thoracic cavity /CV Flashcards
- Hennet, JFMS 2022. Closure-related complications after median sternotomy in cats: 26 cases (2010–2020)
complication rate? how were they closed?
o 7% complications – related to closure of sternotomy – not SSI or dehiscence
- Pilot, VS 2022. Comparison of median sternotomy closure-related complication rates using orthopedic wire or suture in dogs
complication rate? which closure was better?
what was associated with inc complications?
o Use of orthopedic wire or suture are appropriate closure methods for sternotomy in dogs of any size
o 14% complications – only factor assoc w/ inc risk of closure complications was dog size
lower than previously reported (17%–78%)
- Racette, JVECC 2022. Retrospective evaluation of fluid production at the time of thoracostomy tube removal following elective and emergency surgery in dogs (2010–2017): 185 cases
what was assoc/ persistent effusion at 2 wks? what was not associated with effusion?
o Pleural effusion @ 2 wks= 7% dogs; more common if preop PE, chylothorax, or LLT
Fluid prod @ tube pull was NOT assoc persistent effusion @ 2wk
- Liptak, VS 2008. Reconstruction of Chest Wall Defects After Rib Tumor Resection: A Comparison of Autogenous, Prosthetic, and Composite Techniques in 44 Dogs
complication rate bw autogenous and prosthetics?
recc for mesh use? what type of mm flap is lat?
o Complications= autogenous = 10%, composite= 25%, prosthetic =65%
prosthetic mesh should be covered with muscle/omentum to decrease the risk of postoperative complications
o mm flaps latissimus = type V flap (thoracodorsal); deep pec = type V flap (lateral thoracic)
- Dickson, VS 2024. Outcome of video‐assisted thoracoscopic treatment of idiopathic chylothorax in 15 cats
persistent PE? recurrence rate? mortality rate?
o persistent pleural effusion = 33%
recurrence in 14%
o overall mortality = 47%
- Carrol, JAVMA 2024. Thoracoscopic removal of cranial mediastinal masses in dogs is associated with a low conversion rate, excellent survival to discharge, and good long-term outcome
negative prognostic indicators and relative %?
MST for thymoma vs thymoma/MG?
o Preop myasthenia gravis = 35%; megaesophagus =22% – negative prognostic indicators
o MST thymoma = 1,102 days (3yr) vs thymoma/MG =182 d (6mo)
- Johnson, JVIM 2023. Etiology and effusion characteristics in 29 cats and 60 dogs with pyothorax (2010-2020)
causes in dog vs cats? cat pyothorax bacteria? dog bacteria?
dogs = FB inhalation vs cats = bites/trauma
Cats = polymicrobial, anaerobic (73%) cats = higher cell counts, polymicrobial, intracell bacteria
Pasteurella (aerobic) & bacteriodies/fuso/peptostrep most common (oral flora)
o Dogs = one microbe, aerobes more common – actinomyces/strep/staph
- Marks, JSAP 2023. Prognostic factors and outcome in cats with thymic epithelial tumours: 64 cases (1999‐2021)
MST? mortality rate?
o MST = 897d (2.5yr)
o mortality rate = 11%
- Mayhew, JAVMA 2022. Resolution, recurrence, and chyle redistributions and thoracic duct ligation with or without pericardiectomy in dogs with naturally occurring idiopathic chylothorax
resolution rates for TDL alone or TDL/P (if CPP)? recc for pericardiectomy?
o Resolution rates: TDL (no CP) = 94% vs TDL/P (yes CP) =88%
o In dogs w/o evidence of CPP, TDL alone was assoc w/ a very good px – if no CPP benefit of pericardiectomy is questionable
- Kanai, VRU 2021. Canine idiopathic chylothorax: Anatomic characterization of the pre and postoperative thoracic duct using computed tomography lymphography
% of pts w/ obvious TD after 1wk postop?
o 1 wk postop CT lymphangio identified 50% of TD – poss d/t “invisible or sleeping” fine ducts not seen on preop CTL
- Kramer, JSAP 2021. Short and long term outcome in cats diagnosed with pyothorax: 47 cases (2009-2018)
med mgmt failure rate? mortality rate? recur?
15% failed med mgmt then had surgery
o 28% mortality rate & Recurrence rate = 6%
- Dickson, JAVMA 2021. Surgical management and outcome of dogs with primary spontaneous pneumothorax: 110 cases (2009–2019)
recurrence rate?
o Recurrence = 13% – most likely <30d after sx
- Kanai, Vet Surg 2020. Efficacy of en bloc thoracic duct ligation in combination with pericardiectomy by video assisted thoracocscopic surgery for canine idiopathic chylothorax
remisson rate for en bloc vs conventional?
o Clinical improvement = 91.7%
o Remission rates higher w/ en bloc-TDL (85.7%) group vs conventional TDL (20%)
- Mayhew, Vet Surg 2019. Long term outcome of video assisted thoracoscopic thoracic duct ligation and pericardectomy in dogs with chylothorax: a multiinstitution study of 39 cases
resolution rates?
o Resolution =95%
- Stockdale, JAVMA 2018. Comparison of thoracic duct ligation plus subphrenic pericardiectomy with or without cisterna chyli ablation for treatment of idiopathic chylothorax in cats
recc for CCA?
o Addition of CCA to sx – longer GA w/ no better outcome
- Garneau, VS 2015. Perioperative Mortality and Long‐Term Survival in 80 Dogs and 32 Cats Undergoing Excision of Thymic Epithelial Tumors
mortality rates for dog v cat? MST? what is associated with w dec survival?
o Mortality: dogs =20% vs cats= 22%
o MST: dogs = 1.5yr vs cats = 3.5yr
o Survival decreased w/ paraneoplastic syndromes or incomplete margins
- Meakin. JSAP 2013. Prevalence, outcome and risk factors for postoperative pyothorax in 232 dogs undergoing thoracic surgery
mortality rate?
o 67% mortality rate
- Boothe, JAVMA 2010. Evaluation of outcomes in dogs treated for pyothorax: 46 cases (1983-2001)
survival rate for sx vs chest tube vs thoracocentesis
o survival rate: thoracocentesis =29%; chest tubes=77%; surgery = 92%
- Mcnamara, JAVMA 2023. Risk factors for intraoperative hemorrhage and perioperative complications and short- and long-term outcomes during surgical patent ductus arteriosus ligation in 417 dogs
intraop hemorrhage rate? % of dogs surviving intraop hemorrhage? mortality rate?
o Intraop hemorrhage = 11% 95% with intraop hemorrhage survived
o intraop mortality =2% 97% survived to discharge
- Grimes, VS 2022. Surgical ligation of patent ductus arteriosus in dogs: Incidence and risk factors for rupture
intraop hemorrhage? mortality rate?
factors not associated with rupture?
o Intraop rupture = 7% Mortality rate = 0.4%
o Residual PDA flow = 9% dogs w/ rupture were more likely to have residual flow (but if ligation re-attempted then no diff)
o Age and weight not assoc w/ inc risk for hemorrhage (same as Mcnamara 2023)
- Raleigh et al. JAVMA 2022. The development of ventricular fibrillation as a complication of pericardiectomy in 16 dogs
assoc bw vfib and use of electrosx? mortality rate?
o Vfib assoc w/ electrosx = 53% 93% dogs had electrosx used intraop
o Preop arrhythmias = 45%
o Mortality rate = 87% (d/t Vfib)
- Carvajal et al, JAVMA 2019. Outcome in dogs with presumptive idiopathic pericardial effusion after thoracoscopic pericardiectomy and pericardioscopy
% w/ lesions on pericardioscopy? MST if lesions?
conclusion
o 0% had lesions on echo 50% had abN on pericardioscopy (mass/nodule/adhesion)
o MST: lesions = 66d (2mo)(1’ mesothelioma) vs no lesions = not reached
o Recc thoracoscopic pericardectomy/pericardioscopy + targeted bx for dogs with idiopathic PE
What was the primary finding of Mihara et al, Vet Surg 2024 regarding mitral valve repair in dogs?
Mitral valve geometry was completely changed within 1 week and VHS lasted for ~3mo
Mitral valve repair changed valvular geometry and improved hemodynamics, leading to postoperative morphological modification and coaptation area creation.
What percentage of dogs experienced intraoperative hemorrhage during patent ductus arteriosus ligation according to Mcnamara, JAVMA 2023?
11%
95% with intraoperative hemorrhage survived, and 44% received blood transfusions.
What was the intraoperative mortality rate for PDA reported by Mcnamara, JAVMA 2023?
2%
97% of dogs survived to discharge.
According to Grimes, VS 2022, what was the incidence of intraoperative rupture during patent ductus arteriosus ligation?
7%
Mortality rate associated with intraoperative rupture was 0.4%.
What was the residual patent ductus arteriosus flow percentage reported in Grimes, VS 2022?
9%
Dogs with rupture were more likely to have residual flow, but if ligation was re-attempted, then no difference was observed.
What association was found between preoperative arrhythmias and electrosurgery in the study by Raleigh et al., JAVMA 2022?
Ventricular fibrillation was associated with electrosurgery in 53% of cases
45% had preop arrhythmias
93% of dogs had electrosurgery used intraoperatively.
What was the mortality rate due to ventricular fibrillation in the study by Raleigh et al., JAVMA 2022?
87%
This was specifically due to ventricular fibrillation.
What did Chmelvoski, VS 2021 find regarding the use of external jugular vein grafts in dogs?
Autologous external jugular vein grafts had an external diameter similar to subclavian artery and a significantly longer length
This makes them acceptable for use with modified Blalock-Taussig shunt.
What are the components of Tetralogy of Fallot as described in the study by Chmelvoski, VS 2021?
- Interventricular septal defect
- Right ventricular hypertrophy
- Overriding aorta
- Pulmonic stenosis
What was the outcome for dogs with idiopathic pericardial effusion treated with thoracoscopic pericardiectomy and pericardioscopy according to Carvajal et al, JAVMA 2019?
0% had lesions on echo, while 50% had abnormalities on pericardioscopy
MST for lesions was 66 days (primary mesothelioma) vs not reached for no lesions.
What was the median survival time for dogs with neoplasia after treatment for recurrent idiopathic pericardial effusion according to Michelotti et al, JAVMA 2019?
76 days (2 months)
Dogs without cancer had a median survival time of 1 year.
What percentage of dogs experienced recurrent pleural effusion leading to death as reported by Michelotti et al, JAVMA 2019?
50%
This was noted in dogs with recurrent pleural effusion.
What was the focus of the study by Barbur, VS 2018 regarding thoracoscopic pericardectomy?
Epicardial exposure provided by a novel thoracoscopic pericardectomy technique compared to standard pericardial window
The novel technique improves exposure of the epicardium.
What is the prevalence of spontaneous pneumomediastinum in sighthounds compared to other breeds?
14% in sighthounds vs 2% in other breeds
Not associated with pulmonary pathology or general anesthesia.
What is the Macklin effect?
Gas leaks from the alveoli into interstitial lung tissue leading to pneumomediastinum.
What was the survival rate reported after median sternotomy closure in cats? Hennet 2022
81%
Closure was performed with suture in all cats.
What were the complication rates associated with median sternotomy closure in dogs using orthopedic wire or suture?
14% complications with an even split between both groups
Only factor associated with complications was dog size.
What factors were associated with higher fluid production during thoracostomy tube removal?
Preoperative effusion or median sternotomy.
What is the primary cause of pyothorax in dogs and cats?
Dogs: foreign body inhalation; Cats: bites/trauma.
In cats with neoplasia causing bicavitary effusion what was the increased risk of death?
2x increased risk
Neoplasia was the most common cause of bicavitary effusion.
What are the most common complications related to suture closure of median sternotomy in cats?
7% complications related to closure, not surgical site infection or dehiscence.
What is the mortality rate associated with surgical treatment of thoracic trauma in cats?
13%
Increased risk of death with cardiopulmonary arrest and higher triage scores.
What is the effect of muscle-sparing lateral thoracotomy on postoperative pain?
Decreased postoperative pain and thoracic lameness.
What is the prognosis for dogs with thymic epithelial tumors based on tumor stage?
MST: 1366d for stage I/II vs 454d for stage III/IV.
What is the overall mortality rate following video-assisted thoracoscopic treatment of idiopathic chylothorax in cats?
47%.
What is the common outcome for dogs with pneumothorax following nasogastric feeding tube misplacement?
70% developed respiratory signs and 40% had cardiopulmonary arrest.
What are the types of closure techniques compared in canine median sternotomy?
Suture tape and orthopedic wire cerclage.
What is the complication rate for autogenous, composite, and prosthetic techniques in chest wall reconstruction?
- Autogenous: 10%
- Composite: 25%
- Prosthetic: 65%
Prosthetic mesh should be covered with muscle/omentum to reduce complications.
How did the use of orthopedic wire compare to suture in sternotomy closure in terms of biomechanical properties?
Suture tape was biomechanically similar to orthopedic wire, but wire constructs were stiffer.
What are the common clinical signs associated with traumatic pneumomediastinum?
- Subcutaneous emphysema
- Pneumothorax
- Dyspnea.
What is the recommended preoperative treatment for dogs with myasthenia gravis undergoing thoracoscopic surgery?
Pyridostigmine (acetylcholinesterase inhibitor) for 2 weeks preoperatively.
What factors influence the duration of chest tube usage following thoracic surgery in dogs and cats?
- Median sternotomy
- Rib resection
- Preoperative pleural effusion.
What is the most common surgical treatment for idiopathic chylothorax in dogs?
TDL + subtotal pericardiectomy (40%)
TDL stands for thoracic duct ligation.
What is the most common surgical treatment for idiopathic chylothorax in cats?
Thoracic duct ligation (51%)
What was the resolution rate for video assisted thoracoscopic thoracic duct ligation and pericardectomy in dogs? Mayhew 2019
95%
Late recurrence rate was 9%.
What is the significance of the study by Mayhew in 2019 regarding chylothorax in dogs?
Successful outcome of VATS TDL + pericardectomy.
In the study by Singh in 2019, what were the surgical approaches optimized for?
Thoracoscopic‐assisted pulmonary surgery in dogs.
L or R 4-5 =LEFT cranial /caudal and RIGHT cranial/middle
R 5-6 =RIGHT caudal and accessory lung
What percentage of foreign bodies were retrieved via bronchoscopy in the study by Gibson in 2019?
37%
70% were retrieved surgically.
What was the survival rate reported by Gibson in 2019 for dogs with intrathoracic disease due to plant awn migration
95%
What was the median survival time (MST) for cats treated with TDL + pericardiectomy? Stockdale 2018
774 days (2yr)
What was the MST for cats treated with TDL/PC/CCA?
380 days
True or False: The addition of cisterna chyli ablation (CCA) to surgery improved outcomes in cats with idiopathic chylothorax.
False
It resulted in longer general anesthesia with no better outcome.
What percentage of sites showed recanalization after video assisted thoracoscopic thoracic duct sealing in healthy cats?
80%
What were the mortality rates associated with excision of thymic epithelial tumors in dogs and cats?
Dogs: 20%; Cats: 22%
What was the median survival time for dogs versus cats undergoing excision of thymic epithelial tumors?
Dogs: 1.5 years; Cats: 3.5 years
What was the percentage of dogs that developed postoperative pyothorax in the study by Meakin?
6%
What was the mortality rate associated with postoperative pyothorax in dogs?
67%
What was the survival rate for dogs treated with thoracocentesis, chest tubes, and surgery for pyothorax?
Thoracocentesis: 29%; Chest tubes: 77%; Surgery: 92%
What factors were associated with decreased survival in dogs undergoing excision of thymic epithelial tumors?
Paraneoplastic syndromes or incomplete margins
What was the disease-free rate at 1 year for medical management versus surgical treatment of pyothorax in dogs?
Medical management: 25%; Surgical treatment: 78%
Fill in the blank: The likelihood of treatment failure in dogs treated medically for pyothorax was _______ times higher than in those treated surgically.
5.4
