Liz Bode

Hi Cristina,

Thank you again for good questions. Also, that you think clients would be interested and you are right, clinicians need to be as clued up as possible to advise.

The aim is to eventually stop most/ all heart meds. A correctly placed device should result in reverse remodelling such that the heart gets smaller. The devices are only really placed in stage C dogs, therefore, the aim is to stop furosemide but pimobendan might need to be continued. The survival data is relatively sparse currently as it is such a new technique, however this pilot study suggests feasibility and obviously will then lead to survival data. The cost will be lower than MV repair via bypass, but the device itself is expensive and so the procedure overall will be £10,000 plus. The device stays where it is for the life of the dog and shouldn’t need to be replaced if placed appropriately.

Watch this space…

Liz

Replying to Emma G. 14/01/2025 - 17:59

Hi Emma,

In terms of medetomidine you can’t make any assumptions about global left ventricular systolic function, so if the whole LV looks reduced you won’t know if that’s real or whether it’s the medetomidine. However, cats with DCM have extremely poor systolic function and so you might still be suspicious of that even with medetomidine on board. However, if there is regional hypokinesis (for example the septum looks poorly contractile but the septum looks normal) then perhaps this is real and not the medetomidine. You’d expect medetomidine to affect the whole of the left side not just one wall.

In terms of butorphanol, we will go up to 0.4mg/kg, our anaesthetists say it’s a bit like water!! If you can’t get an IV we will usually try IM alfaxalone before medetomidine, the reason behind that is as discussed above it affects TS the echo far less. The only issue with that is it is unpredictable so some cats will sedate nicely but others it hardly touches.

Liz

Replying to Emma G. 10/01/2025 - 17:31

Hi Emma,

Thanks for the question. It is eccentric hypertrophy, yes, as you’ve got a dilated LV chamber with relatively thin walls. So we describe this as eccentric hypertrophy too.

Liz 🙂

Replying to Emma G. 10/01/2025 - 16:37

Hi Emma,

Great question! I only touch on endocarditis as the nuances of it would be a lecture in itself.

In short MMVD dogs are not at higher risk of endocarditis compared to those dogs that don’t have MMVD. The only disease process thought to increase the risk of endocarditis is sub aortic stenosis. In dogs with that we would tend to advise prophylactic antibiotics a day or two before the procedure to reduce bacterial load.

Overall, I worry very little about anaesthetising a stage B1/B2 dog, they have good systolic function so BP maintenance is good. I worry more about stage C but I would say the benefit of sorting teeth is greater in these dogs than not doing it. They still tend to have good systolic function, you just need to use fluids carefully and make sure their BP is maintained. It’s dogs with poor systolic function we need to worry about more 🙁

Liz

Hey

Physiology can be confusing – I think a lot of it is made harder because of the terminology. I’d probably suggest looking at some videos to understand the cardiac cycle better. This one might be helpful;

In terms of frame rate the definition is the number of frames the computer can display per second. The more frames you have per second the better the temporal resolution. In animals with fast heart rates you want the number of frames per second to be as high as possible, at least over 30 frames per second. I change it by changing settings such as width, depth etc and try and maximise it for each image I take.

Standing echo is fine, an esteemed colleague in France performs all her echos standing. However, it’s probably just what I’m used to, but I find it much better to get good images in lateral, mainly because the Lings don’t get in the way.

If you use sedatives such as butorphanol, low dose ACP, alfaxalone or midazolam then they don’t change what you see in a clinically relevant way. If you have to use medetomidine or dexmedetomidine then they do change systolic function so we try and avoid those. I find 0.3-0.4mg/kg butorphanol works for most dogs to calm them down. We can combine that with oral trazadone and gabapentin if required. In cats gabapentin works well and sometimes we also add butorphanol but if we need something stronger we will add in alfaxalone (same for dogs). A quiet room, with one good or two good handlers works well for most of our patients but it depends on the temperament of the population and how many people you have to help you!

Liz