saranchhoey
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- Apr 14, 2019
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Dear all editors
I would like to say thank you so much for your help, comments and suggestion. I also would like to say apologize for my mistake of my first post such as words together and space. The topic of my article is “Effect of Respiratory Phase for Detecting Left Heart Enlargement on Thoracic Radiography in Dogs with MitralRegurgitation”. In the top of each paragraphs are my article results which I written as “B” and next the “B” is my discussion parts for each result of each paragraphs. Please help me for correct of any errors such as phrase and grammar or give me the suggestion to correct it. Thank you so much again for your help.
Discussion
In dogs with mitral regurgitation (MR), the respiratory phase when the thoracic radiograph was taken did not significantly affect the overall heart size based on the vertebrae heart score (VHS) and intercostal space (ICS). In the recent study, the influence of respiration on thoracic conformation at multiple vertebral levels in Garman shepherd dog (Hassan, 2019). The above study said did not change significantly during respiration along the different vertebral levels, as the change in thoracic depth in lateral. The other previous study (GUGLIELMINI, 2008) about the use of the vertebrae heart score in coughing dogs with chronic degenerative mitral valve disease was noticed VHS=11.7 the cardiac enlargement on the right lateral expiration radiographs. The relationship of end diastolic and end systolic that irregularity index to LA size and also heart size (VHS). The end systolic was slightly positive, due to some increase in severely enlargement of the heart (Todosijevic, 2007). In the human study (Alehan, 1996), about effects of respiration on left ventricular diastolic function in healthy children were indicate that respiration has significant effects on left ventricle (LV) diastolic function in normal children, and respiration phase should be assessment into account as standard. In addition, the left heart enlargement due to the relationship of left atrium (LA) and left ventricle (LV) and when the left ventricle (LV) developed the pressure of chronic diastolic dysfunction, and volume overload, it means the result will lead left ventricle (LA) enlargement as well as. Through these studies above, the measurement of vertebrae heart score (VHS) is not only a possible assessment to determine only left heart enlargement with mitral regurgitation (MR) of dogs. Although, the vertebrae heart score (VHS) assessment should supply with all of the cardiac diseases which mean the dogs with a heart murmur should have a kind of cardiac evaluation to check for heart disease. The cardiac disease progresses other sign may accuse such as labored breathing, cyanosis, open-mouthed breathing, syncope, lethargy and etc (Resort, Care).
There was evidence of statistically significant correlation of thoracic radiographic measurement of respiratory phase. In the previous study (Silverman, S, 1975), suggested the accurate indication the radiograph was exposed during inspiration. The respiratory phase thoracic radiographic measurement of vertebrae heart score (VHS) in the lateral view greatest exception was specified between vertebrae heart score (VHS) in the diastolic inspiratory phase (mean± SD, 10.59 ±0.49) and systolic expiratory phase (mean ± SD,10.11 ± 037) which no correlation heart rate with vertebrae heart score (VHS) in inspiration and expiration phase (Olive , 2015). There was a study as long as knew the arterial pulse pressure change during the automatic ventilation and the result as increased during inspiration phase but, decreased the arterial pulse pressure during the expiration phase (MALONEY, 1952). There is a difference from the results of this study that indicated the thoracic radiographic on the expiration point the left atrium (LA) enlargement measured on lateral view is significantly severe in the expiration phase higher than the inspiration phase. The size and shape of cardiac is the difference also cause of blood circulation in the respiratory phase as the normal mechanisms of physiologic possessed of cardiac and other factors of cardiac size change is the cardiac disorder was accused.
The quantitative assessment of left atrium (LA) size using vertebrae left atrium size (VLAS) and the degree of dorsal tracheal deviation also did not differ according to the respiratory phase. However, left atrium (LA) enlargement was qualitatively assessed to be significantly higher in the expiration than inspiration in the lateral view as well as in VD view. In the human study (Vieillard-Baron, 2003), about cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography, there was the significant increase in the pulmonary vein (PV) during the dynamic phase oflung inflation followed by a significant drop during the expiration phase. The characterize of PV dilated due to the blood flowed back from left ventricle (LV)to RA and overstock in left atrium (LA) of mitral regurgitation and also the cause of increased blood pressure. The present study, the thoracic radiographic taken in expiration phase is significant to be detecting of left atrium (LA) enlargement more than the thoracic radiographic taken in the inspiration. However, there are a few of results no significant coordination of respiratory phase such as the parameter measurement degree of dorsal tracheal deviation on the lateral view. In consonance with the previous study (Alexandre & Roux,2012), the results of that study signify that there was an expanded overlap between the tracheal bifurcation angles of clinical in the normal dogs. Therefore, the sensitivity of the tracheal bifurcation angle was insufficient to support use in clinical settings. Through the previous examination (Alexandre &Roux, 2012) and another study (M.k, 2012) which supported there are no correlation between dorsal tracheal deviation or bronchial that always suggestion for detecting of left atrium (LA) enlargement with mitral regurgitation (MR).
All radiographic parameters measured in both inspiration and expiration were significantly correlated with LA/Ao ratio on echocardiography. The thoracic radiographic in the inspiration was already found the significant correlation between radiographic and LA/Ao ratio on the echocardiographic of left heart enlargement in dogs with MR (W, 1985). The cardiac disease reported in dogs with respiratory disease, heart warm (HW) and chronic degenerative mitral valve(CDM) was generally higher than pulmonary arterial pressure (PAP), through the echocardiographic assessment that indices of HW and moderate-to-severe CDM of the right heart in dogs (T.C. & H.P., 2013). In our study, we assessment of thoracic radiographic with both of respiratory phase taken in account and LA/Ao ratio on echocardiographic and we measurement of left heart of dogs. The result of the present study provided the thoracic radiographic on expiration have a significant correlation with LA/ Ao radio on echocardiographic of dogs with mitral valve regurgitation (MR). According to the result of this examination and the previous result of the studies above which mean when we procedure of thoracic radiographic for performing the cardiac disease. However, left or right heart and also heart murmur showed as the clinical sing heart disease, we would suggest to take the radiographic with both respiratory phase and the final confirm with the echocardiographic.
In conclusion, the respiratory phase thoracic radiographic is necessary to detecting of left heart enlargement of dogs with mitral regurgitation (MR). Even in the hands of experienced clinicians, radiography is always used the thoracic radiographic as the inaccurate method for diagnosing canine. The radiographers should be considered with both respiratory phase radiographic. Clinicians should be very cautious about diagnosing congenital cardiac disease based thoracic radiographs on expiration as inspiration phase. We considered to use expiration phase radiographic also to perceive left heart enlargement with mitral regurgitation (MR) of dogs as for small animals practice and we hope that this method reflects the most common approach used in clinical practice.
I would like to say thank you so much for your help, comments and suggestion. I also would like to say apologize for my mistake of my first post such as words together and space. The topic of my article is “Effect of Respiratory Phase for Detecting Left Heart Enlargement on Thoracic Radiography in Dogs with MitralRegurgitation”. In the top of each paragraphs are my article results which I written as “B” and next the “B” is my discussion parts for each result of each paragraphs. Please help me for correct of any errors such as phrase and grammar or give me the suggestion to correct it. Thank you so much again for your help.
Discussion
In dogs with mitral regurgitation (MR), the respiratory phase when the thoracic radiograph was taken did not significantly affect the overall heart size based on the vertebrae heart score (VHS) and intercostal space (ICS). In the recent study, the influence of respiration on thoracic conformation at multiple vertebral levels in Garman shepherd dog (Hassan, 2019). The above study said did not change significantly during respiration along the different vertebral levels, as the change in thoracic depth in lateral. The other previous study (GUGLIELMINI, 2008) about the use of the vertebrae heart score in coughing dogs with chronic degenerative mitral valve disease was noticed VHS=11.7 the cardiac enlargement on the right lateral expiration radiographs. The relationship of end diastolic and end systolic that irregularity index to LA size and also heart size (VHS). The end systolic was slightly positive, due to some increase in severely enlargement of the heart (Todosijevic, 2007). In the human study (Alehan, 1996), about effects of respiration on left ventricular diastolic function in healthy children were indicate that respiration has significant effects on left ventricle (LV) diastolic function in normal children, and respiration phase should be assessment into account as standard. In addition, the left heart enlargement due to the relationship of left atrium (LA) and left ventricle (LV) and when the left ventricle (LV) developed the pressure of chronic diastolic dysfunction, and volume overload, it means the result will lead left ventricle (LA) enlargement as well as. Through these studies above, the measurement of vertebrae heart score (VHS) is not only a possible assessment to determine only left heart enlargement with mitral regurgitation (MR) of dogs. Although, the vertebrae heart score (VHS) assessment should supply with all of the cardiac diseases which mean the dogs with a heart murmur should have a kind of cardiac evaluation to check for heart disease. The cardiac disease progresses other sign may accuse such as labored breathing, cyanosis, open-mouthed breathing, syncope, lethargy and etc (Resort, Care).
There was evidence of statistically significant correlation of thoracic radiographic measurement of respiratory phase. In the previous study (Silverman, S, 1975), suggested the accurate indication the radiograph was exposed during inspiration. The respiratory phase thoracic radiographic measurement of vertebrae heart score (VHS) in the lateral view greatest exception was specified between vertebrae heart score (VHS) in the diastolic inspiratory phase (mean± SD, 10.59 ±0.49) and systolic expiratory phase (mean ± SD,10.11 ± 037) which no correlation heart rate with vertebrae heart score (VHS) in inspiration and expiration phase (Olive , 2015). There was a study as long as knew the arterial pulse pressure change during the automatic ventilation and the result as increased during inspiration phase but, decreased the arterial pulse pressure during the expiration phase (MALONEY, 1952). There is a difference from the results of this study that indicated the thoracic radiographic on the expiration point the left atrium (LA) enlargement measured on lateral view is significantly severe in the expiration phase higher than the inspiration phase. The size and shape of cardiac is the difference also cause of blood circulation in the respiratory phase as the normal mechanisms of physiologic possessed of cardiac and other factors of cardiac size change is the cardiac disorder was accused.
The quantitative assessment of left atrium (LA) size using vertebrae left atrium size (VLAS) and the degree of dorsal tracheal deviation also did not differ according to the respiratory phase. However, left atrium (LA) enlargement was qualitatively assessed to be significantly higher in the expiration than inspiration in the lateral view as well as in VD view. In the human study (Vieillard-Baron, 2003), about cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography, there was the significant increase in the pulmonary vein (PV) during the dynamic phase oflung inflation followed by a significant drop during the expiration phase. The characterize of PV dilated due to the blood flowed back from left ventricle (LV)to RA and overstock in left atrium (LA) of mitral regurgitation and also the cause of increased blood pressure. The present study, the thoracic radiographic taken in expiration phase is significant to be detecting of left atrium (LA) enlargement more than the thoracic radiographic taken in the inspiration. However, there are a few of results no significant coordination of respiratory phase such as the parameter measurement degree of dorsal tracheal deviation on the lateral view. In consonance with the previous study (Alexandre & Roux,2012), the results of that study signify that there was an expanded overlap between the tracheal bifurcation angles of clinical in the normal dogs. Therefore, the sensitivity of the tracheal bifurcation angle was insufficient to support use in clinical settings. Through the previous examination (Alexandre &Roux, 2012) and another study (M.k, 2012) which supported there are no correlation between dorsal tracheal deviation or bronchial that always suggestion for detecting of left atrium (LA) enlargement with mitral regurgitation (MR).
All radiographic parameters measured in both inspiration and expiration were significantly correlated with LA/Ao ratio on echocardiography. The thoracic radiographic in the inspiration was already found the significant correlation between radiographic and LA/Ao ratio on the echocardiographic of left heart enlargement in dogs with MR (W, 1985). The cardiac disease reported in dogs with respiratory disease, heart warm (HW) and chronic degenerative mitral valve(CDM) was generally higher than pulmonary arterial pressure (PAP), through the echocardiographic assessment that indices of HW and moderate-to-severe CDM of the right heart in dogs (T.C. & H.P., 2013). In our study, we assessment of thoracic radiographic with both of respiratory phase taken in account and LA/Ao ratio on echocardiographic and we measurement of left heart of dogs. The result of the present study provided the thoracic radiographic on expiration have a significant correlation with LA/ Ao radio on echocardiographic of dogs with mitral valve regurgitation (MR). According to the result of this examination and the previous result of the studies above which mean when we procedure of thoracic radiographic for performing the cardiac disease. However, left or right heart and also heart murmur showed as the clinical sing heart disease, we would suggest to take the radiographic with both respiratory phase and the final confirm with the echocardiographic.
In conclusion, the respiratory phase thoracic radiographic is necessary to detecting of left heart enlargement of dogs with mitral regurgitation (MR). Even in the hands of experienced clinicians, radiography is always used the thoracic radiographic as the inaccurate method for diagnosing canine. The radiographers should be considered with both respiratory phase radiographic. Clinicians should be very cautious about diagnosing congenital cardiac disease based thoracic radiographs on expiration as inspiration phase. We considered to use expiration phase radiographic also to perceive left heart enlargement with mitral regurgitation (MR) of dogs as for small animals practice and we hope that this method reflects the most common approach used in clinical practice.
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