Intrapulmonary arteriovenous anastomoses in dogs with severe Angiostrongylus vasorum infection: clinical, radiographic, and echocardiographic evaluation

Matos, José Novo; Malbon, Alexandra; Dennler, Matthias; Glaus, Toni M

doi:10.1016/j.jvc.2015.10.008

Cited by 10 publications

(14 citation statements)

References 51 publications

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“… Dirofilaria and Angiostrongylus have been associated with endarteritis, PE/PT/PTE, inflammatory pulmonary parenchymal disease, or all, as their mechanisms of PH.…”

Section: Echocardiographic Assessment Of Phmentioning

confidence: 99%

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

Reinero

Visser

Kellihan

et al. 2020

Veterinary Internal Medicne

179

383

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Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.

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“… Dirofilaria and Angiostrongylus have been associated with endarteritis, PE/PT/PTE, inflammatory pulmonary parenchymal disease, or all, as their mechanisms of PH.…”

Section: Echocardiographic Assessment Of Phmentioning

confidence: 99%

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

Reinero

Visser

Kellihan

et al. 2020

Veterinary Internal Medicne

179

383

View full text Add to dashboard Cite

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“…Severe hypoxemia was unlikely in this dog, however, because of the physiological respiratory rate and the lack of severe respiratory signs at presentation, when the clinical signs were the worst. Arterial blood gas analysis was not performed in this patient because of a risk for bleeding complications resulting from the (subclinical) coagulopathy that might accompany Angiostrongylus vasorum infection [ 1 , 27 ]. As a consequence, in the present dog, a number of other conditions that could cause pulmonary hypertension were not actively excluded, such as pulmonary thromboembolism and diffuse interstitial pulmonary diseases (such as idiopathic pulmonary fibrosis).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous tricuspid valve chordal rupture in a dog with severe, irreversible pulmonary hypertension caused by Angiostrongylus vasorum infection

Szatmári

2020

BMC Vet Res

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Background: The adult worms of Angiostrongylus vasorum reside in the pulmonary artery of dogs and can lead to cardiac, respiratory, and central neurologic signs. Due to luminal obstruction and perivascular inflammation of the pulmonary artery branches, pulmonary hypertension can arise. Pulmonary hypertension, in turn, can lead to severe damage of the right-sided cardiac structures, leading to right ventricular remodeling and tricuspid valve regurgitation. Case presentation: An 8-year-old neutered female English Cocker Spaniel was presented to the author's institution because of abdominal distention and exercise intolerance. Ascites caused by congestive right-sided heart failure was found to be responsible for these problems. The underlying etiology of the right-sided heart failure was a severe pulmonary hypertension caused by Angiostrongylus vasorum infection. Echocardiography revealed, in addition to a severe concentric and eccentric right ventricular hypertrophy, right atrial and pulmonary trunk dilation, severe tricuspid valve regurgitation, and a systolic flail of the anterior leaflet of the tricuspid valve, resulting from ruptured chordae tendineae. As a coincidental finding, a congenital mitral stenosis was found. Oral therapy was initiated with daily administration of fenbendazole for 2 weeks along with daily administration of oral sildenafil until the recheck examination. At the 6-week recheck the dog showed full clinical and partial echocardiographic recovery, and both the blood antigen test for Angiostrongylus vasorum and the fecal Baermann larva isolation test were negative. When the sildenafil therapy was ceased after tapering the daily dosage, the owner reported recurrence of abdominal distension. Restarting the sildenafil therapy resulted in resolution of this problem. The dog was reported to be clinically healthy with daily sildenafil administration 7 months after the initial presentation. Conclusions: The present case report describes a dog where angiostrongylosis led to congestive right-sided heart failure resulting from severe pulmonary hypertension. The secondary right ventricular eccentric hypertrophy together with suspected papillary muscular ischemia were the suspected cause of the ruptured major tricuspid chordae tendineae, which led to a severe tricuspid valve regurgitation. Despite eradication of the worms, the severe pulmonary hypertension persisted. Treatment with daily oral sildenafil, a pulmonary arterial vasodilator, was enough to keep the dog free of clinically apparent ascites.

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“…Thrombi associated with parasitic larvae were present in the pulmonary arteries of untreated dogs but, at the same time point, echocardiographic-derived PAP estimation was within the normal limits. Matos et al [15, 16] hypothesized that one of the possible causes of the low prevalence of PH in A. vasorum infected dogs could be the recruitment of large diameter IPAVAs. The IPAVAs are dynamic preformed vascular conduits that have the function of avoiding excessive flow and pressure increases in the pulmonary microcirculation during exercise [30], following acute pulmonary embolism [31] and in response to hypoxia [32] in order to minimize the negative effects of PH on the capillary bed and reduce RV afterload [16].…”

Section: Discussionmentioning

confidence: 99%

“…Matos et al [15, 16] hypothesized that one of the possible causes of the low prevalence of PH in A. vasorum infected dogs could be the recruitment of large diameter IPAVAs. The IPAVAs are dynamic preformed vascular conduits that have the function of avoiding excessive flow and pressure increases in the pulmonary microcirculation during exercise [30], following acute pulmonary embolism [31] and in response to hypoxia [32] in order to minimize the negative effects of PH on the capillary bed and reduce RV afterload [16]. Large diameter IPAVAs are known to exist in many species including humans [33, 34] and dogs [15, 16, 31].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the widespread distribution of A. vasorum infection and the severity of pulmonary lesions, reports of PH in natural infected dogs have been uncommonly described [13, 14]. Some authors have hypothesized that one of the possible causes of the low prevalence of PH in A. vasorum infected dogs could be the recruitment of large diameter intrapulmonary arteriovenous anastomoses (IPAVAs) which attenuate pulmonary vascular resistance, reducing the pulmonary arterial pressure (PAP) [15, 16]. The present report describes the pulmonary arterial response to A. vasorum natural infection in two dogs, assessed by echocardiography.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary arterial response to Angiostrongylus vasorum in naturally infected dogs: echocardiographic findings in two cases

et al. 2019

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Background Angiostrongylus vasorum is a nematode living in the pulmonary arteries of canids. Infected dogs develop severe pulmonary lesions which can potentially lead to pulmonary hypertension (PH). However, reports of PH in natural infected dogs are scant. One of the possible causes of the low prevalence of PH in A. vasorum -infected dogs could be the establishment of large diameter intrapulmonary arteriovenous anastomoses (IPAVAs), which attenuate pulmonary vascular resistance, thus reducing the pulmonary arterial pressure. The present report describes the pulmonary arterial pressure (PAP) response to A. vasorum natural infection in two dogs, assessed by echocardiography and by the saline contrast echocardiographic test (SCE). Results Both dogs showed clinical signs of respiratory disease. At presentation, case 1 did not show echocardiographic signs of PH and the SCE test was positive proving the presence of IPAVAs. However, at the follow-up visit, despite A. vasorum infection resolution, the same dog showed PH and the SCE test resulted negative, which ruled out the presence of IPAVAs. Case 2 suffered from severe pulmonary arterial hypertension and right-side congestive heart failure since the day of presentation. Saline contrast echocardiography was negative both at the time of presentation and at the follow-up visit. Conclusions In the two cases described above, the PH was not associated with IPAVAs. During A. vasorum infection, IPAVAs recruitment mechanism is able to contrast the rise of PAP until a certain level. It probably represents an initial escape mechanism of PH that, over time, exhausts its compensatory capacities allowing PAP to rise and to be detectable on echocardiography. Electronic supplementary material The online version of this article (10.1186/s13071-019-3544-2) contains supplementary material, which is available to authorized users.

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Intrapulmonary arteriovenous anastomoses in dogs with severe Angiostrongylus vasorum infection: clinical, radiographic, and echocardiographic evaluation

Cited by 10 publications

References 51 publications

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

Spontaneous tricuspid valve chordal rupture in a dog with severe, irreversible pulmonary hypertension caused by Angiostrongylus vasorum infection

Pulmonary arterial response to Angiostrongylus vasorum in naturally infected dogs: echocardiographic findings in two cases

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