Balloon Valvuloplasty for Treatment of Pulmonic Stenosis in English Bulldogs with an Aberrant Coronary Artery-2 Years Later

Transvalvular pulmonic stent angioplasty: procedural outcomes and complications in 15 dogs with pulmonic stenosis

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.

Novel coronary artery anomaly in a French bulldog with pulmonary stenosis

A 9-month-old French Bulldog with pulmonary stenosis (PS) underwent transthoracic echocardiography (TTE) and electrocardiogram-gated coronary computed tomography angiography (ECG-CCTA) for presurgical planning of pulmonary balloon valvuloplasty (PBV). Transthoracic echocardiography revealed severe PS and identified two distinct coronary ostia (left and right). Electrocardiogram-gated coronary computed tomography angiography showed a circumpulmonary course of the interventricular paraconal coronary artery, which abnormally originated from the right coronary artery. Based on this case report, the echocardiographic identification of two coronary ostia does not rule out a coronary artery anomaly with circumpulmonary course (as previously hypothesized), and coronary computed tomography angiography may be recommended for presurgical planning of PBV in French Bulldogs.

Transesophageal echocardiography to diagnose anomalous right coronary artery type R2A in dogs

OBJECTIVES

To assess the feasibility of transesophageal echocardiography (TEE) as an alternative to angiography for the diagnosis of R2A coronary artery (CA) abnormalities.

ANIMALS

Twenty-two dogs with a diagnosis of type R2A CA anomaly were reviewed/analyzed.

METHODS

A retrospective study of case records. Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), angiography, and follow-up investigations of pulmonic stenosis (PS) with R2A CA were carried out to compare different diagnostic methods.

RESULTS

Based on the TTE morphology, PS with an aberrant CA was suspected in all dogs (n = 22) and later confirmed by angiography in 18 cases (18/22), and necropsy in two cases (2/22). In 12 cases (12/22), TEE and angiography were both performed and confirmed the diagnosis of an R2A anomaly. Two cases (2/22) were diagnosed only with TEE.

CONCLUSIONS

Transesophageal echocardiography may be considered an effective tool to diagnose CA abnormalities, in particular when TTE is inconclusive. Transesophageal echocardiography offers detailed and easily reproducible views of coronary ostia, and the spatial relationship between the right common CA and the great arteries. Although it is not possible to define the course of the more distal coronary branches, TEE has proven reliable in recognizing those elements that can constitute a risk for the execution of a balloon valvuloplasty (BV). Therefore, TEE can be used to confirm this type of CA anomaly and prevent a BV, which is contraindicated in these cases. In addition, TEE avoids any further vascular access, radiation exposure, and contrast medium injection.