Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis

A 3-month-old, 9.9 kg, male pit bull cross was referred for evaluation of collapse. A left basilar systolic heart murmur graded V/VI and a grade IV/VI right basilar systolic heart murmur were ausculted. Echocardiography showed severe pulmonic stenosis characterized by annular hypoplasia, leaflet thickening, and leaflet fusion. After 1 month of atenolol therapy, a pulmonic valve balloon valvuloplasty procedure was performed, and the intra-operative right ventricular pressure was reduced by 43%. Echocardiography, performed the following day, showed apparent rupture of a pulmonary valve leaflet and a membranous structure within the pulmonary artery consistent with a dissecting membrane. Short-term follow-up has shown no apparent progression of the pulmonary artery dissection and the patient remains free of clinical signs.     

Percutaneous balloon valvuloplasty for treatment of pulmonic stenosis in a dog

A 2.5-year-old dog with congenital pulmonary valve dysplasia was treated by percutaneous balloon dilation of the stenotic orifice. Clinical and hemodynamic improvement was apparent immediately and for 9 months after the valvuloplasty procedure.     

Surgical correction of pulmonic stenosis using transventricular pulmonic dilation valvuloplasty (Brock) in a dog

A two-month-old male long coated Chihuahua, which had symptoms including anorexia and decreased growth, was diagnosed with pulmonic valvular stenosis. Echocardiography showed the severe progression of pulmonary arterial velocity (6.29 m/s, Pressure gradient (PG); 158 mmHg). Transventricular pulmonic dilation valvuloplasty (Brock) was conducted, and stenosed valve was dilated by the oto forceps. Pleural effusion was observed postoperatively, however, it was diminished under the intensive care for five days after the surgery. The right ventricular systolic pressure was decreased to 60 mmHg in angiocardiography conducted two months postoperatively and the dog has kept a good general condition with recovered vigor and appetite.     

Balloon valvuloplasty of valvular pulmonic stenosis in the dog

Balloon valvuloplasty has become the accepted method of therapy for the majority of dogs with valvular pulmonic stenosis. Success rate of balloon valvuloplasty is excellent but the procedure can have a steep learning curve. An understanding of the equipment used and specifics of the procedure is important to maximize success and minimize risk. This paper will review criteria for choosing candidates for balloon valvuloplasty, discuss the equipment used, discuss the procedure in detail, and finally discuss assessment of success and possible complications.     

Percutaneous catheter-based treatment of pulmonic stenosis and patent ductus arteriosus in a dog

A 6-months old female German shepherd dog was referred for management of congenital heart disease. A diagnosis of pulmonic stenosis (PS) and patent ductus arteriosus (PDA) was confirmed by Doppler echocardiography and cardiac catheterisation. The conditions were treated during a single cardiac catheterisation procedure using percutaneous techniques. Gianturco coil embolisation was used to close the PDA, and the PS was relieved using a balloon valvuloplasty technique.     

Use of an extracardiac conduit in the repair of supravalvular pulmonic stenosis in a dog.

Congenital supravalvular pulmonic stenosis was diagnosed in a dog. A pulmonary artery-to-pulmonary artery anastomosis of a Dacron arterial conduit restored continuity of blood flow around the obstruction in the main pulmonary artery. By the 6th day after surgery, right ventricular systolic pressure averaged 85 mm of Hg, a decrease of 90 mm from the preoperative value. Angiocardiography confirmed the patency of the conduit. At examination 6 months after surgery, the dog was clinically normal.     

Tracheal resection and anastomosis for congenital stenosis in a dog

A one-year-old Cocker Spaniel dog was presented for the investigation of exercise-related stridor and respiratory embarrassment evident since birth. Radiography demonstrated a segmental tracheal stenosis at the thoracic inlet which was found to result from the congenital absence of tracheal rings at this point. The stenotic segment was resected at surgery and an end-to-end tracheal anastomosis performed. The dog now enjoys normal respiratory and exercise function with minimal narrowing of the trachea at the site of the anastomosis.     

Valvular pulmonic stenosis in bullmastiffs

Six bullmastiffs with congenital heart disease were evaluated over a three-year period. In all the cases the problem was shown to be dysplasia of the pulmonary valve. Five cases were male, one was female. All dogs available to follow-up developed signs of cardiac decompensation. Bullmastiffs must be added to the list of breeds in which valvular pulmonic stenosis is encountered frequently.     

Specific features and survival of French bulldogs with congenital pulmonic stenosis: a prospective cohort study of 66 cases

Introduction

The objectives of this study were to characterize the epidemiological, clinical, and echocardiographic features of French bulldogs (FBs) with congenital pulmonic stenosis and document their survival times and risk factors for cardiac death (CD).

Percutaneous balloon valvuloplasty in four dogs with pulmonic stenosis

Four young dogs with severe pulmonic stenosis were treated by percutaneous balloon valvuloplasty. Pressure gradients between the right ventricle and pulmonary artery were markedly reduced by the procedure resulting in dramatic improvements in growth rate and clinical condition. No postoperative problems were encountered.     

Results of balloon valvuloplasty in 40 dogs with pulmonic stenosis

The records of 43 dogs presenting with severe pulmonic stenosis in which balloon valvuloplasty was attempted were reviewed. Thirty-four dogs (79 per cent) were symptomatic at initial presentation. All patients were selected for balloon valvuloplasty on the basis of a Doppler-derived trans-stenotic pressure gradient of over 80 mmHg and concurrent evidence of mild to severe right ventricular hypertrophy. Forty dogs underwent balloon valvuloplasty; the procedure was not performed in three dogs because of an aberrant coronary artery in two cases and because catheterisation of the pulmonary artery was not possible in the third. Overall, 37 out of the 40 dogs (93 per cent) were successfully ballooned, resulting in a mean reduction in the pressure gradient of 46 per cent, with a mean pressure gradient of 124 mmHg on presentation and 67 mmHg six months after the procedure. Three dogs died during balloon valvuloplasty (all of which had a concurrent defect) and three dogs showed a poor clinical response to the procedure. Thus balloon valvuloplasty was successful and resulted in a sustained clinical improvement in 80 per cent of previously symptomatic cases. This study was undertaken to document the results of balloon valvuloplasty in a larger population of dogs than has previously been published.     

Prospective evaluation of the balloon-to-annulus ratio for valvuloplasty in the treatment of pulmonic stenosis in the dog

BACKGROUND: In dogs, treatment of pulmonic valve stenosis (PS) with pulmonary balloon valvuloplasty (PBV) is a viable method to decrease the pressure gradient across the valve. However, to the authors' knowledge, the variables that influence the selection of the correct balloon size for the procedure have not been explored. Moreover, the lesions caused by the procedure have not been detailed. HYPOTHESIS: Variables that influence the measurement of the annulus could affect selection of the balloon size. We sought to determine the effects of treatment when the balloon-to-annulus ratio (BAR) was or > 1.3, but within the recommended range of 1.2-1.5, regardless of whether dilation was performed with single or double balloon technique. ANIMALS: Twenty-five Beagles with PS were studied. METHODS: Inter- and intra-observer variability, echocardiography versus angiocardiography, and systolic versus diastolic timing were evaluated for the BAR. Assessment of right ventricular (RV) pressure, Doppler gradient, stenotic valve area, and RV wall thickness were compared before and 1, 90, and 180 days after treatment. Postmortem examination of the heart was done. RESULTS: Significant correlations existed in measurement of the annulus; however, variation existed that would change balloon size. Improvement in the degree of PS was significant regardless of the BAR or single or double ballooning. In the most severely affected dogs, continued improvement was noted on day 90. Postmortem examination revealed tears in the commissures and the valve leaflets. CONCLUSIONS: Multiple factors influenced determination of the BAR and a range of 1.2-1.5 was effective without detrimental consequences. Dogs with severe PS had continued decrease in RV pressure 3 months after treatment.