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Ultrasound Approach To Diagnose Aortopulmonary Fistulation In Friesian Horses

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Abstract
Aortopulmonary fistulation (APF) is extremely rare in the general horse population but relatively common in Friesian horses. Typically, a transverse tear in the aorta occurs near the remnant of the ligamentum arteriosum, with formation of a fistula towards the pulmonary artery. The fistulation often is a relatively long and irregular shaped tract. A wide range of clinical signs may occur. Tachycardia and right heart failure with pulmonary hypertension are usually present. Often a holosystolic and early diastolic murmur are found dorsal to the aortic valve area. Obtaining good quality cardiac ultrasound images may be challenging in some Friesians due to their body conformation. The purpose of this study was to describe how to take diagnostic ultrasound images of APF, applicable in equine practice. Data from 9 Friesian geldings and 3 mares (mean body weight 591±54 kg) were included. Age ranged from 4 to 12 years (median 5.8). All horses underwent a full echocardiographic exam including 2D, M-mode and color flow Doppler. In addition, specific views were acquired to visualize the APF. All horses showed ultrasound changes compatible with severe pulmonary hypertension and a decrease in aortic size. From the right parasternal left ventricular outflow tract view and right ventricular (RV) inflow-outflow view (Fig. 1), APF could be visualized in the triangle between right atrium (RA), aorta (Ao) and pulmonary artery (PA) in 8 horses, but lesions were sometimes subtle. Color flow examination from these views did show abnormal flow suggestive for APF in 6 horses. One horse showed an aortic dissection with a circular pseudo-aneurism (cuff) of the entire visible aorta. Left-sided long-axis views of the PA from the third intercostal space [1] were superior to visualize the APF. With cranial (45°) and slight dorsal (10°) angulation (no rotation) (Fig. 2), the PA and Ao were visualized. Subsequently, the course of the PA was followed until its bifurcation by gradually rotating the probe clockwise and simultaneously angling it dorsally and caudally. From these views, the APF could be clearly identified between PA and Ao in all horses. It was located dorsal to the PA, caudal and ventral to the Ao. Color flow Doppler indicated turbulent flow in the APF and PA in all horses. The actual tear in both vessels could be identified in 11 horses. In all horses APF was confirmed on post-mortem. In conclusion, Friesians with APF show ultrasound findings that indicate pulmonary hypertension and right heart failure. However, for accurate diagnosis specific ultrasound views from aorta and pulmonary artery are needed. Longitudinal images from the PA, taken from the left third intercostal space clearly showed the APF in all horses.
Keywords
Horse, heart, cardiovascular, aortic ruputure

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Chicago
van Loon, Gunther, Dominique De Clercq, Annelies Decloedt, Lisse Vera, Glenn Van Steenkiste, Marco De Bruijn, Margreet Ploeg, Willem Back, Catherine Delesalle, and Koen Chiers. 2019. “Ultrasound Approach To Diagnose Aortopulmonary Fistulation In Friesian Horses.” In Proceedings of the American College of Veterinary Medicine (ACVIM) Forum, 184–184.
APA
van Loon, G., De Clercq, D., Decloedt, A., Vera, L., Van Steenkiste, G., De Bruijn, M., Ploeg, M., et al. (2019). Ultrasound Approach To Diagnose Aortopulmonary Fistulation In Friesian Horses. Proceedings of the American College of Veterinary Medicine (ACVIM) forum (pp. 184–184). Presented at the American College of Veterinary Medicine (ACVIM) forum.
Vancouver
1.
van Loon G, De Clercq D, Decloedt A, Vera L, Van Steenkiste G, De Bruijn M, et al. Ultrasound Approach To Diagnose Aortopulmonary Fistulation In Friesian Horses. Proceedings of the American College of Veterinary Medicine (ACVIM) forum. 2019. p. 184–184.
MLA
van Loon, Gunther et al. “Ultrasound Approach To Diagnose Aortopulmonary Fistulation In Friesian Horses.” Proceedings of the American College of Veterinary Medicine (ACVIM) Forum. 2019. 184–184. Print.
@inproceedings{8619460,
  abstract     = {Aortopulmonary fistulation (APF) is extremely rare in the general horse population but relatively common in Friesian horses. Typically, a transverse tear in the aorta occurs near the remnant of the ligamentum arteriosum, with formation of a fistula towards the pulmonary artery. The fistulation often is a relatively long and irregular shaped tract. A wide range of clinical signs may occur. Tachycardia and right heart failure with pulmonary hypertension are usually present. Often a holosystolic and early diastolic murmur are found dorsal to the aortic valve area. Obtaining good quality cardiac ultrasound images may be challenging in some Friesians due to their body conformation. The purpose of this study was to describe how to take diagnostic ultrasound images of APF, applicable in equine practice. Data from 9 Friesian geldings and 3 mares (mean body weight 591±54 kg) were included. Age ranged from 4 to 12 years (median 5.8). All horses underwent a full echocardiographic exam including 2D, M-mode and color flow Doppler. In addition, specific views were acquired to visualize the APF. All horses showed ultrasound changes compatible with severe pulmonary hypertension and a decrease in aortic size. From the right parasternal left ventricular outflow tract view and right ventricular (RV) inflow-outflow view (Fig. 1), APF could be visualized in the triangle between right atrium (RA), aorta (Ao) and pulmonary artery (PA) in 8 horses, but lesions were sometimes subtle. Color flow examination from these views did show abnormal flow suggestive for APF in 6 horses. One horse showed an aortic dissection with a circular pseudo-aneurism (cuff) of the entire visible aorta. Left-sided long-axis views of the PA from the third intercostal space [1] were superior to visualize the APF. With cranial (45°) and slight dorsal (10°) angulation (no rotation) (Fig. 2), the PA and Ao were visualized. Subsequently, the course of the PA was followed until its bifurcation by gradually rotating the probe clockwise and simultaneously angling it dorsally and caudally. From these views, the APF could be clearly identified between PA and Ao in all horses. It was located dorsal to the PA, caudal and ventral to the Ao. Color flow Doppler indicated turbulent flow in the APF and PA in all horses. The actual tear in both vessels could be identified in 11 horses. In all horses APF was confirmed on post-mortem. In conclusion, Friesians with APF show ultrasound findings that indicate pulmonary hypertension and right heart failure. However, for accurate diagnosis specific ultrasound views from aorta and pulmonary artery are needed. Longitudinal images from the PA, taken from the left third intercostal space clearly showed the APF in all horses.},
  author       = {van Loon, Gunther and De Clercq, Dominique and Decloedt, Annelies and Vera, Lisse and Van Steenkiste, Glenn and De Bruijn, Marco and Ploeg, Margreet and Back, Willem and Delesalle, Catherine and Chiers, Koen},
  booktitle    = {Proceedings of the American College of Veterinary Medicine (ACVIM) forum},
  keywords     = {Horse,heart,cardiovascular,aortic ruputure},
  language     = {eng},
  location     = {Phoenix, Arizona, US},
  pages        = {184--184},
  title        = {Ultrasound Approach To Diagnose Aortopulmonary Fistulation In Friesian Horses},
  year         = {2019},
}