Ch. 106-108: Cardiac, pericardial, & vascular surgery Flashcards
Ranganathan JAVMA 2018
Comparison of major complication and survival rates between surgical ligation and use of a canine ductal occluder device for treatment of dogs with left-to-right shunting PDA
SL comp rate?
CDO comp rate?
Survival to dc?
Dogs treated by CDO significantly older and heavier than SL & had more pathological cardiac remodeling
Major complication rate for SL 10% (6/62) S greater than dogs treated by CDO implantation (0/58 0%)
Overall rate of survival to hospital discharge 99% (119/120)
Claretti JSAP 2019
Complications during catheter-mediated PDA closure and pulmonary balloon valvuloplasty
Overall complication rate?
ACDO complication rate (anat vs technical)?
PBV complication rate (anat vs tech)?
524 dogs included, 62 had complications – 12%
ACDO 32 total : 6/32 (19%) due to anatomical abnormalities & 26 (81%) from technical complications
PBV procedure 30 total; 10 (33%) 2nd to additional anatomic abnormalities 20 (67%) technical
Grimes Vet Sx 2022
Surgical ligation of patent ductus arteriosus in dogs: incidence and risk factors for rupture
% rupture? Overall mortality? % residual flow? Risk factors for rupture?
- Rupture 7%
- Overall mortality was 0.4%
- 9.4% residual flow
- No specific risk factors for rupture identified
Hulsman JVIM 2021
Low profile vascular plug for transarterial occlusion of patent ductus arteriosus in small dogs
Device name? Catheter size for placement? How many dogs had closure of PDA?
- Amplatzer Vascular Plug 4 (AVP-4)
- Can be implanted through a 4Fr diagnostic catheter
- Immediate closure occurred in 5 dogs (/7 dogs)
Greet JVIM 2021
Clinical features and outcome of dogs and cats with bidirectional and continuous right-to-left shunting patent ductus arteriosus
Clinical signs dogs/cats? What caused shorter MST? What tx prolonged MST?
Hind limb collapse was most common presenting sign in dogs; c/s in cats were variable
Dogs w/ R-CHF had shorter MST (58 days)
Dogs tx w/ sildenafil at initial presentation survived longer (1839 days vs 302 days) & only independent predictor of survival
Hildebrandt JVIM 2022
Transvenous embolization of moderate to large patent ductus arteriosus in dogs using the Amplatzer vascular plug II
Difference b/w AVP I & II? Success rate? % complete occlusion?
AVP II is woven more densely than AVP I w/ finer nitinol mesh in 2-3 layers
Success in 95% after first intervention, 100% after second
Complete occlusion in 53% (24 hours after intervention was 95%)
Carvajal Vet Sx 2019
Outcome in dogs with presumptive idiopathic pericardial effusion after thoracoscopic pericardectomy and pericardioscopy
Dogs had masses/lesions?
MST for abnormalities vs. not?
Which dogs had better survival times?
Poss PQ - what procedure(s) associated with success?
Total 18 dogs, 0 dogs had mass lesions or cause of effusion ID on echo; 9 dogs pericardioscopic abnormalities with masses, nodules, adhesions
MST for 9 dogs with abnormalities 66d vs MST 9 dogs with unremarkable exam not reached
Dogs with presumptive idiopathic pericardial effusion without evidence of masses, nodules, and/or adhesions during thoracoscopic pericardectomy and pericardioscopy lived longer than dogs in which abnormalities were identified during pericardioscopy
Cook JVECC 2020
Prospective evaluation of pericardial catheter placement versus needle pericardiocentesis in the management of canine pericardial effusion
How long were catheters in place?
% of needle group require repeated pericardiocentesis?
Catheters kept in situ for median of 21 hours; enabled repeated large volume PE drainage in 4 cases
20% of dogs in needle group required repeated pericardiocentesis within 24 hours
Michelotti Vet Sx 2019
Outcomes of dogs with recurrent idiopathic pericardial effusion treated with a 3-port right-sided thoracoscopic subtotal pericardiectomy
MST?
Effusion recurrence rate?
Intra-op complications?
Poss PQ - what procedure(s) associated with success?
16 dogs; MST after surgery was 365 d (5-1345).
Recurrent pleural effusion ultimate cause of death for euthanasia in 8/16 dogs.
Thoracocscopic subtotal pericardiectomy successfully completed in all dogs, with no surgical complications
Scheuermann Vet Sx 2021
Systematic review of the treatment options for pericardial effusions in dogs
What is associated with shorter survival?
Neoplastic effusions were associated with shorter survival for both conservative and surgical management compared with idiopathic pericarditis
The articles had inconsistent inclusion criteria, outcome measures, and follow-up, making comparison of outcomes difficult.
Raleigh Vet Sx 2022
The development of ventricular fibrillation as a complication of pericardiectomy in 16 dogs
- % VF during electrosurgery?
- % dogs with arrhythmias prior to VF?
- % died from VF?
- Ventricular fibrillation appeared to be initiated during electrosurgical use in 8/15 (53%) dogs
- 7/16 (43%) dogs arrhythmias noted prior to development of VF
- 14/16 (88%) died from intraoperative VF
Nucci JAVMA 2018 PQ
Retrospective comparison of short-term outcomes following thoracoscopy versus thoracotomy for surgical correction of persistent right aortic arch in dogs
Difference in post-op comps? PQ
Diff in time tube in place? PQ
Diff for duration of sx? PQ
Diff for hospitalization time? PQ
No difference in post-op complications
Thoracoscopy not associated with higher morbidity or mortality rates, compared with thoracotomy.
Median duration of surgery was not markedly different among groups, nor was the incidence of postoperative complications or median amount of time a thoracostomy tube was maintained in place.
Median duration of hospitalization was 1 day for dogs that underwent thoracoscopy and 2 days for dogs that underwent thoracotomy or in which thoracoscopy was converted to a thoracotomy.
Bascunan Vet Sx 2020
Vascular ring anomalies in cats: 20 cases (2000-2018)
% PRAA?
Survival to discharge after surgery?
Outcome of those survived to discharge?
A PRAA diagnosed in 17/20 (85%) cats with concurrent aberrant left subclavian artery in 4 of the cats
Surgical treatment was associated with survival to discharge in 18/20 (90%) cats (90% had no intraoperative complications)
Outcome excellent in 3 (23%) good in 8 (62%) and poor in 2 (15%) that survived to discharge
Regier Vet Sx 2021
Ligation of the ligamentum arteriosum and aberrant left subclavian artery in five dogs in which persistent aortic arch had been diagnosed
thoracoscopic vs converted?
Complications?
3/5 performed with thoracoscopy alone, 2/5 converted
No intraoperative or postoperative complications
Olson Vet Sx 2021
Surgical treatment of persistent right aortic arch with combined ligamentum arteriosum transection and esophageal diverticulum resection in three dogs
Esophageal resection performed using TA stapler with suture overlay
No peri or post-op complications
All cases (3) had resolved regurgitation and did not recur in any dogs
Rossanese JSAP 2022
Clinical findings, surgical treatment and long-term outcome of dogs and cats with double aortic arch: four cases (2005–2022)
ICS for sx? what ligated?
Improvement?
Owner perception of outcome?
Surgery was performed via a left fourth intercostal thoracotomy; ligation and transection of the lesser left aortic arch
All animals showed a marked improvement during the postoperative period.
Owners’ perception of the surgical procedure outcome and quality of life was described as excellent for all animals
Shua-Haim VRU 2023
CT features of double aortic arch in 6
which was dominant? minor? aberrant?
Common CTA features of DAA included:
- dominant left aortic arch (median diameter: 8.1 mm)
- minor right aortic arch (median diameter: 4.3 mm; 83%)
- aberrant right subclavian artery arising directly from the right aortic arch (83%)
- segmental esophageal constriction (100%)
- variable degrees of dilation cranial to the heart base (median % change: –55%)
- marked tracheal luminal compression (median % change: 100%)
- leftward curvature of the trachea at the level of the bifurcation of the aortic arches (100%)
Reeves VRU 2023
A repeatable CT protocol for quantifying caudal vena cava growth in medium and large breed dogs
Overall CVC thoracic circumference range?
Difference between medium & large breeds?
The CVC thoracic circumference ranged from 2.5 to 4.9 cm from 1 to 18 months of age.
Medium & large breeds had similar CVC growth trajectories, with comparable estimated marginal means
Medium dogs reached 80% of predicted final CVC size approximately 4 weeks earlier than large breed dogs.
This new protocol provides a standardized technique for evaluation of the CVC circumference over time using contrast-enhanced CT and is most repeatable when taken at the thoracic level.
Cheng JVIM 2022
Changes in renin-angiotensin-aldosterone system during cardiac remodeling after mitral valvuloplasty in dogs
Reduction in what? Valvuloplasty has what affect?
Reduction in PRA (renin), AT2 (angiotensin II), and PAC (aldosterone) at Post-1M, Post-2M, Post-3M compared to baseline
Mitral valvuloplasty contributes to decreased RAAS activity in MMVD dogs
Jack Vet Sx 2019
Feasibility of open-chest CPR through a transdiaphragmatic approach in dogs
Conclusions?
*In cadavers
Mean time between incision and initiation of cardiac compressions for TD approach (85 + 35 sec) was noninferior to the LT (84 + 28 sec)
No difference between complication rates of each approach
Chmelovski Vet Sx 2020
Comparison of diameter and length of subclavian arteries to external jugular veins in variably sized dogs: A cadaveric study
Conclusion?
The external jugular vein measured longer than the subclavian artery in all dogs (52.0 ± 20.8 mm and 23.0 ± 8.9 mm, respectively), with a mean difference of 28 ± 14.3 mm (P < .001)
Autologous external jugular vein grafts had an external diameter similar to subclavian artery & a significantly longer length in variably sized dogs - supports its use as an autologous vein graft
Gavin JVIM 2022
Stenting of the caudal aorta and aortic trifurcation for the treatment of thrombosis in 7 dogs
What CS and comorbidity were common?
Four of 7 dogs were non-ambulatory
Five of the 7 dogs had protein-losing nephropathy
No deaths occurred during the procedure.
Median survival time (MST) of the 7 dogs was 264 days (range, 1-1053 days)
Five of 7 dogs were ambulatory within 2 days of stenting
Sack JAVMA 2022
Decortication, thoracic omentalization, and pericardiectomy for treatment of severe fibrosing pleuritis in a cat
Complete pleural decortication, pericardiectomy, and thoracic omentalization
Long-term home care
prednisolone, rutin supplementation, and low-fat diet
Cat remained tachypneic at 3, 7, and 20 weeks but no distress
Maeda JSAP 2021
Three-dimensional conformal radiation therapy for canine aortic body tumor: 6 cases (2014-2019)
Response?
Median dose per fraction of 7 Gy, median of seven divided doses, and a total median dose of 49 Gy
Side effects in 4 dogs
1 dog CR, 1 dog PR, stable in 4 animals
(33% responded)
Klainbart JVECC 2021
Balloon expandable aortic stent-graft for the treatment of aortic aneurysm and rupture in a dog
Stent graft (12mm x 50 mm) placed fluoroscopically
Access right femoral artery
90 days doing well
Weisse JVIM 2021
Transarterial stenting for long-term management of cardiac tumor obstruction of the right atrium in 3 dogs
Did clinical signs resolve? Additional stents required? Survival times?
Resolution of clinical signs was marked in all dogs
Two dogs required additional stent placement at 6 and 14mo
Survival times were 3, 21 and 37mo post stenting (3m, ~2 years, ~3 years)
Ruehl JVIM 2020
Outcome and treatments of dogs with aortic thrombosis: 100 cases (1997-2014)
Overall px classification? What presenting sign associated with worse outcome?
dogs w/ ATh have poor px and dogs that are non-ambulatory have worse outcome.
Although comorbidities that predispose to hyercoag are common, the cause is not always ID
Andruzzi JVIM 2021
Brachial artery thrombosis in a dog causing monoparesis mimicking nerve sheath tumor
Tx?
Non-weight bearing thoracic limb lameness, muscle atrophy with cool paw pads and painful axillary region
MRI, CT, US, and exploratory surgery confirmed chronic thrombus
Managed long term on rivaroxaban and clopidogrel
Cusack VRU 2021
Correlations between age, body size, sex, and conformation and ultrasound-measured femoral vessel diameter in the dog, with implications for transvascular procedural planning
Was there a difference in size between sides? Male vs female? What factor correlated most with diameter?
Allometrically scaled body wt had strongest correlation with FA and FV diameter, although thigh circumference and withers height were also strongly correlated
Males have smaller FA vs females, but not for FV
Femoral vessel diameter in dogs is influenced by multiple factors w/ potential for clinically relevant differences b/w right and left sided vessels. U/S measurement can help improve preprocedural planning
Reich JVECC 2022
Evaluation of resuscitative endovascular balloon occlusion of the aorta catheter placement and comparison to resuscitative thoracotomy with aortic clamping in cadaver dogs
Endovascular balloon occlusion of the aorta can be achieved by cutdown with and without external chest compressions (ECC), but resuscitative thoracotomy with aortic clamping (RT-AC) is faster.
Successful balloon position in Z1 (xiphoid) could be achieved with knowledge of external anatomical landmarks, but landmarks for Z3 need further study
Negro VRU 2023
Multidetector-row CT (MDCT) features and histopathological analysis of pericardial recesses in dogs
PRs were identified as fluid-attenuating (10-30 HU), non-enhancing structures showing varied appearance
A dorsal, slight oblique multiplanar section through the aortic bulb → best technique for visualization of all the recesses
