Publications by authors named "Laurencie Brunel"

14 Publications

  • Page 1 of 1

Intracardiac Echocardiography for Point-of-Care Guided Left Ventricular Assist Device Implantation: Surgical Implications for COVID-19.

Surg Innov 2021 Aug 8:15533506211037787. Epub 2021 Aug 8.

Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, NSW, Australia.

Data from animal models is now available to initiate assessment of human safety and feasibility of wide-angle three-dimensional intracardiac echocardiography (3D ICE) to guide point-of-care implantation of percutaneous left ventricular assist devices in critical care settings. Assessment of these combined new technologies could be best achieved within a surgical institution with pre-existing expertise in separate utilization of ICE and Impella.
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http://dx.doi.org/10.1177/15533506211037787DOI Listing
August 2021

Peripartum clinical manifestations of a mesentericorenocaval shunt in a Burmese cat.

JFMS Open Rep 2020 Jul-Dec;6(2):2055116920961369. Epub 2020 Sep 28.

University Veterinary Teaching Hospital Sydney, School of Veterinary Science, University of Sydney, Camperdown, NSW, Australia.

Case Summary: A 3-year-old entire female Burmese cat was presented for investigation of intermittent lethargy during gestation followed by persistent hypersalivation and ataxia postpartum. The cat had queened three litters in total, with clinical signs worsening during the most recent lactation period. Mild anaemia (26%), hypoglycaemia (2.4 mmol/l; reference interval [RI] 3.9-8.3 mmol/l) and increased postprandial serum bile acids (74 µmol/l; RI <25 µmol/l) were identified on initial bloodwork. Multiphase contrast-enhanced CT identified a mesentericorenocaval portosystemic shunt; this was attenuated surgically with an ameroid constrictor. Clinical signs resolved after surgery. Follow-up 3 months postoperatively revealed normal pre- and postprandial serum bile acids (2 µmol/l and 3 µmol/l, respectively) with repeat CT identifying evidence of shunt attenuation. The cat continued to be healthy and free of clinical signs 12 months postoperatively.

Relevance And Novel Information: Mesentericorenocaval portosystemic shunt morphology has not been previously reported in the cat and should be considered as a differential diagnosis for cats presenting with peripartum onset of malaise, ptyalism or ataxia.
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http://dx.doi.org/10.1177/2055116920961369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536498PMC
September 2020

Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography.

Sci Rep 2020 10 15;10(1):17485. Epub 2020 Oct 15.

Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, Australia.

Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.
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http://dx.doi.org/10.1038/s41598-020-74220-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562902PMC
October 2020

Comparison of dynamic changes in stressed intravascular volume, mean systemic filling pressure and cardiovascular compliance: Pilot investigation and study protocol.

PLoS One 2020 28;15(8):e0238045. Epub 2020 Aug 28.

DVC Research, University of Sydney, Sydney, Australia.

The mean systemic filling pressure (MSFP) represents an interaction between intravascular volume and global cardiovascular compliance (GCC). Intravascular volume expansion using fluid resuscitation is the most frequent intervention in intensive care and emergency medicine for patients in shock and with haemodynamic compromise. The relationship between dynamic changes in MSFP, GCC and left ventricular compliance is unknown. We conducted prospective interventional pilot study following euthanasia in post cardiotomy adult sheep, investigating the relationships between changes in MSFP induced by rapid intravascular filling with fluids, global cardiovascular compliance and left ventricular compliance. This pilot investigation suggested a robust correlation between a gradual increase in the intravascular stressed volume from 0 to 40 ml/kg and the MSFP r = 0.708 95% CI 0.435 to 0.862, making feasible future prospective interventional studies. Based on the statistical modelling from the pilot results, we expect to identify a strong correlation of 0.71 ± 0.1 (95% CI) between the MSFP and the stressed intravascular volume in a future study.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238045PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454998PMC
October 2020

Three-dimensional intracardiac echocardiography and pulmonary embolism.

Cardiovasc Ultrasound 2020 Aug 20;18(1):36. Epub 2020 Aug 20.

Sydney Core Research Facility, University of Sydney, Hybrid Theatre, Charles Perkins Building, Johns Hopkins Dr, Camperdown, Sydney, NSW, 2006, Australia.

Background: Three-dimensional intracardiac echocardiography (3D ICE) with wide azimuthal elevation is a novel technique performed for assessment of cardiac anatomy and guidance of intracardiac procedures, being able to provide unique views with good spatial and temporal resolution. Complications arising from this invasive procedure and the value of 3D ICE in the detection and diagnosis of acute cardiovascular pathology are not comprehensively described. This case illustrates a previously unreported iatrogenic complication of clot displacement from the intra-vascular sheath upon insertion of a 3D ICE catheter and the value of 3D ICE in immediate diagnosis of clot in transit through the heart with pulmonary embolism.

Case Presentation: We conducted a translational study of 3D ICE with wide azimuthal elevation to guide implantation of a left ventricular assist device (Impella CP®) in eight adult sheep. A large-bore 14 Fr central venous sheath was used to enable right atrial and right ventricular access for the intracardiac catheter. Insertion of the 3D ICE catheter was accompanied by a sudden severe cardiorespiratory deterioration in one animal. 3D ICE revealed a large highly mobile mass within the right heart chambers, determined to be a clot-in-transit. The diagnosis of pulmonary clot embolism resulting from the retrograde blood entry into the large-bore sheath introducer, rapid clot formation and consequent displacement into venous circulation by the ICE catheter was made. The sheep survived this life-threatening event following institution of cardiovascular support allowing completion of the primary research protocol.

Conclusion: This report serves as a serious warning to the researchers and clinicians utilizing long large-bore sheath introducers for 3D ICE and illustrates the value of 3D ICE in detecting clot-in-transit within right heart chambers.
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http://dx.doi.org/10.1186/s12947-020-00220-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441699PMC
August 2020

Colonic malignant peripheral nerve sheath tumour in a cat.

JFMS Open Rep 2019 Jan-Jun;5(1):2055116919849979. Epub 2019 May 28.

Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia.

Case Summary: A 14-year-old male neutered domestic mediumhair cat presented with a 4 month history of inappetence and weight loss. Pertinent abnormalities on haematology and biochemistry included a mild microcytic regenerative anaemia (packed cell volume [PCV] 24% [reference interval (RI) 30-45%], mean cell volume 30.8 fl [RI 40-45 fl], absolute reticulocyte count 326.8 × 10) and increased alkaline phosphatase activity (76 IU/l; RI <50 IU/l). Abdominal ultrasound and CT scan revealed masses in the transverse colon (2.0 cm × 1.2 cm) and right medial liver lobe (5.0 cm diameter). Thoracic radiographs were unremarkable. Right medial liver lobe resection and colectomy were performed. Immunohistochemistry was positive for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly positive for c-kit and negative for muscle-specific actin and CD18, consistent with a colonic malignant peripheral nerve sheath tumour (MPNST) with a hepatic metastasis. Postoperative treatment with metronomic cyclophosphamide was well tolerated. Eighteen months postoperatively the cat re-presented after 3 days of progressive lethargy and inappetence. Haematology revealed a marked non- or pre-regenerative anaemia (PCV 10%). Coagulation times were prolonged (prothrombin time 39 s [RI 15-22 s] and activated partial thromboplastin time >300 s [RI 65-119 s]). Abdominal ultrasound identified multiple renal and hepatic nodules. Euthanasia was performed and post-mortem examination confirmed metastasis of the MPNST.

Relevance And Novel Information: This report describes the treatment of a metastatic colonic peripheral nerve sheath tumour in a cat. Feline visceral MPNSTs are rare and little is known about prognosis or optimal treatment.
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http://dx.doi.org/10.1177/2055116919849979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572897PMC
May 2019

Acute adrenal haemorrhage in two cats with aldosterone-secreting adenocarcinomas.

JFMS Open Rep 2019 Jan-Jun;5(1):2055116919840828. Epub 2019 Apr 3.

Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia.

Case Summary: Two 13-year-old domestic shorthair cats were diagnosed with unilateral right adrenocortical carcinomas (ACCs) and primary hyperaldosteronism (PHA). Both had polyuria, polydipsia and weight loss, and developed severe anaemia from an episode of acute adrenal haemorrhage. In one case, this occurred during hospitalisation and treatment of severe muscle weakness with cervical ventroflexion, while the other cat had acute collapse at home. A diagnosis of PHA was confirmed in both cases based on measurement of plasma aldosterone and renin activity. In one case, basal progesterone was also measured and was elevated. On ultrasonography and CT in one case, haemorrhage into the right retroperitoneal space was identified. Unilateral adrenalectomy was performed in both cases and there was no evidence of venous tumoral invasion in either. On histopathology of the excised adrenal glands both were ACCs with tumour necrosis, and one had extensive intratumoral haemorrhage. Both cats were diagnosed with International Renal Interest Society stage 2 or 3 chronic kidney disease postoperatively; one survived for 18 months and the other was well 8 months postoperatively.

Relevance And Novel Information: Acute adrenal haemorrhage secondary to adrenal neoplasia has been reported in only one other cat, in which tumour type and function were not specified. Acute adrenal haemorrhage can occur as a consequence of tumour necrosis and rupture and can cause severe hypovolaemia and anaemia in cats with primary hyperaldosteronism.
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http://dx.doi.org/10.1177/2055116919840828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6449812PMC
April 2019

Development of a Customized Interbody Fusion Device for Treatment of Canine Disc-Associated Cervical Spondylomyelopathy.

Vet Comp Orthop Traumatol 2019 Jan 15;32(1):79-86. Epub 2019 Jan 15.

Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia.

Objectives:  The main purpose of this study was to design, manufacture and implant a customized three-dimensional (3D) printed, intervertebral spacer to treat disc-associated cervical spondylomyelopathy (DACSM) in dogs. This study also used advanced imaging to assess implant movement, subsidence and interbody fusion.

Animals:  Two client-owned dogs with DACSM.

Method:  Customized interbody devices were designed and 3D printed in titanium alloy. The devices were implanted in dogs diagnosed with DACSM. The dogs were evaluated at time points 0, 2 and 6 months to determine clinical outcome, degree of interbody fusion, implant migration and subsidence.

Results:  Progressive fusion was noted across the affected intervertebral space by 6 months. Implants mildly shifted cranially in the 2-month interim. There was no subsidence of the intervertebral device through the vertebral end plates in dog 1 and minimal in dog 2 (∼0.5 mm). Clinically, the neurological status improved in both dogs.

Conclusions:  The customized interbody devices restored the intervertebral space and resulted in a degree of interbody fusion and resolution of clinical signs.

Clinical Significance:  This report illustrates preliminary outcomes of DACSM treated with a customized, end plate conforming, intervertebral device. Collaboration between clinicians and engineers with advanced manufacturing technologies can provide a cutting-edge standard of care for patients suffering from DACSM.
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http://dx.doi.org/10.1055/s-0038-1676075DOI Listing
January 2019

Consequences and Management of Canine Brachycephaly in Veterinary Practice: Perspectives from Australian Veterinarians and Veterinary Specialists.

Animals (Basel) 2018 Dec 21;9(1). Epub 2018 Dec 21.

Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.

This article, written by veterinarians whose caseloads include brachycephalic dogs, argues that there is now widespread evidence documenting a link between extreme brachycephalic phenotypes and chronic disease, which compromises canine welfare. This paper is divided into nine sections exploring the breadth of the impact of brachycephaly on the incidence of disease, as indicated by pet insurance claims data from an Australian pet insurance provider, the stabilization of respiratory distress associated with brachycephalic obstructive airway syndrome (BOAS), challenges associated with sedation and the anaesthesia of patients with BOAS; effects of brachycephaly on the brain and associated neurological conditions, dermatological conditions associated with brachycephalic breeds, and other conditions, including ophthalmic and orthopedic conditions, and behavioural consequences of brachycephaly. In the light of this information, we discuss the ethical challenges that are associated with brachycephalic breeds, and the role of the veterinarian. In summary, dogs with BOAS do not enjoy freedom from discomfort, nor freedom from pain, injury, and disease, and they do not enjoy the freedom to express normal behaviour. According to both deontological and utilitarian ethical frameworks, the breeding of dogs with BOAS cannot be justified, and further, cannot be recommended, and indeed, should be discouraged by veterinarians.
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http://dx.doi.org/10.3390/ani9010003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356869PMC
December 2018

Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation.

Vet Surg 2019 Jan 17;48(1):42-49. Epub 2018 Nov 17.

Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia.

Objective: To compare mechanisms of and pressures at failure of 4 methods of securing 2 types of cellophane bands around a vein.

Study Design: Ex vivo mechanical evaluation.

Methods: Cellophane bands composed of 3 or 4 layers were applied around a cadaveric external jugular vein (EJV) to create 25% or 50% attenuation. These bands were secured with a medium or medium-large polymer locking ligation clip (PLLC), or a medium or medium-large titanium ligation clip (TLC). Sterile saline 0.9% was instilled into the lumen of the EJV until a pressure of 100 mm Hg was reached. Failure mechanism and luminal pressure at failure were compared between groups.

Results: Medium clips failed less often than medium-large clips (P < .001) and consistently sustained 100 mm Hg without failing. Three-layer cellophane bands were 4.1 times more likely to fail than 4-layer bands (P = .003, CI 1.6-10.2) and failed at lower pressures (28.32 ± 3.59 mm Hg and 44.81 ± 6.51 mm Hg, respectively, P = .027). Failure rates of the cellophane band constructs did not differ whether secured with PLLC or with TLC (P = .635) or with 25% vs 50% attenuation (P = .780).

Conclusion: A single medium clip withstood physiological forces and secured a cellophane band at up to 50% attenuation. A 3-layer cellophane band was more likely to fail compared with a 4-layer cellophane band.

Clinical Significance: These ex vivo results provide evidence to support the application of a 4-layer cellophane band secured with a single medium PLLC or TLC for portosystemic shunt attenuation. A single medium PLLC should be used to eliminate computed tomography artifacts during postoperative evaluation of shunt closure.
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http://dx.doi.org/10.1111/vsu.13125DOI Listing
January 2019

Recanalisation of a congenital extrahepatic portosystemic shunt previously attenuated with cellophane banding in a cat.

JFMS Open Rep 2018 Jul-Dec;4(2):2055116918795717. Epub 2018 Aug 29.

University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia.

Case Summary: A congenital extrahepatic portosystemic shunt was attenuated with commercial roll cellophane banding in a cat and postoperative liver changes were monitored using CT angiography (CTA). The patient clinically improved after cellophane banding, characterised by resolution of hepatic encephalopathy, weight gain, reference interval (RI) bile acid stimulation tests, as well as CTA-documented increased liver size, increased hepatic vasculature and shunt attenuation. Six months later the cat re-presented with recurrence of clinical signs and increased bile acids. CTA confirmed recanalisation of the shunt. Shunt attenuation was repeated using pure cellophane banding and nearly complete closure of the shunt was later documented by CTA. Seven months later, recanalisation was again documented via CTA and associated with clinical signs and increased bile acids. Complete ligation of the shunt was achieved using a polypropylene ligature and a titanium ligating clip. At long-term follow-up, the cat was clinically well, and bile acids and biochemistry were within the RIs.

Relevance And Novel Information: This is the first report of CTA-documented recanalisation of an extrahepatic portosystemic shunt previously attenuated with cellophane banding. Recanalisation should be considered as a differential for recurrence of hepatic encephalopathy following cellophane banding.
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http://dx.doi.org/10.1177/2055116918795717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117867PMC
August 2018

An emergency airway management system to improve fresh gas delivery in a dog undergoing tracheal resection.

Vet Anaesth Analg 2018 03 7;45(2):234-235. Epub 2017 Nov 7.

Department of Small Animal Surgery, Veterinary Teaching Hospital, University of Sydney, Sydney, Australia.

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http://dx.doi.org/10.1016/j.vaa.2017.09.041DOI Listing
March 2018

Caecocolic intussusception associated with a caecal polyp and concurrent hepatocellular carcinoma in a cat.

JFMS Open Rep 2017 Jan-Jun;3(1):2055116917706652. Epub 2017 May 4.

Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia.

Case Summary: A 17-year-old female neutered domestic shorthair cat presented for several days of reduced faecal volume and a rectal prolapse. Physical examination revealed a 2 cm rectal prolapse, hepatomegaly and a low body condition score of 3/9. Haematology and biochemistry revealed a mild non-regenerative anaemia (haematocrit 24.5%; reference interval [RI] 30.3-52.3%), a mild mature neutrophilia (16.21 × 10/l; RI 1.48-10.29 × 10/l) and a mild increase in alanine aminotransferase activity (222 IU/l; RI 12-130 IU/l). Abdominal radiographs identified hepatomegaly. The rectal prolapse was reduced under general anaesthesia. Abdominal ultrasound identified a caecocolic intussusception and a large hepatic mass. Thoracic radiographs were unremarkable. Hepatic fine-needle aspirate cytology revealed well-differentiated hepatocytes. A typhlectomy was performed and the quadrate liver lobe, with mass, was resected. Gross examination of the caecum identified a focal polyp; histopathology showed moderate plasmacytic-lymphocytic typhlitis and reactive mucosal-associated lymphoid tissue. The hepatic mass was diagnosed as a well-differentiated hepatocellular carcinoma. Six weeks postoperatively the cat had gained 0.5 kg, had an improved body condition score of 5/9 and resolution of clinical signs. The cat died acutely 1 year later from an unknown cause.

Relevance And Novel Information: Caecocolic intussusception is rare in cats and uncommon in dogs. This is the third report in a cat and the first associated with a caecal polyp. As reported in dogs, the outcome following surgery was good. Hepatocellular carcinoma is a rarely reported feline neoplasm, which may have a good prognosis with surgical resection.
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http://dx.doi.org/10.1177/2055116917706652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423586PMC
May 2017
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