Ch. 106-108: Cardiac, pericardial, & vascular surgery

Question 1

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?

Answer 1

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)

Question 2

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)?

Answer 2

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

Question 3

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?

Answer 3

• Rupture 7%
• Overall mortality was 0.4%
• 9.4% residual flow
• No specific risk factors for rupture identified

Question 4

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?

Answer 4

• Amplatzer Vascular Plug 4 (AVP-4)
• Can be implanted through a 4Fr diagnostic catheter
• Immediate closure occurred in 5 dogs (/7 dogs)

Question 5

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?

Answer 5

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

Question 6

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?

Answer 6

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%)

Question 7

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?

Answer 7

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

Question 8

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?

Answer 8

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

Question 9

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?

Answer 9

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

Question 10

Scheuermann Vet Sx 2021

Systematic review of the treatment options for pericardial effusions in dogs

What is associated with shorter survival?

Answer 10

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.

Question 11

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?

Answer 11

• 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

Question 12

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

Answer 12

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.

Question 13

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?

Answer 13

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

Question 14

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?

Answer 14

3/5 performed with thoracoscopy alone, 2/5 converted

No intraoperative or postoperative complications

Question 15

Olson Vet Sx 2021

Surgical treatment of persistent right aortic arch with combined ligamentum arteriosum transection and esophageal diverticulum resection in three dogs

Answer 15

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

Question 16

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?

Answer 16

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

Question 17

Shua-Haim VRU 2023

CT features of double aortic arch in 6

which was dominant? minor? aberrant?

Answer 17

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%)

Question 18

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?

Answer 18

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.

Question 19

Cheng JVIM 2022

Changes in renin-angiotensin-aldosterone system during cardiac remodeling after mitral valvuloplasty in dogs

Reduction in what? Valvuloplasty has what affect?

Answer 19

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

Question 20

Jack Vet Sx 2019

Feasibility of open-chest CPR through a transdiaphragmatic approach in dogs

Conclusions?

Answer 20

*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

Question 21

Chmelovski Vet Sx 2020

Comparison of diameter and length of subclavian arteries to external jugular veins in variably sized dogs: A cadaveric study

Conclusion?

Answer 21

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

Question 22

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?

Answer 22

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

Question 23

Sack JAVMA 2022

Decortication, thoracic omentalization, and pericardiectomy for treatment of severe fibrosing pleuritis in a cat

Answer 23

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

Question 24

Maeda JSAP 2021

Three-dimensional conformal radiation therapy for canine aortic body tumor: 6 cases (2014-2019)

Response?

Answer 24

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)

Question 25

Klainbart JVECC 2021

Balloon expandable aortic stent-graft for the treatment of aortic aneurysm and rupture in a dog

Answer 25

Stent graft (12mm x 50 mm) placed fluoroscopically
Access right femoral artery

90 days doing well

Question 26

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?

Answer 26

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)

Question 27

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?

Answer 27

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

Question 28

Andruzzi JVIM 2021

Brachial artery thrombosis in a dog causing monoparesis mimicking nerve sheath tumor

Tx?

Answer 28

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

Question 29

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?

Answer 29

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

Question 30

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

Answer 30

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

Question 31

Negro VRU 2023

Multidetector-row CT (MDCT) features and histopathological analysis of pericardial recesses in dogs

Answer 31

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