Myocardial Enhancement Following Agitated Saline Contrast Study in a Boxer Dog

•Myocardial enhancement after agitated saline contrast study in a dog is described.•Suspect air microemboli can inadvertently be introduced into coronary vasculature.•Air are theoretic risk of echocardiography. Echocardiography the primary imaging modality for diagnosing heart disease animals and people. While color flow Doppler identify intracardiac blood direction velocity, injection (introducing microscopic bubbles to perform “saline echocardiogram” or “bubblegram”) additive as it allows detection right-to-left vascular shunts without need anesthesia, which requirement advanced modalities such computed tomography animals.1Mcleod G. Shum K. Gupta T. Chakravorty S. Kachur Bienvenu L. et al.Echocardiography congenital disease.Prog Cardiovasc Dis. 2018; 61: 468-475Crossref Scopus (25) Google Scholar, 2Bassett Lin J. Tran M. Sistino Evaluating potential risks bubble studies during echocardiography.Perfusion. 2015; 30: 219-223Crossref PubMed (9) 3Mitchell C. Rahko P.S. Blauwet L.A. Canaday B. Finstuen J.A. Foster M.C. al.Guidelines performing comprehensive transthoracic echocardiographic examination adults: recommendations from American Society Echocardiography.J Am Soc Echocardiogr. 2019; 32: 1-64Abstract Full Text PDF (796) 4Porter T.R. Mulvagh S.L. Abdelmoneim S.S. Becher H. Belcik J.T. Bierig al.Clinical applications ultrasonic enhancing agents echocardiography: 2018 guidelines update.Journal 31: 241-274Abstract (200) Scholar The microbubbles venous circulation normally removed intravascular space they pass through pulmonary capillaries, that expected visualized only right side systemic but not left arterial circulation. Saline echocardiography therefore considered confirmatory shunt when detected following intravenous injection.1Mcleod 5Jeon D.S. Miyamoto Fontana Friedman A. Siegel R.J. Pulmonary artery compression by saphenous vein graft aneurysm using an mixture ten percent air, blood, saline.J 2002; 15: 1529-1532Abstract (3) 6Masoero Papachristidis Theodoropoulos K.C. Harries D. Monaghan M.J. Sado D.M. Agitated reveals systemic-to-pulmonary shunt.Echocardiography. 35: 747-749Crossref (0) Although routinely performed veterinary cardiology, we unaware reported complications dogs.7Arndt J.W. Oyama M.A. diagnose defect dog.J Vet Cardiol. 2008; 10: 129-132Crossref (20) We describe case myocardial administration with tricuspid dysplasia atrial septal (ASD). A 9-month-old female spayed 20.1 kg boxer was presented cardiology service at North Carolina State University College Veterinary Medicine evaluation 3-month history collapsing episodes. She otherwise healthy. On presentation, she bright alert. Physical revealed rate 120 beats per minute, respiratory 36 breaths grade III/VI basilar systolic murmur, regular rhythm, good femoral pulse quality. Neurologic normal. echocardiogram (TTE) lateral recumbency 8-MHz probe Philips EPIQ ultrasound machine. atrium ventricle were mildly enlarged, subjective mild ventricular wall hypertrophy. valve dysplastic moderate regurgitation, small secundum ASD present. Pulsed-wave showed low-velocity (<1 m/sec) bidirectional across ASD. An confirm atrial-level shunt. Three milliliters physiologic (0.9%) 1 minute vigorous transfer between two 3-mL syringes closed system introduction additional syringes. Two injected catheter. Echocardiographic consistent first atrium, followed confirming (Video 1). As microbubble artifacts dissipating, myocardium became regionally hyperechoic, specifically anterior descending circumflex distribution (midseptum mitral papillary muscles; Video 2). Figure 1A B depicts change echogenicity before This patchy persisted several minutes 3) slow dissipation over next 5 minutes. monitoring electrocardiogram (ECG) sinus rhythm any pathologic ST-T wave changes entire TTE. ambulatory 24-hour (Holter) ECG monitor placed TTE evaluate cardiac arrhythmias cause historical collapse resulting recording normal, no noted period. neurologic suspected based on event description normal ECG, although paradoxical cerebral embolization could ruled out. did return referral hospital requested follow-up examined care veterinarian 2 years later. At time routine wellness unremarkable, new client complaints noted, clinically significant abnormalities found complete count biochemical profile. episodes continued intermittently reduced frequency oral cannabidiol oil prescribed veterinarian. frequently used aid abnormal communications defects, patent foramen ovale, intrapulmonary (arteriovenous) shunts.1Mcleod Scholar,6Masoero 7Arndt 8Malakan Rad E. Aghaei-Moghadam Mirzaaghayan M.R. Pouraliakbar H.R. artery-focused supplemental oxygen(PCESO) diagnosis anomalous origin artery: Novel use old technique.Clin Case Rep. 7: 1777-1781Crossref (1) poses theoretical present, potentially predisposing tissue ischemia infarction. There particular concern possibility infarction embolization.1Mcleod Scholar,2Bassett Scholar,5Jeon Depending size bubbles, microembolisms obstruct capillary beds, ischemia, inflammation, activation complement.5Jeon Scholar,9Barak Katz Y. Microbubbles.Chest. 2005; 128: 2918-2932Abstract (242) In people, embolisms have been study, transient ischemic attacks cerebrovascular accidents.1Mcleod Scholar,10Romero J.R. Frey J.L. Schwamm L.H. Demaerschalk B.M. Chaliki H.P. Parikh al.Cerebral events associated ‘bubble study’ identification shunts.Stroke. 2009; 40: 2343-2348Crossref (77) Associated clinical signs included dizziness, weakness, left-sided paresthesia, migraines.10Romero rat models, >45 μm diameter caused infarctions regions supplied carotid artery.11Juenemann Yeniguen Schleicher N. Blumenstein Nedelmann Tschernatsch al.Impact model microembolization.J Cardiothorac Surg. 2013; 8: 198Crossref (6) Standard procedures protocols safe yet defined, despite ischemia. location appear most important factors infarction, ideal difficult predict standardize because dynamic behaviors include coalescence, dissolution, splitting.2Bassett vitro closed-circuit dangers μm.2Bassett Generally, lower volumes resulted fewer μm, up 100 still created, low 0.025 mL vessel occlusion vitro.2Bassett Despite risk, first-line diagnostic tool shunting simple, effective, inexpensive compared alternative tomography, cardiovascular magnetic resonance, nuclear scintigraphy, usually require anesthetized.1Mcleod adverse appears low, this has quantified. occurred shortly highlights enter circulation, predispose overt agitation technique standardized within our practice, measured variable. Therefore, reason remains unknown. introducing origins coronary-cameral fistulae humans, given higher more invasive procedures.8Malakan Scholar,12Eldeib Qaddoura F. Sadek Abuelatta R. Naguib Innovative method cameral fistula echocardiography.Echocardiography. 2021; 38: 343-346Crossref Cardiac troponin I measurement would useful injury case; unfortunately, performed. show electrocardiographic 24 hours TTE, does rule out subclinical cardiomyocyte injury. report suggests vasculature presence Studies evaluating safety profile dogs indicated.