8년령의 중성화된 잡종 수컷 고양이 (증례 1)와 3년령의 중성화된 샴 수컷 고양이 (증례 2)가 뒷다리 마비, 지속적인 개구호흡, 그리고 객혈 등을 주증으로 내원하였다. 심잡음 (증례 1)과 분마성심음 (증례 2)이 좌측 심저부에서 청진되었으며, 방사선 검사상 증례 1의 경우 폐포패턴을 동반한 심한 공기연하증이, 증례 2에서는 확연한 심비대가 확인되었다. 심초음파 검사에서 두 마리 고양이 모두에서 좌심실과 심실중격의 구심성 비대와 좌심방의 확장이 확인되었다. 심장 초음파를 포함한 검사를 바탕으로 본 환축은 고양이 심근비대증으로 진단되었으며, 신체검사와 복부 초음파 검사를 통하여 병발한 안장색전증을 확인하였다. 일반적인 치료를 통한 환축의 예후가 불량한 점을 감안하여, 직접적인 혈관내 혈전용해술이 시도되었다. 혈관조영술을 통하여 혈전의 위치와 크기를 확인 할 수 있었으나, 광범위한 색전증으로 인하여 중재적 시술을 이용한 혈전용해는 성공적이지 못했다.
8년령의 중성화된 잡종 수컷 고양이 (증례 1)와 3년령의 중성화된 샴 수컷 고양이 (증례 2)가 뒷다리 마비, 지속적인 개구호흡, 그리고 객혈 등을 주증으로 내원하였다. 심잡음 (증례 1)과 분마성심음 (증례 2)이 좌측 심저부에서 청진되었으며, 방사선 검사상 증례 1의 경우 폐포패턴을 동반한 심한 공기연하증이, 증례 2에서는 확연한 심비대가 확인되었다. 심초음파 검사에서 두 마리 고양이 모두에서 좌심실과 심실중격의 구심성 비대와 좌심방의 확장이 확인되었다. 심장 초음파를 포함한 검사를 바탕으로 본 환축은 고양이 심근비대증으로 진단되었으며, 신체검사와 복부 초음파 검사를 통하여 병발한 안장색전증을 확인하였다. 일반적인 치료를 통한 환축의 예후가 불량한 점을 감안하여, 직접적인 혈관내 혈전용해술이 시도되었다. 혈관조영술을 통하여 혈전의 위치와 크기를 확인 할 수 있었으나, 광범위한 색전증으로 인하여 중재적 시술을 이용한 혈전용해는 성공적이지 못했다.
An 8-year-old castrated male domestic shorthair cat (Case 1) and 3-year-old castrated male Siamese cat (Case 2) was presented with acute paresis of the hindlimbs, constant open-mouth breathing, and hemoptysis. Heart murmur (Case 1) and gallop sound (Case 2) was ausculated on the left heart base. Rad...
An 8-year-old castrated male domestic shorthair cat (Case 1) and 3-year-old castrated male Siamese cat (Case 2) was presented with acute paresis of the hindlimbs, constant open-mouth breathing, and hemoptysis. Heart murmur (Case 1) and gallop sound (Case 2) was ausculated on the left heart base. Radiographs revealed alveolar infiltration of the caudodorsal lung lobes with aerophagea in Case 1 and prominent cardiomegaly in Case 2. Marked concentric hypertrophy of the ventricular septum and free wall, and left atrial enlargement was detected through echocardiography in both cats. Based on the examinations including echocardiography, those cats were diagnosed as hypertropic cardiomyopathy. Abdominal ultrasound revealed echogenic material in the aortic trifurcation region, aortic thromboembolism (ATE). Although prognosis of those animals was guarded, interventional therapeutic approach through direct endovascular thrombolytic therapy was attempted. ATE was visualized through angiography; however dissolving the embolus using interventional thrombolytic approach was not successful due to the extensive thrombus.
An 8-year-old castrated male domestic shorthair cat (Case 1) and 3-year-old castrated male Siamese cat (Case 2) was presented with acute paresis of the hindlimbs, constant open-mouth breathing, and hemoptysis. Heart murmur (Case 1) and gallop sound (Case 2) was ausculated on the left heart base. Radiographs revealed alveolar infiltration of the caudodorsal lung lobes with aerophagea in Case 1 and prominent cardiomegaly in Case 2. Marked concentric hypertrophy of the ventricular septum and free wall, and left atrial enlargement was detected through echocardiography in both cats. Based on the examinations including echocardiography, those cats were diagnosed as hypertropic cardiomyopathy. Abdominal ultrasound revealed echogenic material in the aortic trifurcation region, aortic thromboembolism (ATE). Although prognosis of those animals was guarded, interventional therapeutic approach through direct endovascular thrombolytic therapy was attempted. ATE was visualized through angiography; however dissolving the embolus using interventional thrombolytic approach was not successful due to the extensive thrombus.
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문제 정의
This report describes two cases of feline ATE using angiographic visualizaztion and treatment approach to distal aortic ATE through infusion of direct thrombolytic agent ATE.
제안 방법
Treatment was initiated with oxygen supplementation, furosemide (1 mg/kg, SQ, q 12h, Handok, Seoul, Korea), dil-tiazem (7.5 mg/cat, PO, q 8h, CJ Cheiljedang Pharma, Seou, Korea), clopidogrel (18.75 mg, PO, q 24h, Jin Yang Pharm, Seoul, Korea), and enoxaparin (1 mg/kg, SC, q 12h, SanofiAventis, New Jersy, USA) in both cats. However, no improvement was noted.
성능/효과
In conclusion, this case report demonstrates that clinical approach to demonstrate the ATE through angiography and therapeutic trial for interventional technique. Although this was small series and the approach was not successful, further interventional attempts to deteriorated patients with ATE will be required to improve the clinical outcomes of this disease in the future.
참고문헌 (14)
Abbott JA. Feline hypertrophic cardiomyopathy: an update. Vet Clin North Am Small Anim Parct 2010; 40: 685-700.
Hogan DF, Andrews DA, Green HW, Talbott KK, Ward MP, BM Calloway. Antiplatelet effects and pharmacodynamics of clopidogrel in cats. J Am Vet Med Assoc 2004; 225: 1406-1411.
Jacobs G, Knight DH. M-mode echocardiographic measurements in nonanesthetized healthy cats; Effects of body weight, heart rate, and other variables. Am J Vet Res 1985; 46: 1705-1711.
Koyama H, Matsumoto H, Fukushima RU, Hirose H. Local intra-arterial administration of urokinase in the treatment of a feline distal aortic thromboembolism. J Vet Med Sci 2010; 72: 1209-1211.
Reimer SB, Kittleson MD, Kyles AE. Use of rheolytic thrombectomy in thetreatment of feline distal aortic thromboembolism. J Vet Intern Med 2006; 20: 290-296.
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