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Terrade G, Borenstein N, Chetboul V, Toma C, Guillaume E, Bruneval P, Fiette L, Carazo Arias LE, Morlet A, Le Dudal M. First reported long-term two- and three-dimensional echocardiographic follow-up with histopathological analysis of a transcatheter pulmonary valve implantation in a pet dog. J Vet Cardiol 2024; 53:52-59. [PMID: 38688090 DOI: 10.1016/j.jvc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
Transcatheter pulmonary valve implantation (TPVI) is indicated for use in the management of failing pulmonary valves in humans. We report here the long-term follow-up of the first documented transcatheter pulmonary valve implanted in a client-owned dog. A one-year-old Beagle dog with severe congenital type A valvular pulmonic stenosis first underwent percutaneous balloon pulmonary valvuloplasty, leading two years later to severe pulmonary regurgitation. A TPVI using a Melody™ bioprosthetic valve was then successfully performed, with normalization of the right heart cavities. Repeated two- and three-dimensional transthoracic echocardiographic examinations combined with Doppler modes confirmed the appropriate position and function of the valve for four years. Mitral myxomatous valvular degeneration led to refractory left-sided congestive heart failure, and the dog was humanely euthanized. After postmortem examination, X-ray imaging and histopathological evaluation of the stent and the valve were performed. Ex-vivo imaging of the implanted valve using a Faxitron® Path radiography system and microscopic evaluation of the implanted stent and bioprosthetic leaflets did not show any relevant leaflet or stent alterations. This case provides a proof of concept in interventional veterinary cardiology, showing that TPVI can be performed in dogs with subsequent long-term maintaining normal pulmonary valve function.
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Affiliation(s)
- G Terrade
- Veranex Preclinical Services, 42 Bd Jourdan, 75014 Paris, France; Ecole Nationale Vétérinaire d'Alfort, Unité d'Histologie et d'Anatomie-Pathologique, Biopôle Alfort, 7 Av. du Général de Gaulle, 94700 Maisons-Alfort, France
| | - N Borenstein
- Veranex Preclinical Services, 42 Bd Jourdan, 75014 Paris, France.
| | - V Chetboul
- Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), 7 Av. du Général de Gaulle, 94700 Maisons-Alfort, France; U955, Equipe 03, INSERM (Institut National de la santé et de la recherche médicale), 8 rue du Général Sarrail, 94010 Créteil, France
| | - C Toma
- Veranex Preclinical Services, 42 Bd Jourdan, 75014 Paris, France
| | - E Guillaume
- Veranex Preclinical Services, 42 Bd Jourdan, 75014 Paris, France
| | - P Bruneval
- Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Department of Pathology, 20 Rue Leblanc, 75015 Paris, France
| | - L Fiette
- Veranex Preclinical Services, 42 Bd Jourdan, 75014 Paris, France
| | - L E Carazo Arias
- Veranex Preclinical Services, 42 Bd Jourdan, 75014 Paris, France
| | - A Morlet
- Veranex Preclinical Services, 42 Bd Jourdan, 75014 Paris, France
| | - M Le Dudal
- Ecole Nationale Vétérinaire d'Alfort, Unité d'Histologie et d'Anatomie-Pathologique, Biopôle Alfort, 7 Av. du Général de Gaulle, 94700 Maisons-Alfort, France
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Cambruzzi M, Borgeat K, MacFarlane P. Anaesthetic management of a dog with severe pulmonary stenosis and R2A right coronary artery anomaly undergoing placement of a hybrid transventricular pulmonary stent. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Martina Cambruzzi
- Small Animal Hospital Langford Vets University of Bristol Langford UK
| | - Kieran Borgeat
- Small Animal Hospital Langford Vets University of Bristol Langford UK
| | - Paul MacFarlane
- Small Animal Hospital Langford Vets University of Bristol Langford UK
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Transvalvular pulmonic stent angioplasty: procedural outcomes and complications in 15 dogs with pulmonic stenosis. J Vet Cardiol 2021; 38:1-11. [PMID: 34653742 DOI: 10.1016/j.jvc.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Balloon valvuloplasty is the treatment of choice for dogs with severe type A pulmonic stenosis (PS), but less successful for dogs with annular hypoplasia and unsuitable for supravalvular stenosis or cases with a circumpulmonary coronary malformation. We report outcomes and complications of the first 15 consecutive transvalvular pulmonic stent angioplasty procedures performed by a single center in dogs with PS. ANIMALS Fifteen dogs with naturally occurring PS were included in the study. MATERIALS AND METHODS Dogs underwent echocardiography before and four weeks after the procedure. Transvenous approaches were used to deploy a pre-mounted, balloon-expandable metallic stent in all cases. RESULTS Of 15 dogs, all had annular hypoplasia, and in addition, supravalvular stenosis was diagnosed in 11 of 15 dogs, and three had R2A coronary malformation. All dogs survived to discharge. One dog died less than four weeks postoperatively (non-cardiac), but 14 of 15 dogs were re-examined at four weeks. Severity reduced in all cases; median pressure gradient reduced from 137 mmHg (range 81-202 mmHg) to 83 mmHg (range 31-155 mmHg). Clinical signs improved in all cases, and hematocrit reduced in all dogs with erythrocytosis. The median follow-up time was 280 days (range 95-896 days). Over one-year follow-up was available in six of fifteen dogs. Two dogs died because of refractory right-sided congestive heart failure signs: one at 10 months and one at 22 months postoperatively. CONCLUSIONS Transvalvular pulmonic stent angioplasty technique was associated with an improvement in clinical signs and reduction in stenosis severity for all dogs in this population, including cases with supravalvular PS or circumpulmonary coronary malformation.
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Saunders AB. Key considerations in the approach to congenital heart disease in dogs and cats. J Small Anim Pract 2021; 62:613-623. [PMID: 34180062 DOI: 10.1111/jsap.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/12/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
Congenital heart disease is an important subset of all cardiovascular disease in dogs and cats that is present at birth and most often detected in young animals but can be diagnosed in adulthood. The range of abnormalities that can occur during development of the heart is vast incorporating simple and complex defects, varying degrees of severity and clinical presentations that include heart failure and cyanosis. While some defects do not result in morbidity in an individual animal, others cause severe clinical signs and death at a young age. Advances in imaging and expanding treatment options offer increasingly more possibilities in the diagnosis and management of congenital heart disease which is the focus of this review. The objective is to provide a broad overview of current practice and highlight key aspects to guide practitioners in their approach to congenital heart disease diagnosis and knowledge of available treatment options.
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Affiliation(s)
- A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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A novel hybrid stent technique to treat canine pulmonic stenosis. J Vet Cardiol 2020; 32:1-6. [PMID: 33031996 DOI: 10.1016/j.jvc.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022]
Abstract
Balloon valvuloplasty is routinely performed in dogs with severe pulmonic stenosis using a transvenous approach. We report a novel transventricular approach to stent the right ventricular outflow tract. An 18-month old Havanese with frequent syncope was referred with a diagnosis of severe valvular pulmonic stenosis. Transvenous approaches were unsuccessful; therefore, two Palmaz XL 29 mm by 12 mm transhepatic biliary stents were deployed across the valve using a direct right ventricular approach. The echocardiographically derived systolic pressure gradient decreased from 133 mmHg to 39 mmHg with resolution of clinical signs. The patient continues to do well after 3 years with occasional syncope when extremely excited despite pressure gradient increases to 130 mmHg at 12 months and 174 mmHg at 22 months.
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Transpulmonary Stent Implantation for Dysplastic Pulmonary Valve Stenosis with a Single Left Coronary Ostium and Anomalous Prepulmonary Right Coronary Artery in an English Bulldog. ACTA ACUST UNITED AC 2020; 4:540-545. [PMID: 33376850 PMCID: PMC7756185 DOI: 10.1016/j.case.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Coronary artery anomalies may exist with congenital PS. PS occurs in both animals and humans. Transpulmonary stenting may be considered in dogs with PS and coronary anomalies.
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Patata V, Scalise F, Sorropago G, Marchesotti F, Nicoli S, Auriemma E, Rondelli V, Pesaresi M, Glaus TM, Baron Toaldo M, Vezzosi T, Domenech O. Closure of an unusual morphology patent ductus arteriosus with a covered stent in a dog. J Vet Cardiol 2020; 32:7-15. [PMID: 33039928 DOI: 10.1016/j.jvc.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 07/01/2020] [Accepted: 09/02/2020] [Indexed: 02/02/2023]
Abstract
Patent ductus arteriosus (PDA) with unusual morphology was diagnosed in a 3-year-old German shepherd presented for exercise intolerance. Two interventional PDA closure procedures with various Amplatzer devices and one surgical ligation were attempted to close the PDA. However, PDA closure failed with both methods due to the unusual morphology and the severe enlarged ductus ampulla. Therefore, the patient underwent an aortic covered stent placement, and successful closure of the PDA was achieved. Eight months after the procedure, the dog was free of clinical signs and no residual flow was identified through the PDA on transthoracic echocardiography. Moreover, computed tomography angiography demonstrated correct stent positioning, with no evidence of thrombus formation, damage to the stent, nor any aortic wall abnormalities. Aortic covered stent placement is a viable option in dogs with unusual PDA morphology.
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Affiliation(s)
- V Patata
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy.
| | - F Scalise
- Department of Interventional Cardiology, Policlinico di Monza, via Carlo Amati, 111, 20900, Monza, Italy
| | - G Sorropago
- Department of Interventional Cardiology, Policlinico di Monza, via Carlo Amati, 111, 20900, Monza, Italy
| | - F Marchesotti
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy
| | - S Nicoli
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy
| | - E Auriemma
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy
| | - V Rondelli
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy
| | - M Pesaresi
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy
| | - T M Glaus
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zürich, Winterthurerstrasse 260, CH-8057, Zürich, Switzerland
| | - M Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano Emilia, Italy
| | - T Vezzosi
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy; Department of Veterinary Medicine, University of Pisa, Viale delle Piagge, 1, 56124, Pisa, Italy
| | - O Domenech
- Istituto Veterinario di Novara, strada provinciale, 9, 28060, Granozzo con Monticello, Novara, Italy
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Markovic LE, Scansen BA. A pilot study evaluating cutting and high-pressure balloon valvuloplasty for dysplastic pulmonary valve stenosis in 7 dogs. J Vet Cardiol 2019; 25:61-73. [PMID: 31675525 DOI: 10.1016/j.jvc.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/27/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This case series describes early experience and technical aspects of cutting balloon dilation followed by high-pressure balloon pulmonary valvuloplasty in dogs with dysplastic pulmonary valve stenosis. ANIMALS Seven client-owned dogs were enrolled in this study. METHODS Dogs were prospectively enrolled based on echocardiographic diagnosis of severe pulmonary valve dysplasia, defined as marked valve thickening with variable degrees of annular hypoplasia or subvalvar fibrous obstruction and a peak echocardiography-derived transpulmonary pressure gradient higher than 100 mmHg. Preinterventional and postinterventional hemodynamic data and transthoracic pressure gradients were obtained for all dogs. Recheck echocardiography varied in timing by client convenience, with maximum follow-up 35 months after intervention. RESULTS No intraprocedural or periprocedural mortality was observed. The only major complication was partial avulsion of a cutting blade related to exceeding recommended burst pressure of the device, which was not associated with obvious clinical consequence. Invasive hemodynamic measurements demonstrated an average reduction of 46% in peak systolic right ventricular-to-pulmonary artery pressure gradient (range, 31-77%). The echocardiographic results 24 h after procedure demonstrated an average reduction in pressure gradient of 43% (range, 20-66%), with late follow-up demonstrating an average reduction of 35% (range, 10-57%) compared with preprocedural echocardiography. CONCLUSIONS This procedure is a feasible therapeutic transcatheter intervention for dogs with dysplastic pulmonary valves and appears safe in this small cohort. The ideal selection criteria and rate of restenosis for this procedure is under investigation, and long-term follow-up and a large, randomized, controlled study are necessary to demonstrate efficacy.
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Affiliation(s)
- L E Markovic
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO, 80523-1678, USA
| | - B A Scansen
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO, 80523-1678, USA.
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Rohrbaugh M, Schober KE, Bonagura JD, Cheatham S, Rhinehart J, Berman D. Treatment of caudal cavoatrial junction obstruction in a dog with a balloon-expandable biliary stent. J Vet Cardiol 2019; 23:112-121. [PMID: 31174721 DOI: 10.1016/j.jvc.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022]
Abstract
A 2-year-old intact female mixed breed dog was presented for ascites. Echocardiography demonstrated severe obstruction at the level of the caudal right atrium. Initially, a variant of cor triatriatum dexter was diagnosed, and balloon catheter dilation was performed. However, ascites recurred within a week. Further imaging revealed an obstruction at the entrance of the caudal vena cava into the right atrium rather than a dividing membrane in the right atrium. The diagnosis was revised to suprahepatic obstruction of the caudal vena cava because of remnant Eustachian valve tissue. Deployment of a balloon-expandable biliary stent was performed relieving the obstruction. Fifteen months after stent deployment, the patient is doing well without reaccumulation of ascitic fluid.
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Affiliation(s)
- M Rohrbaugh
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 601 Vernon L Tharp St., Columbus, OH 43210, USA
| | - K E Schober
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 601 Vernon L Tharp St., Columbus, OH 43210, USA.
| | - J D Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 601 Vernon L Tharp St., Columbus, OH 43210, USA
| | - S Cheatham
- The Heart Center, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - J Rhinehart
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 601 Vernon L Tharp St., Columbus, OH 43210, USA
| | - D Berman
- The Heart Center, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
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Sosa I, Swift S, Jones A, Estrada A, Fudge J. Stent angioplasty for treatment of canine valvular pulmonic stenosis. J Vet Cardiol 2019; 21:41-48. [DOI: 10.1016/j.jvc.2018.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 11/27/2022]
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Stent placement for palliation of cor triatriatum dexter in a dog with suspected patent foramen ovale. J Vet Cardiol 2016; 18:79-87. [DOI: 10.1016/j.jvc.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 11/22/2022]
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