Bulgaria – Vets on the Balkans - an online journal for veterinarians from the Balkans

WHO ARE Vets on The Balkans? Veterinarians speak…..

January 15, 2017

LUIGI VENCO, DVM , SCPA, Dipl EVPC, Pavia, Italy

It ‘s a wonderful Journal. Open source. Clinical cases and tips useful for the reader. Not just a display of vanity for the authors. Congratulations to the editors for strong expended effort

ROMANIA

Dr Constantin Ifteme – Center of Veterinary Endoscopy and Minimum Invasive Surgery

Vets on the Balkans it is more than a promoting platform of all successful projects from the veterinary medicine in the Balkans region. It can be compared with the Olympics of the veterinarians from this geographical area, with major involvement in training and continuous learning of the veterinary community.

Dr Iuliana Ionascu, DVM , PhD, member ESVO

Vets on the Balkans is the meeting point of the specialists, the friends and of the people who have the joy of sharing their experience in areas of interest in veterinary medicine.Vets on the Balkans helped us by placing us in direct contact with specialists and taught us how to work together. The first step is done. The next step is one that I want from the bottom of my heart: to write therapeutic guides together.So, Vets on the Balkans, my dream has to be your accomplishment in the years to come.I love you for what you created. Good luck on your wonderful journey!

Dr Alexandru Diaconescu, DVM, PhD, Senior Lecturer

I think it’s a great idea! All the vets in the Balkans area can learn from each other’s experience, we can share opinions, interesting clinical cases, etc.

I wish you good luck!

Dr Rares Capitan , DVM, resident ECVD

I think is a good interesting idea. I really hope that this project will continue for a long time and collect many vets as want to share their experience. So the whole community from the Balkans will progress in a good way.

Dr Ana Maria Boncea, DVM, resident ECVD

“Vets on the Balkans” is like a fresh air for all the vet’s from every place…Is an open door for sharing your experience, upgrading your knowledge and enjoy the vet’s life spectaculy. Let’s share together all beautiful insides of our job!

BULGARIA

Dr Vladislav Zlatinov – Central Vet Clinic in Sofia, Bulgaria

It is so great to have such a professional forum, connecting Balkans (and not only) vets! I literally see people from different countries in the region, getting to know each other because of your journal. The “Vets on The Balkans” deserve all the compliments for your great positive initiative and work!

Dr Stefan Savov- Ditton Reach Veterinary Surgery, England

The journal is a really brilliant idea. I read all the articles. I find some really good examples there. It has proved that veterinarians on Balkans are no worse than the colleagues in the western countries. I wish you more and more interesting cases shared on the pages of the journal and lots of luck.

Dr Mila Bobadova ( Veterinary Clinic “ Dobro Hrumvane” in Sofia, Bulgaria)

We needed that kind of journal at Balkans, a connection spot and an open source. It brings veterinary medicine to a new level, but most of all it helps all the vets from Balkans to get to know each other. For that I am very thankful and I am sure it will make a difference.

Dr Svetlina Aleksandrova ( Veterinary Clinic “Light Vet” in Sandanski, Bulgaria)

Vets on the Balkans is great new way for communication and learning. The reality is that we can not know everything for any condition. The learning process continue until the end of our lives. I love the case reports – a lot of photos and good explications. The Learn and Travel initiative will make a lot of collegues better in their prefered section of veterinary medecine. Please, dr Gancheva, continue to do what you do in the best way – connect!

Dr Liliya Mihailova ( Veterinary Clinic “ United Veterinary Clinic “ in Varna, Bulgaria )

According to me ” Vets on the Balkans “o is one of the greatest way for many veterinarians to communicate and share knowledge and experience. Because is a new and modern way to connect veterinarians not only from countries of Balkan peninsula but also from countries all over the world. Moreover It provides the latest scientific information about news in veterinary medicine and useful personal professional experience.

Dr Spas Spasov ( Veterinary Clinic “ United Veterinary Clinic “ in Varna, Bulgaria )

I want to extend my greetings to the great work you do with the magazine. It is very interesting and useful. I wish to become more known. I wish to be ever visited. I think the idea to united vets on the Balkans is realized.

Dr Vanya Stoyanova – Veterinary Clinic Provet in Plovdiv, Bulgaria

Useful veterinary journal,creative realized idea.
Like to read the letters ,interesting posts ,new information for me and classified my level where I am on the market with the Balkan colleagues .Receive information for future symposiums,Conferences and Webinars. Thank You Luba Gancheva & Co
Wish you continue enjoying with your fantastic work!!!

Dr Dimitar Djambazov Veterinary Clinic Sofia in Sofia, Bulgaria

Vets on the Balkans is a unique in its respective category as a journal who strives to connect the countries on the Balkans- a highly diverse and interesting set of countries.

The journal provides easy-to-reach and concise practical knowledge as well as the opportunity for interviews, presentations and step-by-step guidelines for management of specific problems.

From where I stand as a practitioner the case reports are by far my favorite method of acquiring new information in the veterinary field. That is of course after one has a strong basic knowledge on a given subject.

And here’s where the next indispensible role of “Vets on the Balkans” becomes evident. The journal not only acts as a mean of learning and developing oneself as a veterinary professional with blog posts but also serves as a connecting point between the countries and veterinarians in the region, as to promote and organize practical sessions, continuing education projects and various externships. This is indispensible help, strongly appreciated by many and luckily gaining more and more popularity among animal caregivers on the Balkans.
The effort invested in the journal by its creator and her collaborators is immense and undoubtedly greatly acknowledged as we all know how hard it can be to sustain such a project, be a practicing veterinarian at the same time and have a life from time to time as well.

As a young and still lacking a certain amount of experience, vet, I appreciate the Vets on the Balkans journal as a source of CPD, but also as a opportunity to reach and connect to our neighbors on the Balkans.

CROATIA
Dr Emil Ofner – Veterinary Clinic More in Sibenik, Croatia

Task for every journal is to have a good impact factor on its readers. Vets on the Balkans journal doesn’t do just that, but it also successfully ties up vets from different Balkan countries and others. It is the first of its kind in the Balkans and for sure it will facilitate further development of the veterinary profession. Hopefully it will become a great online tool for improvements of veterinary skills and knowledge.

Dr Mario Kreszinger – Veterinary Clinic Kreszinger in Zagreb, Croatia

It very useful easy approachable source of informations we need in everyday Jobs routine.

Dr Nikola Bunevski– Veterinary Clinic Kreszinger in Zagreb, Croatia

Sharing is caring. Every information is priceless. We are working near each other we have similar problems and questions, it will be better for each of us if we share those questions and problems to one another, we will come to answers faster and painless. Vets on the Balkans can serve that purpose.Thank you for having me.

SERBIA

Dr Zoran Loncar- Veterinary Clinic Novak in Belgrade, Serbia

Vets on the Balkan is refreshment and result of people with good energy and wish to improve our region. We live in small countries and if we cooperate together we have better chance to improve ourselves.

Dr Nikoleta Novak- Veterinary Clinic Novak in Belgrade, Serbia

I read the interview you had with our colleague Nikola Bunevski, and I think he said it perfectly; “Sharing is caring. Vets on the Balkans can serve that purpose””Vets on Balkans” is really a great idea and I do wish you all the best on this exciting and high-minded mission.

SLOVENIA

Dr Marko Novak- Klinika Loka in the city Škofja Loka in Slovenia

I came across VTB when I was scrolling down the facebook and I saw these interesting articles from guys doing great job. I think it is one of those starters that help people to become better at what they do.

TURKEY

Banu Dokuzeylul, DVM, PhD ,Department of Internal Medicine

Faculty of Veterinary Medicine

Istanbul University, Istanbul, Turkey

I like reading. One day I found myself reading a case from Vets on The Balkans Online Journal. This subject was one of my interesting areas in veterinary medicine. With this article, I couldn’t imagine a good collaboration and friendship start. With Dr. Luba Gancheva’s support, I was invited to seminar in Bucharest. As I see until today, the journal improves day by day. Instead of giving important information, this journal combines the colleagues on the Balkans. If you want to be a part of a great friendship and have a vulnerable data, you must start to read the journal as fast as you can.

Patent Ductus Arteriosus in adult dog

July 2, 2016 Leave a Comment

Todor Kalinov, DVM, Zaravet veterinary clinic

Todor Kalinov, DVM, Zaravet veterinary clinic, city of Plovdiv, Bulgaria, e-mail drkalinov80@gmiail.com

INTRODUCTION

Fig 2

Fig 1

Patent Ductus Arteriosus(PDA) is one of the most frequently encountered congenital heart disease in dogs , ranging in prevalence from about 25 to 32 % from reported malformations ¹ , and lest frequently in cats – about 11 % . The ductus arteriosus is normal foetal structure that shunts blood from pulmonary artery to aorta ². Before the birth , it divers approximately 80 to 90 % of the right ventricular output back to the left side of the circulation. After parturition and the onset of breathing , pulmonary vascular resistance falls, flow in the ductus reverses , and the resulting rise in arterial oxygen tension inhibits local prostaglandin release causing constriction of the vascular smooth muscle within the vessel wall and functional closure of the ductus arteriosus³.

Fig 4

Fig 3

Fig 6

Fig 7

Fig 5

Fig 8

The ductal wall usually contains a loose branching pattern of circumferential smooth muscle in normal pups. The increasing genetic liability to PDA represents extension of the noncontractile wall structure of the aorta to an increasing segment of the ductus arteriosus, progressively impairing its capacity to undergo physiologic closure¹.

In typical cases because of the lower pressure in pulmonary circulation there is continuous flow thru the ductus arteriosus from aorta to pulmonary artery. Clinical impact from this is volume overload of the structures in the shunt pathway : the main pulmonary artery, lungs, left atrium, left ventricle, and back to the ascending aorta up to the level of the ductus⁴. In that shunt direction the dogs show signs of left-sided congestive heart failure – exercise intolerance, coughing, eventually pulmonary edema. In rare instances when the ductus still wide after birth, the flow is really enormous and this leads to increase in pulmonary vascular resistance and change in direction of the shunt, so-called Eisenmengers physiology and reversed PDA . This pattern of pulmonary hypertension and reversed (right to left) shunting usually develops within the first few weeks of life³. Clinical signs in reversed PDA are shortness of breath, differential cyanosis – pink mucous membranes in cranial part of the body and cyanosis in caudal membranes, polycythemia , pelvic limb weakness, collapse, and seizures. The changes in pulmonary vasculature are irreversible and closure of the PDA is not suggested.

Many dogs with left to right PDA do not show any clinical signs, but if left heart failure has developed in first year of life, up to 65 % would die if left untreated. In most of the dogs clinical signs are apparent before the third year of age. The appearance of signs in older dogs is unusual².

CASE PRESENTATION

Buky was 7 years old springer spaniel admitted in our clinic with severe respiratory distress. He had history of heart murmur noted on routine examination , several episodes with increasing respiratory rate, and one presyncopal event with rear limb weakness. All clinical signs were apparent past several months.

The dog breathed with open mouth, mucus membranes were cyanotic , respiration rate increased, and on auscultation we have founded continued heart murmur, and crackles on the both side of the thorax. On the X-ray there was severe generalized cardiomegaly, pulmonary overcirculation with dilation if the pulmonary arteries and veins, interstitial to alveolar lung pattern (Figure 1 – L/L projection, Figure 2 – D/V projection). We have applied initial therapy for congestive heart failure with:

Furozemide – 4mg/kg/hour i.v.

Pimobendan – 0.25mg/kg p.os.

Enalapri – 0.5mg/kg p.os.

Sodium nitroprusside – i.v. constant rate infusion

Oxygen – via mask .

After several hours there was a reduction in respiratory rate, and efforts and an ECG and echocardiography were made.

ECG findings :

Sinus tachycardia – 163 bpm

Wide and tall P wave – suggestive of left atrium enlargement

Tall R wave – suggestive of left ventricular enlargement (Figure 8)

Atrial premature complexes (Figure 3)

Ventricular premature complexes(VPC) with origin in left ventricle (Figure 4)

Fusion beats – intermediate morphology between normal complexes and VPC (Figures 5, 6, 7).

ECHOCARDIOGRAPHY

Fig 9

Fig 11

Fig 10

Fig 12

We have made echocardiography at left and right lateral recumbency of the patient with all parasternal views according to accepted standards. From the exam we have found severe left heart volume overloud with eccentric hypertrophy of the left ventricle. Left atrium was dilated with rightward excursion of the atrial septum. Left ventricle was dilated with thin free wall and interventricular septum, dooming of the septum to the right ventricle, and reduced systolic motion of the free wall and the septum (video 1).

Left atrium and aorta was measured on right parasternal short axis view at the heart base and the ratio LA/AO was estimated with results showing at Figure 11. Normal LA/AO ratio have to be < 1,6. Main pulmonary artery was dilated compared to aortic root (video 2)

, and blowing of the pulmonary valve was noted (Figure 12).

Fig 14

Fig 13

Fig 15

Fig 16

On Color Doppler exam there was mild mitral regurgitation with central jet , probably because the dilation of the mitral annulus (Figure 13), and in pulmonary artery was noted typical for PDA continuous flow (video 3).

With CW Doppler the aortic flow velocity was measured 2,19 m/s , with normal speed les then 2.0 m/s. In pulmonary artery CW Doppler show typical continuous bidirectional flow (Figure 14).

On the basis of this findings the dog was diagnosed with Patent Ductus Arteriousus with left to right shunt. Because of the dramatic structural and functional changes in heart, the already developed left heart failure and increased anesthetic risks the owners refused surgical ligation of the ductus. At the time of the diagnosis in our country we did not have the chance for transcatheter coil embolisation. So the only opportunity was to treat congestive heart failure with medications. We have prescribed :

Pimobendan – 0.25 mg/kg/12 h. p.os

Enalapril – 0.5 mg/kg/12 h. p.os

Furozemid – 1.0 mg/kg/12 h. p.os

Spironolacton – 1.0 mg/kg/12 h. p.os

Supplements with L carnitine, taurine, and coenzyme q10.

The dog was very well after the beginning of the therapy and had only exercise intolerance. After about 1 year he had improvement in some echocardiographyc parameters of systolic function – normal fractional shortening, normal pre ejection period, normal ejection time, but the left atrium was bigger then year ago (Figures 15, 16, 17).

Video 4 – right parasternal four and five chamber view year after diagnosis ,

video 5 – modified left parasternal short axis view of heart base with color Doppler of the pulmonary artery showing continuous flow with small turbulent jet in opposite direction.

COMMENTS

The treatments for Patent Ductus Arteriosus are surgical ligation or transcatheter device closure. Because of the technical factors and price in our country no one does make device closure but in many clinics surgical procedure can be done with great success. In this case the owners decline surgery, but mine opinion is also that the dog was not appropriate candidate for operation. Despite the fact that in most cases there is dramatic improvement in clinical status and cardiac function after surgical closure, the age ,the already developed heart failure, and concurrent heart disease, affect negatively survival period after PDA closure⁵. In adult dogs one of the major surgical complications is haemorrhage due to ductus friability². Mitral valve endocardiosis is also an important factor affecting the survival period. On video 1 and 4 we can see the slight thickening and prolapsed mitral valve leaflets, so I supposed that the dog had degeneration of the mitral valve. Conduction instability of the heart is another reason for anesthetic complications. Actually the dog has died suddenly during routine walk without any other signs, about two years after the diagnosis, so malignant arrhythmia can be the reason. Despite this facts in most of the literature, the authors suggest closure of the PDA, even in adult dogs, only important contraindication for not closing is right to left shunt.

CONCLUSION

It is not known why some animals with PDA do not show any signs until adulthood. One of the reasons could be the small diameter of the ductus. In human medicine the maintenance of normal pulmonary vascular resistance is important factor for survival of the older patients². It is certain that the adult dogs with congenital heart diseases are more then we expect, and always when we examine adult animal for some heart disease, we have to think not only for degenerative valve disease and cardiomyopathies but also for congenital and inherited problems. And of course rare things do happen everyday.

Veterinary clinic Blue Cross,Sofia ,Bulgaria

June 17, 2015 Leave a Comment

Veterinary clinic “Blue cross” is a 24 hour Small Animal Hospital working without a day off. It is one of the biggest and modernly equipped veterinary clinics in Bulgaria. They use the most up to date equipment available for emergency care, surgery and laboratory activity. On area of more than 400 square m.,are disposed: waiting room and reception, two consulting rooms, laboratory, x-ray and ultrasound department, surgery room, intensive care unit.

The clinic has highly qualified team who follow and visit during the whole years courses, seminars and congresses all over the world, in order to be up to date in the newest in veterinary medicine.

Part of the team:

Dr.Borislav Georgiev

is born on 10.2.1976 in Sofia. He graduated in University of Foresty, Sofia, Bulgaria.

Specialist in Hip Dysplasia (CHP) and is a member of GRSK (Geraman association of radiologists for hereditary diseases of small animal skeleton). In 2010 he recieved a diploma as an expert in elbow dysplasia. Dr.Georgiev and his team are the first in Bulgaria who made a total hip replacement in dog.

Dr. Rosen Cokev

Dr.Cokev is born 27.11.1984 in Sevlievo. He graduated University of Foresty.

Professional interests: cardiology and echocardiolography, internal medicine.

In 2010 he finished course of clinical echocardiography held by one of the leading experts in the world.

Dr.Miroslav Todorov

is born 02.12.1985 in Dobrich.

2013-Europian School for Advanced Veterinary Studies-neurology course 1

2014-Europian School for Advanced Veterinary Studies-neurology course 2

2014-EVSN/ECVN course-Veterinary Neuroscience and Advanced Clinical Neurology/Neurosurgery Course