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Crofton AE, Kovacs SL, Stern JA. Subvalvular Aortic Stenosis: Learning From Human and Canine Clinical Research. Cardiol Res 2023; 14:319-333. [PMID: 37936623 PMCID: PMC10627371 DOI: 10.14740/cr1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
Subvalvular aortic stenosis (SAS) is the most common congenital heart disease (CHD) in dogs and is also prevalent in human children. A fibrous ridge below the aortic valve narrows the left ventricular outflow tract (LVOT) and increases blood flow velocity, leading to devastating side effects in diseased patients. Due to the similarities in presentation, anatomy, pathophysiology, cardiac development, genomics, and environment between humans and dogs, canine SAS patients represent a critical translational model of human SAS. Potential adverse outcomes of SAS include arrhythmias, left-sided congestive heart failure, endocarditis, exercise intolerance, syncope, and sudden cardiac death. The greatest divergence between canine and human SAS clinical research has been the standard of care regarding treatment of these outcomes, with pharmacological intervention dominating best practices in veterinary medicine and surgical intervention comprising the standard practice for human SAS patients. Regardless of the species, the field has yet to identify a treatment option to prevent disease progression or permanently remove the fibrous ridge, but historical leaps in SAS research support a continued translational approach as the most promising method for achieving this goal.
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Affiliation(s)
- Amanda E. Crofton
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
| | - Samantha L. Kovacs
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
| | - Joshua A. Stern
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
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Tjostheim SS, Showers A, Obernberger C, Shear M. Association of sotalol versus atenolol therapy with survival in dogs with severe subaortic stenosis. J Vet Cardiol 2023; 48:19-30. [PMID: 37307692 DOI: 10.1016/j.jvc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/17/2023] [Accepted: 05/04/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION/OBJECTIVES Dogs with severe subaortic stenosis (SAS) are at risk of dying suddenly from fatal arrhythmias. Survival is not improved when treated with pure beta-adrenergic receptor (β)-blockers; however, the effect of other antiarrhythmic drugs on survival is unknown. Sotalol is both a β-blocker and a class III antiarrhythmic drug; the combination of these differing mechanisms may provide benefit to dogs with severe SAS. The primary objective of this study was to compare survival in dogs with severe SAS that were treated with either sotalol or atenolol. The secondary objective was to evaluate the effect of pressure gradient (PG), age, breed, and aortic regurgitation on survival. ANIMALS Forty-three client-owned dogs. MATERIALS AND METHODS Retrospective cohort study. Medical records of dogs diagnosed with severe SAS (PG ≥ 80 mmHg) between 2003 and 2020 were reviewed. RESULTS No statistical difference was identified in survival time between dogs treated with sotalol (n = 14) and those treated with atenolol (n = 29) when evaluating all-cause mortality (p=0.172) or cardiac-related mortality (p=0.157). Of the dogs that died suddenly, survival time was significantly shorter in dogs treated with sotalol compared to those treated with atenolol (p=0.046). Multivariable analysis showed that PG (p=0.002) and treatment with sotalol (p=0.050) negatively influenced survival in the dogs that died suddenly. CONCLUSIONS Sotalol did not have a significant effect on survival overall but may increase the risk of sudden death in dogs with severe SAS compared to atenolol.
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Affiliation(s)
- S S Tjostheim
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706, USA.
| | - A Showers
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706, USA
| | - C Obernberger
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706, USA
| | - M Shear
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706, USA
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Echocardiographic and electrocardiographic effects of atenolol versus sotalol in dogs with severe subaortic stenosis. J Vet Cardiol 2022; 41:199-208. [DOI: 10.1016/j.jvc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
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Eason BD, Fine-Ferreira DM, Leeder D, Stauthammer C, Lamb K, Tobias A. Natural history of subaortic stenosis in 166 dogs (1999-2011). J Vet Cardiol 2021; 37:71-80. [PMID: 34634578 DOI: 10.1016/j.jvc.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Subaortic stenosis (SAS) is one of the most common congenital cardiac diseases in dogs. The objective of this study was to provide survival times on a large population of dogs with SAS and to propose a redefined pressure gradient (PG) scale to include a mild, moderate, severe and very severe disease group. ANIMALS, MATERIALS AND METHODS Dogs were divided into four groups based on the Doppler-derived PG across the stenosis. Disease severity was defined as follows: mild = PG < 50 mmHg; moderate = PG range 50-80 mmHg; severe = PG range 80-130 mmHg; and very severe = PG > 130 mmHg. Over the study period (1999-2011), 166 client-owned dogs were diagnosed with SAS of which 129 had follow-up information available. RESULTS Unadjusted median survival time for severity groups were as follows: mild 10.6 years; moderate 9.9 years; severe 7.3 years; and very severe 3.0 years. Univariable analysis examining the effect of the PG, age at diagnosis and sex found only the PG and age at diagnosis had a significant effect on survival. Adjusted survival curves showed that the survival time in the very severe group was decreased compared with all other groups. CONCLUSION Based on the results of this study, a revised SAS classification system with four PG groups is appropriate. Dogs with a PG > 130 mmHg were identified as those with the lowest median survival time.
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Affiliation(s)
- B D Eason
- University of Missouri, College of Veterinary Medicine, 900 E Campus Dr, Columbia, MO, 65211, USA.
| | - D M Fine-Ferreira
- University of Missouri, College of Veterinary Medicine, 900 E Campus Dr, Columbia, MO, 65211, USA
| | - D Leeder
- University of Minnesota, College of Veterinary Medicine, 1365 Gortner Ave, St Paul, MN, 55108, USA
| | - C Stauthammer
- University of Minnesota, College of Veterinary Medicine, 1365 Gortner Ave, St Paul, MN, 55108, USA
| | - K Lamb
- Lamb Statistical Consulting LLC, 404 Thompson Ave W, Saint Paul, MN, 55118, USA
| | - A Tobias
- University of Minnesota, College of Veterinary Medicine, 1365 Gortner Ave, St Paul, MN, 55108, USA
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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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Abstract
Subvalvular aortic stenosis (SAS) is one of the most common congenital heart defects of dogs. The disease is characterized by obstruction of the left ventricular outflow tract, resulting in pressure overload on the left ventricle. The etiology of obstruction is a fibromuscular nodule, ridge, or ring of tissue that increases aortic outflow tract velocity. This review is focused on the prevalence, inheritance pattern, and current genetic insights of canine SAS. The prevalence of this disease was reported at 4.7 % in a large veterinary referral hospital. The mode of inheritance for this disease has also been described in breeds with a high disease prevalence such as the Bullmastiff, Bouvier des Flandres, Dogue de Bordeaux, Golden Retriever, Newfoundland, and Rottweiler. Genetic investigations seeking to identify causative mutations for SAS are lacking with only a single published variant associated with SAS in Newfoundlands.
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Sykes KT, Gordon SG, Saunders AB, Vitt JP, O'Brien MT, Fries RC. Palliative combined cutting and high-pressure balloon valvuloplasty in six dogs with severe, symptomatic subaortic stenosis. J Vet Cardiol 2020; 31:36-50. [PMID: 32977126 DOI: 10.1016/j.jvc.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION/OBJECTIVES Severe subaortic stenosis (SAS) is a congenital heart defect in dogs that often results in clinical signs and reduced survival. The objective of this study was to describe characteristics of dogs with severe, symptomatic SAS who underwent combined cutting and high-pressure balloon valvuloplasty (CB/HPBV). ANIMALS, MATERIALS, AND METHODS Retrospective description of the clinical characteristics, CB/HPBV procedural deviations from reported methodology and outcomes in a series of six client-owned dogs with severe, symptomatic SAS. RESULTS Breeds included two each of Newfoundland, Golden retriever, and German shepherd. Median age was 10.1 months (range: 5-72.3 months), and median weight was 25.5 kg (range: 21.8-36.4 kg). Before CB/HPBV, clinical signs were present in all dogs; four were managed for congestive heart failure (CHF). Three dogs had concurrent congenital heart disease. Median Doppler-estimated left ventricular outflow tract pressure gradient was pre-operatively 149.7 mmHg (range: 89.9-254.7 mmHg) and post-operatively 134.1 mmHg (range: 83.9-181.2 mmHg). Median aortoseptal angle was steep at 136° (range: 109-143°). Clinical improvement was documented in all dogs, based on temporary discontinuation of diuretics and/or owner-perceived reduction in clinical signs. At the time of writing, three dogs had died suddenly, one was euthanized because of recurrence of clinical signs, and one died in CHF. Median survival time was 26.4 months after procedure (range: 6.3-45.8 months). One dog remained alive at 44 months after procedure. CONCLUSIONS Palliative CB/HPBV is a potential therapeutic option for dogs with severe, symptomatic SAS complicated by concurrent congenital heart disease, arrhythmias, or CHF.
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Affiliation(s)
- K T Sykes
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - S G Gordon
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - A B Saunders
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA.
| | - J P Vitt
- University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL 61802, USA
| | - M T O'Brien
- Charles River Laboratories, 15 Worman's Mill Ct Suite I, Frederick, MD 21701, USA
| | - R C Fries
- University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL 61802, USA
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Abstract
There remain areas of uncertainty in optimal technique, preferred candidates, and expected outcome for small animal patients undergoing cardiac intervention. This article highlights issues within interventional cardiology that are in need of study and offers the author's opinion and experience on topics such as variants of pulmonary valve anatomy and alternatives to conventional balloon dilation for pulmonary valve stenosis, patient selection for cutting or high-pressure balloon dilation of aortic valvar or subaortic stenosis, occlusion of patent ductus arteriosus in very small dogs, ductal stenting in conditions with reduced pulmonary blood flow, and alternative considerations for vascular access and closure.
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Shen L, Estrada A, Côté E, Powell M, Winter B, Lamb K. Aortoseptal angle and pressure gradient reduction following balloon valvuloplasty in dogs with severe subaortic stenosis. J Vet Cardiol 2017; 19:144-152. [DOI: 10.1016/j.jvc.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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Aoki T, Sunahara H, Sugimoto K, Ito T, Kanai E, Fujii Y. Peripheral pulmonary artery stenosis in three cats. J Vet Med Sci 2015; 77:487-91. [PMID: 25650057 PMCID: PMC4427753 DOI: 10.1292/jvms.14-0388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Case 1 involved a 4-month-old intact male Somali cat in which peripheral pulmonary artery
stenosis (PPS) was recognized after a cardiac murmur remained following patent ductus
arteriosus ligation. Case 2, which involved a 1-year-old neutered male Norwegian Forest
cat, and Case 3, which involved a 6-month-old intact female American Curl cat, were
referred, because of cardiac murmurs. Grades III to IV/VI systolic heart murmurs were
auscultated at the left heart base in all 3 cats. All cases showed bilateral pulmonary
artery stenosis, although there were no associated clinical signs. In Cases 1 and 2, the
pressure gradient through the stenosis decreased after treatment with atenolol.
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Affiliation(s)
- Takuma Aoki
- Laboratory of Veterinary Surgery I, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201, Japan
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Aoki T, Sunahara H, Sugimoto K, Ito T, Kanai E, Fujii Y. Infective endocarditis of the aortic valve in a Border collie dog with patent ductus arteriosus. J Vet Med Sci 2014; 77:331-6. [PMID: 25391395 PMCID: PMC4383780 DOI: 10.1292/jvms.14-0384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Infective endocarditis (IE) in dogs with cardiac shunts has not been reported previously.
However, we encountered a dog with concurrent patent ductus arteriosus (PDA) and IE. The
dog was a 1-year-old, 13.9-kg female Border collie and presented with anorexia, weight
loss, pyrexia (40.4°C) and lameness. A continuous murmur with maximal intensity over the
left heart base (Levine 5/6) was detected on auscultation. Echocardiography revealed a PDA
and severe aortic stenosis (AS) caused by aortic-valve vegetative lesions.
Corynebacterium spp. and Bacillus subtilis were
isolated from blood cultures. The dog responded to aggressive antibiotic therapy, and the
PDA was subsequently surgically corrected. After a series of treatments, the dog showed
long-term improvement in clinical status.
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Affiliation(s)
- Takuma Aoki
- Laboratory of Veterinary Surgery I, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201, Japan
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Belanger MC, Côté E, Beauchamp G. Association between aortoseptal angle in Golden Retriever puppies and subaortic stenosis in adulthood. J Vet Intern Med 2014; 28:1498-503. [PMID: 24965966 PMCID: PMC4895594 DOI: 10.1111/jvim.12390] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 04/02/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022] Open
Abstract
Background Predicting subaortic stenosis (SAS) in adult Golden Retriever dogs (GRs) by evaluating them as puppies is hampered by the progressive expression of the SAS phenotype in youth. In some children who develop SAS as adults, an abnormal aortoseptal angle (AoSA) precedes development of stenosis. Objectives To determine the normal AoSA in young adult GRs using echocardiography; to assess the value of AoSA in GR puppies for predicting development of the SAS phenotype. Animals Forty‐eight 2‐ to 6‐month‐old GR puppies. Methods Prospective study. Puppies were recruited from clients and breeders. Puppies were evaluated with a physical examination and an echocardiogram, and this evaluation was repeated when they were 12–18‐month‐old adults. Puppies were classified as unaffected (WNL) or affected (SAS) retroactively, based on their results as adults. Results In WNL young adult GRs, mean ± SD AoSA was 152.3 ± 6.5°. Mean ± SD AoSA in SAS puppies (144.9 ± 8.6°) was significantly different from mean AoSA in WNL puppies (155.7 ± 8.8°, P < .01). No puppy with AoSA >160° had the SAS phenotype as a young adult; 93% (75.7–99.1%) of puppies with AoSA <145° had the SAS phenotype as young adults. Peak LVOT velocity increased significantly between evaluations (P < .0001) whereas AoSA did not (P = .45). Conclusion and Clinical Significance A steep AoSA in GR puppies is associated with the SAS phenotype in young adulthood. Some GR puppies have an abnormal AoSA that persists in young adulthood and is detectable before peak LVOT velocity reaches levels consistent with SAS.
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Affiliation(s)
- M C Belanger
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
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Eason BD, Fine DM, Leeder D, Stauthammer C, Lamb K, Tobias AH. Influence of beta blockers on survival in dogs with severe subaortic stenosis. J Vet Intern Med 2014; 28:857-62. [PMID: 24597738 PMCID: PMC4895480 DOI: 10.1111/jvim.12339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/20/2013] [Accepted: 01/28/2014] [Indexed: 12/15/2022] Open
Abstract
Background Subaortic stenosis (SAS) is one of the most common congenital cardiac defects in dogs. Severe SAS frequently is treated with a beta adrenergic receptor blocker (beta blocker), but this approach largely is empirical. Objective To determine the influence of beta blocker treatment on survival time in dogs with severe SAS. Methods Retrospective review of medical records of dogs diagnosed with severe, uncomplicated SAS (pressure gradient [PG] ≥80 mmHg) between 1999 and 2011. Results Fifty dogs met the inclusion criteria. Twenty‐seven dogs were treated with a beta blocker and 23 received no treatment. Median age at diagnosis was significantly greater in the untreated group (1.2 versus 0.6 years, respectively; P = .03). Median PG at diagnosis did not differ between the treated and untreated groups (127 versus 121 mmHg, respectively; P = .2). Cox proportional hazards regression was used to identify the influence of PG at diagnosis, age at diagnosis, and beta blocker treatment on survival. In the all‐cause multivariate mortality analysis, only age at diagnosis (P = .02) and PG at diagnosis (P = .03) affected survival time. In the cardiac mortality analysis, only PG influenced survival time (P = .03). Treatment with a beta blocker did not influence survival time in either the all‐cause (P = .93) or cardiac‐cause (P = .97) mortality analyses. Conclusions Beta blocker treatment did not influence survival in dogs with severe SAS in our study, and a higher PG at diagnosis was associated with increased risk of death.
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Affiliation(s)
- B D Eason
- College of Veterinary Medicine, University of Missouri, Columbia, MO
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Pelosi A, Anderson LK, Paugh J, Robinson S, Eyster GE. Challenges of cardiopulmonary bypass-a review of the veterinary literature. Vet Surg 2012; 42:119-36. [PMID: 23164065 DOI: 10.1111/j.1532-950x.2012.01008.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiopulmonary bypass (CPB) has been used in veterinary medicine in experimental surgery and to address congenital and acquired diseases. We review the veterinary literature and expose common challenges of CPB in dogs and cats. Specifically, we describe the most specific elements of this technique in veterinary patients. The variety in animal size has made it difficult to standardize cannulation techniques, oxygenators, and priming volumes and solutions. The fact that one of the most common cardiovascular disorders, mitral valve disease, occurs predominantly in small dogs has limited the use of bypass in these patients because of the need for small, low prime oxygenators and pumps that have been unavailable until recently. Coagulation, hemostasis, and blood product availability have also represented important factors in the way CPB has developed over the years. The cost and the challenges in operating the bypass machine have represented substantial limitations in its broader use.
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Affiliation(s)
- Augusta Pelosi
- Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824-1314, USA.
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Kleman ME, Estrada AH, Maisenbacher HW, Prošek R, Pogue B, Shih A, Paolillo JA. How to perform combined cutting balloon and high pressure balloon valvuloplasty for dogs with subaortic stenosis. J Vet Cardiol 2012; 14:351-61. [DOI: 10.1016/j.jvc.2011.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 07/27/2011] [Accepted: 11/01/2011] [Indexed: 11/28/2022]
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Tobias AH, Stauthammer CD. Minimally invasive per-catheter occlusion and dilation procedures for congenital cardiovascular abnormalities in dogs. Vet Clin North Am Small Anim Pract 2010; 40:581-603. [PMID: 20610013 DOI: 10.1016/j.cvsm.2010.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
With ever-increasing sophistication of veterinary cardiology, minimally invasive per-catheter occlusion and dilation procedures for the treatment of various congenital cardiovascular abnormalities in dogs have become not only available, but mainstream. Much new information about minimally invasive per-catheter patent ductus arteriosus occlusion has been published and presented during the past few years. Consequently, patent ductus arteriosus occlusion is the primary focus of this article. Occlusion of other less common congenital cardiac defects is also briefly reviewed. Balloon dilation of pulmonic stenosis, as well as other congenital obstructive cardiovascular abnormalities is discussed in the latter part of the article.
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Affiliation(s)
- Anthony H Tobias
- Veterinary Clinical Sciences Department, University of Minnesota, St Paul, MN 55108, USA.
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Griffiths LG. Surgery for Cardiac Disease in Small Animals: Current Techniques. Vet Clin North Am Small Anim Pract 2010; 40:605-22. [DOI: 10.1016/j.cvsm.2010.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Congenital heart disease (CHD) is defined as a morphologic defect of the heart or associated great vessels present at birth. Abnormalities are caused by alterations or arrests in particular phases of embryonic development of the fetal heart. The term congenital does not imply that the defect was inherited, and the defect may have occurred spontaneously or secondary to a drug or toxin. By studying families of animals with specific CHDs, many defects have also been shown to be heritable.Additionally, if the defect was caused by a spontaneous de novo mutation,that individual has the potential to transmit the mutation to offspring. The diagnosis of CHD is important not only to the health of the patient but to eliminate affected individuals from the breeding pool.
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Affiliation(s)
- Kristin A MacDonald
- The Animal Care Center of Sonoma, 6470 Redwood Drive, Rohnert Park, CA 94928, USA.
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Meurs KM, Lehmkuhl LB, Bonagura JD. Survival times in dogs with severe subvalvular aortic stenosis treated with balloon valvuloplasty or atenolol. J Am Vet Med Assoc 2005; 227:420-4. [PMID: 16121608 DOI: 10.2460/javma.2005.227.420] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine survival times in dogs with severe subvalvular aortic stenosis (SAS) treated by means of balloon valvuloplasty or with atenolol, a beta-adrenoceptor blocking drug. DESIGN Prospective study. ANIMALS 38 dogs < 24 months old with severe SAS (peak systolic pressure gradient > or = 80 mm Hg). PROCEDURE 10 dogs underwent balloon valvuloplasty and were reexamined 6 weeks later to determine the feasibility of the procedure. The remaining 28 dogs were randomly assigned to undergo balloon valvuloplasty (n = 15) or to be treated with atenolol long term (13) and were reexamined annually for 9 years or until the time of death. RESULTS For the first 10 dogs, mean pressure gradient 6 weeks after balloon valvuloplasty (mean +/- SD, 119 +/- 32.6 mm Hg) was significantly decreased, compared with mean baseline pressure gradient (167 +/- 40.1 mm Hg). Median survival time for dogs that underwent balloon valvuloplasty (55 months) was not significantly different from median survival time for dogs treated with atenolol (56 months). CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that balloon valvuloplasty can result in a significant decrease in the peak systolic pressure gradient in dogs with severe SAS, at least for the short term. No clear benefit in survival times was seen for dogs that underwent balloon valvuloplasty versus dogs that were treated with atenolol.
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Affiliation(s)
- Kathryn M Meurs
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
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Freedom RM, Yoo SJ, Russell J, Perrin D, Williams WG. Thoughts about fixed subaortic stenosis in man and dog. Cardiol Young 2005; 15:186-205. [PMID: 15845164 DOI: 10.1017/s1047951105000399] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robert M Freedom
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Tornto M5G 1X8, Canada.
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Hirao H, Inoue T, Hoshi K, Kobayashi M, Shimamura S, Shimizu M, Tanaka R, Takashima K, Mori Y, Noishiki Y, Yamane Y. An Experimental Study of Apico-Aortic Valved Conduit (AAVC) for Surgical Treatment of Aortic Stenosis in Dogs. J Vet Med Sci 2005; 67:357-62. [PMID: 15876784 DOI: 10.1292/jvms.67.357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A new valved conduit was developed using a canine aortic valve. The bioprosthetic valve was fixed with glutaraldehyde and epoxy compound (Denacol-EX313/810). A vascular graft composed of ultra-fine polyester fiber (10 mm in diameter, 200 mm in length) was used. Four dogs underwent apico-aortic valved conduit (AAVC) implantation and aortic banding (bypass group, BG), while another 4 dogs underwent aortic banding without AAVC implantation (control group, CG). Cardiac catheterization and angiocardiography were performed for assessment of hemodynamics 2 weeks and 6 months after surgery. Left ventricular systolic pressure, left ventricular end-diastolic pressure and the left ventricular-aortic pressure gradient differed significantly (P<0.01) between the BG and CG dogs. Left ventricular angiocardiography showed patency of the valved conduit in all the BG dogs. Echocardiography was performed before and 2, 4 and 6 months after surgery, and showed that while pressure overload caused concentric myocardial hypertrophy in the CG dogs, the left ventricle dilated eccentrically in the BG dogs. Furthermore, relief of left ventricular pressure overload by AAVC was maintained.
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Affiliation(s)
- Hidehiro Hirao
- Department of Veterinary Surgery, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Japan
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Nelson DA, Fossum TW, Gordon S, Miller MW, Felger MC, Mertens MM, McMichael M, Nelson KT, Pahl G. Surgical correction of subaortic stenosis via right ventriculotomy and septal resection in a dog. J Am Vet Med Assoc 2004; 225:705-8, 698. [PMID: 15457663 DOI: 10.2460/javma.2004.225.705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
After 2 years of medical management with a beta-adrenoreceptor blocking agent, a 30-month-old castrated male Golden Retriever with subaortic stenosis was treated surgically because of progression of its condition. In an attempt to achieve complete relief of the left ventricular outflow obstruction, a modified Konno procedure consisting of right ventriculotomy and septal myectomy from the infundibular portion of the right ventricle was performed; this combination of procedures allowed wide resection of the septal portion of the left ventricular outflow obstruction. Two years after surgery, the mass of the dog's left ventricle had decreased and the peak calculated pressure gradient across the aortic valve had decreased to 40 mm Hg, compared with a preoperative value of 240 mm Hg; at that evaluation, the dog had gained weight and was able to play normally. It is suggested that use of this modified approach to the outflow tract may have a positive effect on long-term survival time in dogs with subaortic stenosis.
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Affiliation(s)
- David A Nelson
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843-4474, USA
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Hirao H, Hoshi K, Kobayashi M, Shimizu M, Shimamura S, Tanaka R, Machida N, Maruo K, Yamane Y. Surgical Correction of Subvalvular Aortic Stenosis Using Cardiopulmonary Bypass in a Dog. J Vet Med Sci 2004; 66:559-62. [PMID: 15187370 DOI: 10.1292/jvms.66.559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A three-month-old male Golden Retriever had symptoms including exercise intolerance, dyspnea and syncope and was diagnosed with subvalvular aortic stenosis. Cardiac catheterization revealed a left ventricular-aortic systolic pressure gradient of 90 mm Hg. Surgical correction of the condition was achieved using cardiopulmonary bypass. The subvalvular fibrous lesion was resected through an aortotomy. The stenosis was dilated from 8.5 mm to 12.0 mm in diameter. Postoperatively the dog was asymptomatic. Seven months after surgery, the pressure gradient decreased to 44 mm Hg. However, after another three months, the dog died suddenly without any premonitory signs. Postmortem examination revealed that pathologic changes caused by increased left ventricular pressure overload were not severe.
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Affiliation(s)
- Hidehiro Hirao
- Department of Veterinary Surgery, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
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Abstract
OBJECTIVE To assess the physiologic response to, and acute survival of, cats undergoing cardiopulmonary bypass (CPB) and to evaluate the efficacy of a commercial human pediatric oxygenator system on cats weighing less than 6 kg. STUDY DESIGN Experimental study. ANIMALS Six intact male cats METHODS Cats were placed on cardiopulmonary bypass by cannulating the cranial and caudal vena cavae and the carotid artery. The pediatric CPB circuit was primed with 150 mL of a balanced crystalloid solution. Venous drainage was enhanced by a controlled, vacuum-assist system. A cross-clamp was placed on the ascending aorta and cardiac arrest was induced by antegrade infusion of a cold cardioplegia solution. After 45 minutes of arrest time, the cross-clamp was removed and the cats were weaned off bypass and decannulated. No blood products were administered. Heart rate, mean arterial pressure (MAP), central venous pressure, arterial blood gas, hematocrit (HCT), total plasma protein concentration (TP), serum electrolyte concentrations, and activated clotting time (ACT) were measured at baseline period (BL), during CPB, 60 minutes after CPB (CPB 60) and 90 minutes after CPB (CPB 90). A complete blood count (CBC), blood chemistry profile, and urinalysis were performed at BL, during CPB, and CPB 90. Cats were euthanatized after CPB 90. RESULTS Cardiopulmonary bypass resulted in a significant (P <.05) decrease in mean HCT (18.0%) and TP (2.3 gm/dL) at CPB 90 when compared to BL (30.5% and 6.0 gm/dL, respectively). The MAP at CPB 90 (54 mm Hg) was decreased from BL (94 mm Hg). The ACT increased from a mean of 124 seconds to > 400 seconds with heparinization and was reversed to 300 seconds with protamine. Mean platelet counts decreased from BL (369,000 /microL) to CPB 90 (94,500 /microL). Mean white blood cell counts decreased from 13,200 /microL at BL to 2,200 /microL at CPB 90. Upon reperfusion, 1 cat fibrillated but was successfully defibrillated. CONCLUSIONS Cardiopulmonary bypass was performed successfully in 6 cats weighing less than 6 kg. Acute survival to 90 minutes after CPB was achieved in all 6 cats CLINICAL RELEVANCE The ability to perform CPB in the cat may allow intracardiac repair of various heart defects in this species.
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Affiliation(s)
- Jeff D Brourman
- Ohio State University College of Veterinary Medicine, Columbus, OH, USA
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