Abnormal Regurgitation Research Articles

An oesophageal fistula associated with cervical osteomyelitis in a 17‐month‐old Holstein heifer

AbstractA 17‐month‐old Holstein heifer was presented to the Centre Hospitalier Universitaire Vétérinaire in Saint‐Hyacinthe (QC, Canada) for abnormal regurgitation. Upon admission, pain was elicited upon mobilisation of the neck and a left‐sided, painless, fluctuating subcutaneous mass was detected in the area of the fifth and sixth cervical vertebrae. An oesophageal fistula with osteomyelitis of the corresponding vertebrae was diagnosed by medical imaging (endoscopy, ultrasound and radiography) and treated medically. No sequelae were reported in the long term. Considering the low prevalence of abnormal regurgitation in cattle, this paper provides the practitioner with an example of a diagnostic approach.

Acquired megaoesophagus in a Suffolk ram

A one-year-old Suffolk ram was evaluated after a four-month history of intermittent left-sided bloating and regurgitation. The ram had been slowly losing condition while other sheep in the cohort were...

Abnormal regurgitation in three cows caused by intrathoracic perioesophageal lesions

BackgroundThree Brown Swiss cows with abnormal regurgitation because of a perioesophageal disorder are described.Case presentationThe cows were ill and had poor appetite, salivation and regurgitation of poorly-chewed feed. Collection of rumen juice was successful in one cow, and in another, the tube could be advanced to the level of the 7th intercostal space, and in the third, only saliva could be collected. In one cow, oesophagoscopy revealed a discoloured 10-cm mucosal area with fibrin deposits. Thoracic radiographs were normal. The cows were euthanased and examined postmortem. Cow 1 had a large perioesophageal abscess containing feed material at the level of the thoracic inlet, believed to be the result of a healed oesophageal injury. Cow 2 had an abscess between the oesophagus and trachea 25 cm caudal to the epiglottis with the same presumed aetiology as in cow 1. Cow 3 had a mediastinal carcinoma that enclosed and constricted the oesophagus.ConclusionsAbnormal regurgitation in cattle is usually the result of an oesophageal disorder. Causes of oesophageal disorders vary widely and their identification can be difficult.

English

Acute rheumatic fever and its sequelae, Rheumatic Heart Disease continues to be a major health problem in our country. Lack of specific criteria had lead to diagnostic chaos until the Jones Criteria in 1944. Despite Jones criteria and four revision and modifications Acute rheumatic fever is often under diagnosed. Modern facility like radiography and ECHO is not included in Jones criteria. Chest radiograph is an important part of the evaluation of patients with disease. Medical and Surgical treatment of mitral valve disease is particularly successful early in the course of the disease; therefore detection at initial presentation is of considerable importance. Characteristic changes in cardiac contour, are helpful in confirming the radiographic diagnosis in affected patients. The pulmonary parenchymal manifestations are the result of either pulmonary venous hypertension in mitral stenosis or abnormal regurgitation into pulmonary veins in mitral insufficiency. In this study we discuss and illustrate the imaging appearances of a variety of cardiac and pulmonary parenchymal manifestations of Rheumatic Heart Disease including selective chamber enlargement, pulmonary venous cephalization, pulmonary edema, diffuse alveolar hemorrhage, haemosiderosis and ossification. Familiarity with the gamut's of cardiac and pulmonary findings in patients with rheumatic heart disease, is crucial for early and rapid diagnosis and optimal patient care;

Prevalence and diagnostic value of precordial murmurs for valvular regurgitation in obese patients treated with dexfenfluramine

Echocardiography is recommended for the detection of valvular regurgitation in asymptomatic users of anorexigens with a heart murmur. To determine the prevalence and diagnostic value of heart murmurs for valvular regurgitation, 223 patients receiving dexfenfluramine therapy for 6.9 months and 189 matched controls underwent history and cardiac auscultation by experienced noncardiologists unaware of echocardiography. Color Doppler echocardiograms were interpreted by 3 observers unaware of patients’ clinical data. The frequency of at least mild regurgitation of any valve and abnormal regurgitation (moderate mitral or tricuspid or mild aortic regurgitation) were determined. Heart murmurs heard in 31 dexfenfluramine users (14%) and in 20 controls (11%) were all systolic and of grade I to II/VI intensity. Mild or worse regurgitation of any valve showed a trend in patients (18% vs 11.6% in controls, odds ratio [OR] 1.66, confidence interval [CI] 0.95 to 2.9, p = 0.08), but abnormal regurgitation (includes Food and Drug Adminstration grade regurgitation) was more common in patients (9% vs 3% in controls, OR 3.0, CI 1.18 to 7.65, p = 0.02). In dexfenfluramine users, heart murmurs were associated with at least mild or abnormal regurgitation (OR 3.1 and 3.05, 95% CI 1.34 to 7.13 and 1.1 to 8.67; p = 0.008 and 0.036, respectively), had a specificity of 89% and 88%, negative predictive value of 85% and 93%, but sensitivity of 37% and 30%, and positive predictive value of 35% and 19%, respectively. Most valves missed by cardiac auscultation had normal morphology and mild regurgitation. Finally, heart murmurs had better diagnostic value for either type of valvular regurgitation than heart murmurs and clinical variables or clinical variables alone. In summary, in dexfenfluramine users the prevalence of heart murmurs was low and their absence predicted absence of mild or worse regurgitation of any valve or abnormal valvular regurgitation. Therefore, cardiac auscultation should be the screening method of choice for detecting valvular regurgitation in users of anorexigens.

Morphology of the atrioventricular valve in asplenia syndrome: A peculiar type of atrioventricular canal defect

The high risk of atrioventricular (AV) valve regurgitation is a major point of concern in the natural history of patients with atrioventricular canal defect (AVCD) and asplenia syndrome (AS). The morphology of the common AV valve in patients with AVCD and AS was therefore studied and compared with the anatomy of patients with AVCD but with atrial situs solitus. We compared the anatomic features of hearts with common AV valve (ventricular loop; AV valve alignment on ventricles; number of leaflets; number and morphology of papillary muscles and relationship of the bridging leaflets with the ventricular septum) in the hearts of 33 patients with AVCD and asplenia syndrome (Group 1) with those of 44 patients with common AV valve, complete AVCD, and atrial situs solitus (Group 2). Hearts featuring asplenia syndrome showed a significantly higher occurrence of anomalies of the ventricular loop ( p < .0001), right ventricular dominance ( p < .01), and a reduced number of valvular leaflets and papillary muscles ( p < .0005). On the contrary, hearts with situs solitus of the atria showed a significantly higher frequency of balanced ventricles ( p < .0001) and a common AV valve with five leaflets and five papillary muscles ( p < .000001). These data suggest that AVCDs in association with asplenia syndrome present morphologic peculiarities that may be considered as the substrate for the abnormal regurgitation. Recognizing the presence of these features could be of great value for the planning of a specific surgical treatment. These anatomic differences support the hypothesis of a genetic heterogeneity of AVCDs.

Colour flow Doppler mapping in the assessment of prosthetic valve regurgitation.

Two hundred Carpentier-Edwards, Björk-Shiley, and Starr-Edwards prostheses in 173 patients were examined. Sixteen (16%) in the aortic and 24 (25%) in the mitral position were associated with clinical signs of regurgitation. A phased array system (Hewlett-Packard A77020A) with a 2.5 MHz duplex and 1.9 MHz continuous wave transducer was used. Colour flow mapping showed trivial transvalvar regurgitation in 23 (53%) metal aortic prosthesis, and only nine (20%) metal mitral prostheses. This difference was probably attributable to shielding of the left atrium by the metal components. Colour mapping confirmed abnormal regurgitation in all aortic prostheses with early diastolic numbers, but regurgitation was also shown in 25 (29%) with no diastolic murmur. Abnormal mitral regurgitation was found in 13 (54%) patients with a pansystolic murmur, but also in six (8%) with no systolic murmur. Two patients, thought on clinical grounds to have mild mitral regurgitation, had unexpectedly large jets on colour flow mapping. About one in three prostheses had paraprosthetic leaks, 65 (79%) of which were small with a jet area less than 20% of the area of the receiving chamber. The development of new paraprosthetic leaks led to the diagnosis of bacterial endocarditis in two patients. In eight patients regurgitation was first diagnosed with continuous wave Doppler, but was afterwards shown with colour mapping and in a further 10 regurgitation could only be shown by continuous wave Doppler. Colour flow mapping was less sensitive than continuous wave Doppler in detecting regurgitation,but seemed able to distinguish normal transvalvar from paraprosthetic regurgitation. Further studies in the natural course of paraprosthetic leaks and a comparison of the transoesophageal and transthoracic approaches in the assessment of mitral prostheses are needed.