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Catheter-guided percutaneous heartworm removal using a nitinol basket in dogs with caval syndrome.

Yoon WK, Han D, Hyun C - J. Vet. Sci. (2011)

Bottom Line: Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs.In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure.With this technique, we successfully treated four dogs with caval syndrome.

View Article: PubMed Central - PubMed

Affiliation: Section of Small Animal Internal Medicine, and Institute of Veterinary Science, College of Veterinary Medicine, Kangwon National University, Chuncheon 200-701, Korea.

ABSTRACT
Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs. Several non-surgical and interventional methods are currently used for mechanical worm removal. However, the success rate and complications related to these methods are heavily dependent on methodology and retrieval devices used. In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure. With this technique, we successfully treated four dogs with caval syndrome.

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Echocardiography and clinical outcomes. (A) M-mode echocardiography revealed clumps (arrow) of heartworms in the right ventricle due to heavy worm burden. (B) B-mode echocardiography showed heartworms migrating from the right ventricle to the right atrium (arrow). (C) Multiple worm removal per trial in a dog (Case 2). (D) Disappearance of heartworms from the right atrium and ventricle after the removal procedure on B-mode echocardiography in a dog (Case 1).
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Figure 2: Echocardiography and clinical outcomes. (A) M-mode echocardiography revealed clumps (arrow) of heartworms in the right ventricle due to heavy worm burden. (B) B-mode echocardiography showed heartworms migrating from the right ventricle to the right atrium (arrow). (C) Multiple worm removal per trial in a dog (Case 2). (D) Disappearance of heartworms from the right atrium and ventricle after the removal procedure on B-mode echocardiography in a dog (Case 1).

Mentions: The first case in our study was a 7-year-old intact mixed male dog (body weight 4.5 kg). The dog presented with hemoglobinuria, severe cough, and exercise intolerance. Heart auscultation revealed a grade V/VI systolic regurgitant murmur in the right and left apex. The main laboratory findings were hypochromic anemia (packed cell volume 28.3%, reference range 37~55%; hemoglobin 9.7 g/dL, reference range 12~18 g/dL), leukocytosis (total number of white blood cells, 21.8 K/uL, reference range 6~17 K/uL) with eosinophilia, hypoproteinemia (total protein, 5.0 g/dL, reference range 5.4~8.2 g/dL), and prerenal azotemia (blood urea nitrogen, 40 mg/dL, reference range 7~25 mg/dL; creatinine, 2.0 mg/dL, reference range 0.3~1.4 mg/dL). Both the immunological test (SNAP 4Dx; Idexx, USA) for adult worms and the microscopic examination for microfilaria were positive. Thoracic radiography revealed a right-sided cardiomegaly (reverse 'D' shape) with marked dilation of the main pulmonary artery and caudal vena cava. Echocardiographic examination revealed a septal flattening of the right ventricle (due to a marked elevation of right ventricular pressure), severe pulmonary (pulmonic regurgitant velocity, 4.32 m/sec) and tricuspid regurgitation (tricuspid regurgitant velocity, 4.2 m/sec), and marked right atrial enlargement. Hyperechogenic clumps (consistent with a heavy worm burden) moving from the right ventricle to right atrium was clearly visualized by echocardiography (Figs. 2A and B). Further echocardiographic examination also revealed a moderate mitral regurgitation (mitral regurgitant velocity, 5.1 m/sec) due to degenerative changes in the mitral valves.


Catheter-guided percutaneous heartworm removal using a nitinol basket in dogs with caval syndrome.

Yoon WK, Han D, Hyun C - J. Vet. Sci. (2011)

Echocardiography and clinical outcomes. (A) M-mode echocardiography revealed clumps (arrow) of heartworms in the right ventricle due to heavy worm burden. (B) B-mode echocardiography showed heartworms migrating from the right ventricle to the right atrium (arrow). (C) Multiple worm removal per trial in a dog (Case 2). (D) Disappearance of heartworms from the right atrium and ventricle after the removal procedure on B-mode echocardiography in a dog (Case 1).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3104177&req=5

Figure 2: Echocardiography and clinical outcomes. (A) M-mode echocardiography revealed clumps (arrow) of heartworms in the right ventricle due to heavy worm burden. (B) B-mode echocardiography showed heartworms migrating from the right ventricle to the right atrium (arrow). (C) Multiple worm removal per trial in a dog (Case 2). (D) Disappearance of heartworms from the right atrium and ventricle after the removal procedure on B-mode echocardiography in a dog (Case 1).
Mentions: The first case in our study was a 7-year-old intact mixed male dog (body weight 4.5 kg). The dog presented with hemoglobinuria, severe cough, and exercise intolerance. Heart auscultation revealed a grade V/VI systolic regurgitant murmur in the right and left apex. The main laboratory findings were hypochromic anemia (packed cell volume 28.3%, reference range 37~55%; hemoglobin 9.7 g/dL, reference range 12~18 g/dL), leukocytosis (total number of white blood cells, 21.8 K/uL, reference range 6~17 K/uL) with eosinophilia, hypoproteinemia (total protein, 5.0 g/dL, reference range 5.4~8.2 g/dL), and prerenal azotemia (blood urea nitrogen, 40 mg/dL, reference range 7~25 mg/dL; creatinine, 2.0 mg/dL, reference range 0.3~1.4 mg/dL). Both the immunological test (SNAP 4Dx; Idexx, USA) for adult worms and the microscopic examination for microfilaria were positive. Thoracic radiography revealed a right-sided cardiomegaly (reverse 'D' shape) with marked dilation of the main pulmonary artery and caudal vena cava. Echocardiographic examination revealed a septal flattening of the right ventricle (due to a marked elevation of right ventricular pressure), severe pulmonary (pulmonic regurgitant velocity, 4.32 m/sec) and tricuspid regurgitation (tricuspid regurgitant velocity, 4.2 m/sec), and marked right atrial enlargement. Hyperechogenic clumps (consistent with a heavy worm burden) moving from the right ventricle to right atrium was clearly visualized by echocardiography (Figs. 2A and B). Further echocardiographic examination also revealed a moderate mitral regurgitation (mitral regurgitant velocity, 5.1 m/sec) due to degenerative changes in the mitral valves.

Bottom Line: Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs.In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure.With this technique, we successfully treated four dogs with caval syndrome.

View Article: PubMed Central - PubMed

Affiliation: Section of Small Animal Internal Medicine, and Institute of Veterinary Science, College of Veterinary Medicine, Kangwon National University, Chuncheon 200-701, Korea.

ABSTRACT
Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs. Several non-surgical and interventional methods are currently used for mechanical worm removal. However, the success rate and complications related to these methods are heavily dependent on methodology and retrieval devices used. In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure. With this technique, we successfully treated four dogs with caval syndrome.

Show MeSH
Related in: MedlinePlus