary hypertension: 1992-1996.

          Pulmonary hypertension occurs as a primary or secondary disorder of the pulmonary vasculature. Doppler echocardiography provides a noninvasive tool for the estimation of pulmonary arterial pressure when tricuspid regurgitation or pulmonic insufficiency is present. The cardiology database at Colorado State University was reviewed, and echocardiographic records from cases diagnosed with pulmonary hypertension were evaluated. Application of the modified Bernoulli equation to the maximal instantaneous velocity of a right-sided regurgitant jet provided evidence of pulmonary hypertension in 53 dogs over a 4-year period. Tricuspid regurgitant velocity > or = 2.8 m/second or pulmonic insufficiency velocity > or = 2.2 m/second was considered abnormal and indicative of pulmonary hypertension. Tricuspid regurgitant gradients in 51 dogs ranged from 32 to 145 mm Hg (mean, 63.0 mm Hg; median, 57.0 mm Hg; 25th-75th percentiles, 45.2-76.5 mm Hg). Pulmonic insufficiency gradients in 8 dogs ranged from 20 to 100 mm Hg (mean, 59.5 mm Hg; median, 61.5 mm Hg; 25th-75th percentiles, 32.0-84.5 mm Hg). Affected dogs ranged in age from 2 months to 16 years. Clinical signs were characteristic of cardiopulmonary disease, but a relatively high frequency of syncope was noted (12 of 53 dogs, 23%). Pulmonary hypertension was probably due to increased pulmonary vascular resistance in 23 dogs, pulmonary overcirculation in 2 dogs, and pulmonary venous hypertension in 23 dogs. Five dogs lacked a clinically recognizable cardiopulmonary cause of pulmonary vascular disease. Our results suggest that pulmonary hypertension can occur as a complication of commonly encountered cardiopulmonary diseases, and that Doppler echocardiography can facilitate recognition of this condition.
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            Doppler echocardiography-derived evidence of pulmonary arterial hypertension in dogs with degenerative mitral valve disease: 86 cases (2001-2005).

            To determine the prevalence of Doppler echocardiography-derived evidence of pulmonary arterial hypertension (DEE-PAH) in dogs with mitral valve disease (MVD) classified according to the International Small Animal Cardiac Health Council (ISACHC) heart failure classification scheme and various echocardiographic and Doppler indices of MVD severity. Retrospective case series. 617 dogs examined from 2001 to 2005 with MVD in ISACHC classes I to III. Dogs were examined echocardiographically. Criteria used for systolic and diastolic DEE-PAH were detection of high tricuspid (> or = 2.5 m/s) and telediastolic pulmonic (> or = 2.0 m/s) valvular peak regurgitant jet velocities, respectively, by use of continuous-wave Doppler echocardiography. 86 (13.9%) dogs with MVD had a diagnosis of DEE-PAH. Severity and prevalence of DEE-PAH increased with ISACHC class (3.0%, 16.9%, 26.7%, and 72.2% prevalences for ISACHC classes Ia, Ib, II, and III, respectively). A significant correlation between systolic or diastolic pulmonary arterial pressure and left atrial-to-aortic diameter ratio (LA/Ao) was detected. Doppler echocardiography-derived evidence of pulmonary arterial hypertension was detected in 18 dogs with values of LA/Ao within reference range, all of which had moderate (n = 2 dogs) or severe (16) mitral valve regurgitation on color Doppler imaging. The prevalence and degree of DEE-PAH were related to the severity of MVD. Changes associated with DEEPAH may be detected in early stages of the disease, but only in dogs with severe mitral valve regurgitation.
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              Doppler echocardiographic prediction of pulmonary hypertension in West Highland white terriers with chronic pulmonary disease.

              Pulmonary hypertension (PH) is commonly diagnosed by Doppler echocardiography (DE) of tricuspid regurgitation (TR). However, TR may be absent or difficult to measure. Doppler-derived systolic time intervals of pulmonary artery (PA) flow may be used to predict PH in dogs. Seventy-three healthy dogs and 45 West Highland white terriers (WHWT) with interstitial pulmonary disease (IPD). Echocardiographic studies, including determination of right ventricular acceleration time (AT), ejection time (ET), and AT : ET ratio; right ventricular shortening fraction (RV-SF); and TR velocity, were performed. Pulmonary hypertension was defined by TR >3.1 m/s. In healthy WHWT, AT (median, range) was 73 ms (53 to 104) and AT : ET was 0.40 (0.28 to 0.55). AT : ET was minimally affected by age (R2 = 0.04, 95% confidence interval [CI] 0.01-0.07, P < .001) but not by heart rate, body weight, or RV-SF. In all WHWT with TR, AT and AT : ET were inversely related to calculated systolic PA pressure (R2 = 0.52, 95% CI 0.42-0.62, P < .001 and R2 = 0.36, 95% CI 0.29-0.42, P = .001). Clinical cutoffs to predict systolic PH were defined for AT (58 ms; sensitivity [Se] 88% and specificity [Sp] 80%) and AT : ET (0.31; Se 73% and Sp 87%). PH is common in WHWT with IPD. Analysis of right ventricular AT and AT : ET may be predictive of PH and should be particularly useful if TR is absent.
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                Author and article information

                Journal
                J Vet Sci
                JVS
                Journal of Veterinary Science
                The Korean Society of Veterinary Science
                1229-845X
                1976-555X
                September 2010
                17 August 2010
                : 11
                : 3
                : 257-264
                Affiliations
                [1 ]Department of Internal Medicine, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey.
                [2 ]Department of Surgery, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey.
                [3 ]Department of Thorax Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey.
                [4 ]Department of Small Animal Clinical Sciences, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark.
                Author notes
                Corresponding author: Tel: +90-224-294-08-09; Fax: +90-224-294-08-73, zyilmaz@ 123456uludag.edu.tr
                Article
                10.4142/jvs.2010.11.3.257
                2924488
                20706034
                Copyright © 2010 The Korean Society of Veterinary Science
                Categories
                Original Article

                Veterinary medicine

                heart function, pulmonary hypertension, dog, lobectomy, pneumonectomy

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