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1.
Medical records of 81 dogs with severe pulmonic stenosis from 2 referral centers were examined retrospectively. Forty dogs underwent balloon valvuloplasty (BV), which was performed by 1 operator, whereas 41 did not. The mean age at latest follow-up was 41.5 months. A statistical comparison of the clinical outcome and survival was performed. Dogs revealing clinical signs at presentation showed a 16-fold increase in risk of death compared with asymptomatic dogs (P < .001). Statistical analyses demonstrated that an increase of 1 mm Hg in transstenotic pressure gradient (PG) at presentation was associated with a 3% increase in hazard rate (P < .001). Thirty-seven dogs survived BV with a median reduction in PG of 46%. The median preoperative PG was 120 mm Hg, and median PG 24 hours postoperatively was 55 mm Hg with a median of 55 mm Hg 6 months post-BV. Twenty (49%) of the non-BV (NBV) dogs remained asymptomatic at last follow-up. Fourteen (34%) of the NBV dogs died or were euthanized because of heart disease related to pulmonic stenosis. Twelve of these dogs died suddenly, whereas only 1 of the BV dogs died suddenly. After adjusting for PG, clinical signs at presentation, and age, BV or dilation was associated with a 53% reduction in hazard rate (P = .005). This study indicates that BV, when performed by an experienced operator, appears to be successful both in alleviating clinical signs and in prolonging survival in dogs with severe pulmonic stenosis.  相似文献   

2.
Single right coronary artery (CA) associated with pulmonic stenosis was found in 3 English Bulldogs and a Boxer, suggesting a genetic predisposition for the associated anomalies. The left main coronary branch arose from the single right CA, encircled the pulmonic root over hypoplastic pulmonic valves at the level of the obstruction, and appeared to be the primary cause of underlying pulmonic stenosis. Patch-graft surgery to relieve pulmonic stenosis caused death in 1 dog when the unrecognized anomalous CA was served during the procedure. The anomalous left CA was detectable by use of angiocardiography in all 4 dogs and was recognized before surgery in 2 of them. In 1 dog, a right ventricle-to-pulmonary trunk-bridging conduit was implanted to improve outflow from the right side of the heart.  相似文献   

3.
Background: English Bulldogs (EB) with pulmonic stenosis (PS) sometimes have an aberrant coronary artery (CA) type R2A encircling the pulmonary artery (PA). Balloon valvuloplasty (BV) is treatment of choice for severe PS, but is considered to be contraindicated in dogs with aberrant CA. Hypothesis: Conservative BV in EB with aberrant CA is safe and improves clinical signs and quality of life. Animals: Four client‐owned EB with severe PS were retrospectively reviewed/analysed. Methods: Retrospective study: Case records, echocardiography, BV, and follow‐up investigations of EB diagnosed with severe PS and treated with BV were reviewed. The ratios of PA to aortic (Ao) velocity time integral (VTI) were calculated to assess progression/improvement of PS. Results: An aberrant CA was confirmed on angiography in all EB. Conservative BV was performed, using a balloon of the size of the PA annulus or smaller (0.6–1 × PA annulus size). All dogs survived the procedure, but only a mild reduction in pressure gradient was achieved. There was an improvement in PA to Ao VTI in 3 of 4 dogs (P≤ .017), which were free of evidence of congestive heart failure (CHF) 5, 10, and 15 months after BV. One dog that had right‐sided CHF when BV was performed died due to progressive right‐sided CHF within 3 months. Conclusions: Conservative BV in EB might be safe and might improve quality and quantity of life.  相似文献   

4.
English Bulldogs are the most common breed to have pulmonic stenosis. Previous studies showed that this congenital heart abnormality in Bulldogs frequently is caused by a circumpulmonary left coronary artery originating from a single right coronary artery. Fetal anasarca also occurs often in Bulldogs and might represent congestive heart failure, but the cause is unknown. To determine if fetal anasarca is associated with a coronary anomaly and pulmonic stenosis, major coronary arteries were studied in 6 bulldog puppies with fetal anasarca. Five of the puppies had normal coronary arteries, and this led to the conclusion that fetal anasarca usually is not associated with major coronary abnormalities or pulmonic stenosis. The 6th puppy had single right coronary artery with circumpulmonary left coronary artery and moderate subvalvular pulmonic stenosis. Serial section histology suggests that the underlying cause of this syndrome is malformation of the left aortic sinus (of Valsalva) and inversion of the proximal segment of the left main coronary artery.  相似文献   

5.
Four dogs presented for evaluation and treatment of severe pulmonic valve stenosis and underwent stenting of the pulmonic valve annulus using bare-metal balloon-expandable stents. All dogs survived the procedure with immediate reduction of the transpulmonary valve pressure gradient and increase in activity levels. One dog had a stent fracture and migration 1 month after the intervention. This dog underwent a second procedure, in which multiple stents were used to alleviate the obstruction. The stents that were placed at the level of the right ventricular outflow tract fractured within 1 month of the procedure, and the patient died when a third (surgical) approach was attempted. The other three dogs remain alive 54, 42, and 29 months after the procedure. Stent angioplasty may be a viable option for dogs with valvular pulmonic stenosis in which routine balloon valvuloplasty does not provide a successful outcome. Aggressive attempts to diminish RVOT dynamic obstruction with high-dose beta blockade and avoiding deployment of the stent within the RVOT are recommended to prevent stent fracture and migration.  相似文献   

6.
Valvular pulmonic stenosis and aberrancy of the right coronary artery with subsequent subvalvular stenosis was found on echocardiographic evaluation of a 9-month-old Brittany spaniel. Previous echocardiography at 4 mo of age revealed the pulmonic stenosis; however, the aberrant coronary artery only became apparent during the second evaluation.  相似文献   

7.
Objective : To determine the outcome, independent predictors of cardiac death, and the Doppler‐derived pressure gradient cut‐off for predicting cardiac death in dogs with pulmonic stenosis, with or without tricuspid regurgitation, that do not undergo balloon valvuloplasty or valve surgery. Methods : Review of medical records of two UK referral centres between July 1997 and October 2008 for all cases of pulmonic stenosis that had no balloon valvuloplasty or valve surgery. Inclusion criteria included a diagnosis of pulmonic stenosis; spectral Doppler pulmonic velocity greater than 1·6 m/s; characteristic valve leaflet morphological abnormalities. Exclusion criteria included concurrent significant cardiac defects, including tricuspid dysplasia. Dogs with tricuspid regurgitation were included. Dogs were classified according to Doppler‐derived pressure gradients into mild, moderate or severe pulmonic stenosis categories. Results : Presence of tricuspid regurgitation and severe stenosis were independent predictors of cardiac death. A pulmonic pressure gradient of more than 60 mmHg was associated with 86% sensitivity, and 71% specificity of predicting cardiac death. Clinical Significance : There is an increased probability of cardiac death in those cases which have a pulmonary pressure gradient greater than 60 mmHg and tricuspid regurgitation, though the effect of severity of tricuspid regurgitation on outcome was not measurable because of small sample sizes. These animals might benefit from intervention.  相似文献   

8.
An open patch-graft technique for correction of pulmonic stenosis was performed in four dogs. A synthetic patch-graft was presutured to a partial-thickness incision in the right ventricular outflow tract and to the pulmonary artery along its cranial border. The pulmonary artery and right ventricle were incised during venous inflow occlusion, and dysplastic pulmonic valve leaflets were excised. The arteriotomy was closed by suturing the caudal margin of the incision to the patch-graft. The entire procedure was performed during mild hypothermia (30 degrees - 32 degrees C). The mean circulatory arrest time was 5.5 +/- 0.2 minutes. The mean systolic pressure gradient across the pulmonic valve before surgery was 121 +/- 29 mm Hg; after surgery it was 9 +/- 2 mm Hg.  相似文献   

9.
Valvular pulmonic stenosis has been successfully treated in dogs via minimally invasive transcatheter balloon dilation procedures for almost 20 years. Supravalvular pulmonic stenosis however is not amenable to balloon dilation procedures. Although several surgical procedures are described for treatment of pulmonic stenosis, the morbidity and mortality of these procedures are significantly higher than for transcatheter approaches.Two cases of supravalvular pulmonic stenosis are presented, one acquired and one congenital, which were successfully treated with transcatheter intravascular stent placement. The procedure alleviated the stenotic lesion and resolved clinical signs.  相似文献   

10.
Introduction/objectivesPulmonary artery dissection is a rare complication following balloon valvuloplasty for pulmonic stenosis. We sought to report the rate of this complication in dogs and describe the demographic, clinical, procedural, and outcome data in affected dogs.Animals, materials and methodsMedical records at a single academic institution between 2002 and 2021 were reviewed for dogs with pulmonic stenosis treated by a balloon valvuloplasty. Dogs were included for evaluation if there was evidence of pulmonary artery dissection on echocardiography or necropsy following balloon valvuloplasty. The demographic, clinical, surgical, and follow-up information were then recorded.ResultsSix dogs were included from 210 balloon valvuloplasty procedures for pulmonic stenosis giving a 3.9% rate of pulmonary dissection. There was a variety of signalment, pulmonary valve morphologies, and balloon catheter types used in each dog. All dogs had severe pulmonic stenosis (median pressure gradient of 208 mmHg, range 94–220 mmHg) with 5/6 dogs having a pressure gradient >144 mmHg. The median balloon to pulmonary valve annulus ratio was 1.35 (range 1.25–1.5). Three dogs died perioperatively, and three dogs were alive at follow up 3.3, 4.0, and 4.1 years postoperatively.ConclusionPulmonary artery dissection is a rare complication following balloon valvuloplasty for pulmonic stenosis. Extreme elevations in preoperative pulmonary valve flow velocity were common. Prognosis is variable, with a potential 50% perioperative survival rate, but extended survival times were noted in those patients discharged from hospital.  相似文献   

11.
Objectives : The aim of this study was to report the long‐term outcome of the surgical palliation of pulmonic stenosis in dogs. Methods : The subjects comprised three female and six male dogs, mean (±sd) age: 23 (±25) months, mean (±sd) weight: 3·4 (±2·1) kg, diagnosed with severe pulmonic stenosis and right ventricular hypertrophy, with an average preoperative pressure gradient of 153 (±43) mmHg on echocardiography. Results : The pressure overload with severe pulmonic stenosis was reduced by valvotomy, i.e., open pulmonary valve commissurotomy, with/without biomembrane patch grafting, under cardiopulmonary bypass. The postoperative pressure gradient at 1 to 7 days was significantly decreased to 65 (±39) mmHg (P<0·05). The reduced pressure gradient was maintained at 58 (±38) mmHg at final follow‐up. Clinical Significance : Open valvotomy, pulmonary valve commissurotomy and biomembrane patch grafting were effective in reducing obstruction in severe pulmonic stenosis in dogs.  相似文献   

12.
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.  相似文献   

13.
Tricuspid atresia in a foal   总被引：1，自引：0，他引：1  
An Arabian crossbred foal was examined because of a suspected congenital cardiac anomaly. There was a grade V/V crescendo-decresendo holosystolic murmur and thrill in the left 4th intercostal space. The foal was slightly cyanotic and polycythemic. Electrocardiography suggested left ventricular hypertrophy. Angiography and cardiac and vascular pressure recordings led to a diagnosis of pulmonic stenosis. The foal died after cardiac bypass and corrective surgery. Postmortem examination revealed an enlarged right atrium, atresia of the tricuspid orifice, a large, fenestrated patent foramen ovale, eccentric left ventricular hypertrophy, and a large interventricular septal defect. The right ventricle had a small lumen and a relatively thick wall. There was valvular and supravalvular pulmonic stenosis, with poststenotic dilatation of the pulmonary artery. A single coronary artery originated from the anterior sinus of the aorta.  相似文献   

14.
ObjectivesTo evaluate the natural history of primary pulmonic infundibular stenosis in cats and the effects of balloon valvuloplasty.BackgroundPrimary pulmonic infundibular stenosis is an uncommon congenital defect in cats. The natural history of the disease has not been described. Information regarding balloon valvuloplasty in the cat is limited.AnimalsRecords between January 1, 1999 and December 31, 2005 were reviewed and cats with a confirmed echocardiographic diagnosis of primary pulmonic infundibular stenosis, a complete medical history, and no evidence of significant systemic disease were identified.MethodsEchocardiographic, electrocardiographic, and radiographic findings are described. The natural history of those with severe disease was compared to those with mild to moderate disease. Balloon valvuloplasty was performed in six of the cats. The technique used is described.ResultsA stenotic gradient ≥70 mmHg and a right ventricular outflow tract (measured at the level of the stenosis) to pulmonary valve annulus ratio of ≤0.25 were consistent with clinical and echocardiographic severe disease. Cats with severe disease had a very guarded prognosis with a high incidence of congestive heart failure (CHF). Balloon valvuloplasty was successfully performed in 4 of the cats and appeared to improve prognosis, especially if performed prior to the development of CHF. Concurrent hypertrophic cardiomyopathy complicated the outcome in some cats.ConclusionsSevere primary pulmonic infundibular stenosis carries a very guarded prognosis in the cat. Balloon valvuloplasty should be considered in the presence of severe disease and should be performed prior to the development of CHF if possible. The presence of concurrent hypertrophic cardiomyopathy may complicate the prognosis.  相似文献   

15.
The most common canine congenital heart anomalies include patient ductus arteriosus, ventricular septal defects, tetralogy of Fallot, pulmonic stenosis, and aortic stenosis. Survey radiography and nonselective (venous) angiography can allow the practicing veterinarian to confirm the diagnosis in many of these patients. Typical radiographic findings using these diagnostic procedures are reviewed. Nonselective angiocardiography is a relatively easy, rapid, and noninvasive procedure which can be performed using conventional equipment. The major disadvantage of this special procedure is that the superimposition of opacified structures can make the identification of some left-to-right shunts difficult. Dilution of contrast medium can occur if a rapid bolus injection is not made.  相似文献   

16.
Balloon valvuloplasty was performed on two dogs with pulmonic valve stenosis. Immediately following balloon valvuloplasty, peak right ventricular systolic pressure declined from 92 to 44 mm Hg in the first dog and from 108 to 46 mm Hg in the second dog. The peak systolic pressure gradient across the pulmonic valve declined from 60 to 12 mm Hg in the first dog and from 84 to 22 mm Hg in the second dog. Hemodynamic improvement was sustained in both dogs at the time of recatheterization 3 months later. Both dogs tolerated the procedure well and there were no serious complications. It was concluded that balloon valvuloplasty offers an alternative to surgery for the treatment of valvular pulmonic stenosis in dogs. The exact indications for and limitations of balloon valvuloplasty must await the results of additional and more long-term studies.  相似文献   

17.
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.  相似文献   

18.
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.  相似文献   

19.
The clinical, radiographic and echocardiographic features of two cases of pulmonic stenosis in cats are presented. A rarely reported combination of pulmonic stenosis and tricuspid valve dysplasia is described.  相似文献   

20.
Pulmonic valvuloplasty is a well-established method for the treatment of valvular pulmonic stenosis in people and dogs. In dogs, pulmonic valvuloplasty has been restricted to a single balloon; however, the simultaneous use of two balloons is common in pediatric cardiology. The use of two balloons provides an alternative to the use of a single large balloon in small dogs with a pulmonic anulus size that requires a large dilation catheter and large diameter introducer. Moreover, double balloon valvuloplasty permits dilation in large dogs with large pulmonic anulus sizes for which standard dilation catheters are not available. This report outlines the materials required, describes the technique, gives the advantages and disadvantages encountered when performing percutaneous double balloon valvuloplasty and provides some ‘tips’ for a successful outcome.  相似文献   

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