Fatal acute lung injury after balloon valvuloplasty in a dog with pulmonary stenosis |
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| Institution: | 1. Anicura Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy;2. Department of Veterinary Sciences, University of Pisa, Via Livornese lato monte, 56122 San Piero a Grado, Pisa, Italy;3. Anicura Clinica Veterinaria CMV Varese, Viale Padre P.G. Aguggiari 162, 21100 Varese, Italy;4. Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2, 10095 Grugliasco, Turin, Italy;1. Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA;2. Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce St, Philadelphia, PA 19104, USA;1. Small Animal Teaching Hospital, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire, CH64 7TE, UK;2. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire, CH64 7TE, UK;1. Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, Ontario, N1G 2W1, Canada;2. Department of Pathobiology, Ontario Veterinary College, University of Guelph, 419 Gordon St., Guelph, Ontario, N1G 2W1, Canada;3. Mississauga Oakville Veterinary Emergency and Specialty Hospital, 2285 Bristol Circle, Oakville, Ontario, L6H 6P8, Canada;1. Division of Cardiology, Matsubara Animal Hospital, Matsubara-shi, Osaka 580-0044, Japan;2. Faculty of Veterinary Medicine, Okayama University of Science, Imabari-shi, Ehime 794-8555, Japan;3. Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Tokyo 183-8538, Japan;1. Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido, 060-0818, Japan;2. Laboratory of Veterinary Internal Medicine, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki, 889-2192, Japan |
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| Abstract: | A one-year-old French Bulldog was referred for the management of a severe form of pulmonary valve stenosis (PS) complicated by right-sided congestive heart failure.Echocardiography showed severe valvular PS with right ventricular concentric hypertrophy, dilatation and severe right atrial enlargement. A pulmonary balloon valvuloplasty (PBV) was performed with a balloon-to-pulmonary annulus ratio of 1.36. Echocardiography immediately after PBV showed a significant reduction in right atrial and ventricular size, improved opening and mobility of the pulmonary valve leaflets, and a 75% reduction in the pulmonary pressure gradient from 158 mmHg pre-operative to 40 mmHg post-operative. The dog recovered well from anesthesia, but 2 h later, it suddenly showed severe respiratory distress. Focus cardiac ultrasound showed increased left cardiac size with echocardiographic signs of high left ventricular filling pressure. Bedside lung ultrasound showed diffuse numerous-to-confluent B lines, compatible with a severe alveolar-interstitial syndrome. The dog was treated with furosemide, helmet continuous positive airway pressure, and then mechanical ventilation but without success.At post-mortem evaluation, histological examination of the lung showed diffuse, severe broncho-alveolar edema with mixed leukocyte, fibrin, and red blood cell infiltrate. Moreover, severe congestion and multifocal alveolar hemorrhages were evident. All findings were compatible with fatal acute lung injury after PBV secondary to pulmonary reperfusion-ischemia injury and increased pulmonary capillary hydrostatic pressure. Based on the present case, acute lung injury should be considered as a rare but serious complication of PBV. |
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| Keywords: | French Bulldog Pulmonary edema Reperfusion Cardiology Canine |
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