Signs Of Regurgitation Research Articles

Esophageal stenosis as a result of a right aortic arch in 2 cats

A 3-month-old and a 4-year-old cat were presented in the clinic due to regurgitation. The kitten had displayed the symptoms since it had been fed solid foods and was smaller than the litter mates. The 4-year-old cat showed sudden-onset symptoms for 5 days prior to presentation and had a good general condition. Positive contrast thoracic radiographs of both cats in lateral recumbency showed an esophageal dilatation cranial to the heart base and raised a suspicion of foreign material with soft tissue density in this area. In the 4-year-old cat, findings of ventrodorsal thoracic radiographs were compatible with a dextroposition of the aorta and a slightly marked focal left curve of the trachea. The echocardiographic examination of the kitten pictured a right sided aorta, hence a vascular ring anomaly with a dextroposition from the aorta was suspected. Aberrant blood flow as it is seen in a persistent ductus arteriosus was not apparent in the echocardiography. As a result of the sudden development of the clinical signs in the older cat without displaying any former history of regurgitation, an esophagoscopy was performed to exclude an intraluminal esophageal cause for the stricture as well as to extract the foreign material. In this cat, computed tomography imaging also displayed an aberrant left subclavian artery. Both cats recovered well after surgical correction.The diagnosis of a ring anomaly in the kitten via echocardiography is a rare situation. As is the diagnosis of a high-grade esophageal stricture due to a vascular ring anomaly at the age of 4 without a former history of regurgitation.Recovery was excellent in the younger cat. There were no signs of regurgitation 6 months after surgery. The adult cat was in good general condition without clinical symptoms according to the owners when presented for stitch removal. Unfortunately, the adult cat was lost to follow up.

Early Feasibility Study of a Hybrid Tissue-Engineered Mitral Valve in an Ovine Model.

Tissue engineering aims to overcome the current limitations of heart valves by providing a viable alternative using living tissue. Nevertheless, the valves constructed from either decellularized xenogeneic or purely biologic scaffolds are unable to withstand the hemodynamic loads, particularly in the left ventricle. To address this, we have been developing a hybrid tissue-engineered heart valve (H-TEHV) concept consisting of a nondegradable elastomeric scaffold enclosed in a valve-like living tissue constructed from autologous cells. We developed a 21 mm mitral valve scaffold for implantation in an ovine model. Smooth muscle cells/fibroblasts and endothelial cells were extracted, isolated, and expanded from the animal's jugular vein. Next, the scaffold underwent a sequential coating with the sorted cells mixed with collagen type I. The resulting H-TEHV was then implanted into the mitral position of the same sheep through open-heart surgery. Echocardiography scans following the procedure revealed an acceptable valve performance, with no signs of regurgitation. The valve orifice area, measured by planimetry, was 2.9 cm2, the ejection fraction reached 67%, and the mean transmitral pressure gradient was measured at 8.39 mmHg. The animal successfully recovered from anesthesia and was transferred to the vivarium. Upon autopsy, the examination confirmed the integrity of the H-TEHV, with no evidence of tissue dehiscence. The preliminary results from the animal implantation suggest the feasibility of the H-TEHV.

TGF-β Signaling Promotes Tissue Formation during Cardiac Valve Regeneration in Adult Zebrafish

Cardiac valve disease can lead to severe cardiac dysfunction and is thus a frequent cause of morbidity and mortality. Its main treatment is valve replacement, which is currently greatly limited by the poor recellularization and tissue formation potential of the implanted valves. As we still lack suitable animal models to identify modulators of these processes, here we used adult zebrafish and found that, upon valve decellularization, they initiate a rapid regenerative program that leads to the formation of new functional valves. After injury, endothelial and kidney marrow-derived cells undergo cell cycle re-entry and differentiate into new extracellular matrix-secreting valve cells. The TGF-β signaling pathway promotes the regenerative process by enhancing progenitor cell proliferation as well as valve cell differentiation. These findings reveal a key role for TGF-β signaling in cardiac valve regeneration and establish the zebrafish as a model to identify and test factors promoting cardiac valve recellularization and growth.

PS01.034: GENDER AND BODY MASS INDEX HAVE AN INFLUENCE ON DELAYED GASTRIC EMPTYING FOLLOWING ESOPHAGECTOMY AND GASTRIC PULL-UP

Abstract Background Delayed gastric emptying is a common feature after gastric pull-up for reconstruction following esophagectomy. Symptoms range from mild discomfort to life-threatening recurrent aspiration. Apart from the well-known and technically inevitable truncal vagotomy neither causative factors nor effective preventive measures have been clearly identified. Methods We did a retrospective study in 381 patients (317 males, 64 females; age: 22 -88 years; mean: 62,4 years), who underwent esophagectomy and gastric pull-up with cervical esophagogastrostomy between 1/2008 and 12/2017. During this period the surgical technique had been the same except that in the first phase no intervention at the pylorus had been done (N = 207), whereas in the second pyloromytomy (N = 97) and in the third (N = 110) intrapyloric injection of Botulinum-toxin was performed. Delayed gastric emptying was diagnosed by distension of the conduit with an air-fluid level on chest roentgenogram, and by symptoms and signs of regurgitation or vomiting in absence of other bowel obstruction. 122 patients had retrosternal pull-up due to transmural tumour growth or lymph-nodes, in 259 the orthotopic route was chosen. All patients were followed-up for at least three months after the operation. Results 56 patients (14,7%) developed delayed gastric emptying. Neither pyloromytomy nor injection of Botox had any effect as compared with the patients in the no-intervention period. The route of gastric pull-up had no influence either. In women (N = 15; 23,4%), however, delayed gastric emptying was significantly more frequent than in men (N = 41; 12,9%; P = 0.03). Moreover, the Body Mass Index (BMI) of patients with delayed gastric emptying (BMI = 26.6) was significantly higher than in those who had not (BMI = 24,7; P = 0.03). By multivariate analysis the influence of gender and BMI on the development of delayed gastric emptying remained significant. Conclusion The results of our single center retrospective analysis may show that both, gender and BMI might significantly influence the development of postoperative delayed gastric emptying after esophagectomy and reconstruction by gastric pull-up. For a better understanding and management of delayed gastric emptying prospective trials with larger numbers of patients are definitely needed. Disclosure All authors have declared no conflicts of interest.

Endotracheal tube obstruction with a blood clot following aspiration of rumen contents in a reindeer

SummaryAn apparently otherwise healthy female reindeer was anaesthetised for open reduction and fixation of a hip luxation. The animal developed ruminal bloat which was treated with passage of an orogastric...

Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study.

To investigate mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet. Mitral valve posterior leaflet and subvalvular reconstruction was characterized in an acute 80-kg porcine model with 7 pigs acting as their own controls. The characterization was based on pressure catheter measurements of pressure differences to identify mitral regurgitation, stenosis and systolic anterior motion. Furthermore, echocardiography was used for the evaluation of leaflet mobility and geometry, whereas sonomicrometry was used to describe annular and subvalvular geometry. The reconstructed mitral valve was fully functional without any signs of regurgitation (peak left atrial pressure for baseline and reconstruction 12 ± 2 mmHg vs 11 ± 2 mmHg, P = 0.550), mitral valve stenosis (mean pressure difference across the mitral valve 4.8 ± 2.3 mmHg vs 4.1 ± 2.3 mmHg, P = 0.589) or systolic anterior motion. The echocardiographic characterization revealed septal-lateral downsizing, reduced tenting area, increased coaptation length (6.0 ± 0.6 mm vs 8.7 ± 2.3 mm, P = 0.002) and an atrial bend of the reconstructed posterior leaflet. A ballooning effect of the patch material was present at the posterior annular segment. Mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet as patch material was possible in an acute porcine model. The reconstructed mitral valve was fully functional without signs of mitral valve stenosis, valve regurgitation, stenosis or systolic anterior motion. The ballooning appearance of the patch material might, however, constitute an altered leaflet stress distribution in this area.

A Possible Case of Neurogenic Pulmonary Edema in a Sheep following Intracranial Surgery

Abstract Objective: To describe presentation, treatment and outcome of a sheep that developed acute respiratory distress after intracranial surgery. Case summary: A 3-year-old female crossbred sheep weighing 64 kg was anaesthetized for intracranial surgery as a part of a research project. Premedication and induction of anesthesia were uneventful as well as tracheal intubation. Anesthesia was maintained with isoflurane in a 50% mixture of oxygen and air, fentanyl (5-15 μg kg-1h-1) and lidocaine (1.8 mg kg-1h-1). During anesthesia, an increased alveolar-arterial oxygen gradient was calculated on the basis of arterial blood gas analysis: inspiratory fraction of oxygen was increased and a recruitment manoeuvre was performed. After 210 minutes of anesthesia, the sheep was let recover with oxygen supplementation under monitoring of pulse-oxymetry, capnography, inspired and expired oxygen, temperature and invasive blood pressure. At tracheal extubation no signs of regurgitation or aspiration were noticed. Twenty-five minutes later, the sheep showed deterioration of neurological status and clonic seizure responsive to diazepam. After transient tachycardia, blood pressure rose acutely and sinus bradycardia followed. Severe tachypnea started in few minutes accompanied by loud respiratory noises and harsh diffuse crackles on both sides of the thorax. Foamy blood nasal exudates discharged from the nostrils. Neurogenic pulmonary edema as a sequel of increased intracranial pressure was suspected and treated with intravenous mannitol (0.5 gkg-1) and furosemide (4 mgKg-1). Hypoxemia was successfully managed with oxygen supplementation. Motor and cognitive functions improved progressively and were deemed normal within 12 hours from the episode, when arterial partial pressure of oxygen was 11.7 kPa (88 mmHg) at room air. New information provided: Severe pulmonary complications may be observed after iatrogenic neurological injury in sheep. Neurogenic pulmonary edema should be taken into account among the differential diagnoses of abrupt respiratory distress following seizure.

Management of a Benign Oesophageal Stricture in a Dog using a Biodegradable Self- Expanding Stent

Summary A three-year-old female neutered Staffordshire bull terrier presented with a progressive two week history of regurgitation following surgery for septic peritonitis. Oesophagoscopy revealed a narrow stricture in the mid-oesophagus. Stricture reformation occurred following repeated endoscopic and fluoroscopic guided balloon dilations, with the addition of intralesional triamcinolone, on eleven occasions. Following the twelfth balloon dilation, a tubular self-expanding biodegradable polydioxanone stent was placed across the stricture under fluoroscopic guidance and sutured to the oesophageal wall. Initially, the dog made a good recovery, however seven days later, signs of regurgitation returned associated with marked oesophagitis. Regurgitation resolved over the next two weeks following intralesional triamcinolone injections and oral prednisolone, ranitidine, omeprazole and sucralfate. Fluoroscopy four months after placement revealed the stent was no longer present and there was no evidence of stricture. Oesophageal motility was subjectively delayed in this area. The dog was tolerating a soft food diet without regurgitation.

Does Active Rescuer Ventilation Have a Place During Basic Cardiopulmonary Resuscitation?

Rescuer ventilation has always been an integral part of both basic (BLS) and advanced (ACLS) cardiac life support.1 Despite 5 decades of continuous attempts to improve training in cardiopulmonary resuscitation (CPR), maintenance of free airways and adequate ventilation continue to be difficult skills to acquire and maintain for both lay persons and professionals. Because of airway problems and excessive inflation pressures, much of the air enters the stomach instead of the lungs during bystander CPR,2 and in a recent study, 39% of patients receiving mouth-to-mouth ventilation had signs of regurgitation at the time of intubation.3 Article p 2525 Bystander CPR increases overall survival in the great majority of clinical studies, but as suspected, the quality of the bystander effort is important. Poor-quality CPR did not increase survival compared with no CPR in 3 clinical studies.4–6 In addition, although the frequency of bystander BLS is as high as 50% to 60% in areas with a long-standing tradition in lay-person CPR training and performance,7,8 others report much lower and falling frequencies.9 This is at least partly due to rescuers’ reluctance to perform mouth-to-mouth ventilation because of fear of disease transmission or esthetic reasons.10,11 Adding the difficulty of instructing ventilations over the telephone, Hallstrom et al7 conducted a randomized study of emergency dispatch telephone instruction in BLS with or without mouth-to-mouth ventilation with 14.6% survival for compressions only versus 10.4% for standard BLS ( P =0.18). In parallel, the CPR research group at the University of Arizona has over the last 15 years conducted a series of studies on the efficacy of chest compressions only versus standard CPR in pigs.9,12–17 The group consistently report better hemodynamics and equal or better outcome with chest compressions only than with standard BLS with 15:2 compression-to-ventilation ratio. …

Persistent right aortic arch and aberrant left subclavian artery in a dog: a case report

A 10-week-old, 4.5 kg female Weimaraner dog was referred to theChonbukNationalUniversity, Animal Medical Centre with signs of regurgitation after weaning. The cervical oesophagus was palpable as a flaccid, air-filled cavity. The thoracic radiographs revealed oesophageal dilatation cranial to the heart and constriction at the level of third rib. A presumptive diagnosis was made as persistent right aortic arch (PRAA). A left 4th intercostal thoracotomy was performed and the definitive diagnosis was made as PRAA with left ligamentum arteriosum (LA) and an aberrant left subclavian artery (SA). The oesophagus was found dually compressed and severely necrosed. The corrective surgery comprised of transection of the LA as well as resection and anastomosis of the oesophagus, which resulted in a complete alleviation of the clinical signs.

The ProSeal™ Laryngeal Mask Airway and the Laryngeal Tube Suction™ for ventilation in gynaecological patients undergoing laparoscopic surgery *

ProSeal Laryngeal Mask Airway (PLMA) and Laryngeal Tube Suction (LTS), supraglottic airway devices allowing gastric drainage, were compared in this prospective, randomized study for airway management under conditions with elevated intra-abdominal pressure induced by capnoperitoneum. Fifty patients undergoing elective gynaecological laparoscopic surgery were randomized to two groups of 25 each. After induction of general anaesthesia, devices were inserted, correct placement was verified, airway leak pressure was measured, and a gastric tube was inserted. Ease of insertion, quality of airway seal, risk of gastric insufflation and patient comfort were investigated. There were no differences in patient characteristics data for both groups. First-time insertion success rates were comparable for both groups: 92%--first attempt, 8%--second attempt for PLMA and LTS. Time until delivery of the first tidal volume for PLMA and LTS was 23.2 +/- 6.1 and 23.5 +/- 6.6s, airway leak pressure was 45.4 +/- 4.9 cmH2O and 45.6 +/- 6.7 cmH2O with cuff pressures adjusted to 60 cmH2O. No gastric insufflation, gas loss or signs of regurgitation were detected. Placement of a gastric tube was successful in all patients. Patients were questioned for sore throat and dysphagia after removal of devices. Sore throat was stated in 1%/0% (PLMA) and 8%/4% (LTS) after 6/24 h, dysphagia in 4%/4% (PLMA) and 12%/4% (LTS). Both devices provide a secure airway even under conditions of elevated intra-abdominal pressure. In this pilot study, no differences concerning handling or quality of airway seal were detected between PLMA and LTS.

Aortic root reimplantation for successful repair of an insufficient pulmonary autograft valve after the Ross procedure

J Thorac Cardiovasc Surg 2002;124:1048-9

Antro-pyloric canal values from early prematurity to full-term gestational age: an ultrasound study.

To evaluate antro-pyloric canal dimensions from early prematurity to full-term gestational age. Ninety infants with no signs of regurgitation or vomiting were studied 3-5 days after birth. Their gestational ages ranged from 26 to 41 weeks (mean 33.7 weeks) and the body weight from 670 to 4150 g (mean 2067 g). Antro-pyloric muscle thickness, canal length and canal width were measured. A positive correlation between gestational age, muscle thickness (R = 0.71, P < 0.001), length (R = 0.63, P < 0.001) and width (R = 0.42, P < 0.001) was found. Furthermore, a positive correlation between body weight, muscle thickness (R = 0.82, P < 0.001) length, (R = 0.67, P < 0.001) and width (R = 0.55, P < 0.001) was observed. This study shows that antro-pyloric canal dimensions increase with gestational age. Moreover, it provides normal values for muscle thickness, canal length and canal width from the early gestation to full term.

The use of the laryngeal mask airway in CPR

The laryngeal mask airway (LMA) was used within the hospital in 50 cardiac arrest cases during cardio-pulmonary resuscitation (CPR). The LMA was inserted mainly by junior anaesthesia staff members with no previous experience with its use. The LMA was easily inserted providing a clear and unobstructed airway in 98% of the patients with clinically satisfactory ventilation and very good blood gas values. No signs of regurgitation or aspiration were detected.