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Phillips V, Linney C, Pedro B, Neves J, Mavropoulou A, Sarcinella F, Swift S, Sparks T, Mathis A. Prophylactic use of a lidocaine constant rate infusion versus saline in dogs undergoing balloon valvuloplasty for management of pulmonic stenosis: A randomized control trial. Vet Anaesth Analg 2023; 50:388-396. [PMID: 37302956 DOI: 10.1016/j.vaa.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/06/2023] [Accepted: 04/29/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the effect of a prophylactic lidocaine constant rate infusion (CRI) on the incidence and malignancy of catheter-induced ventricular ectopic complexes (VECs) during balloon valvuloplasty for management of pulmonic stenosis in dogs. STUDY DESIGN Single-centre, prospective, randomized study. ANIMALS Client-owned dogs (n = 70) with pulmonic stenosis. METHODS Dogs were randomly assigned to one of two anaesthetic protocols: administration of lidocaine 2 mg kg-1 bolus followed by a CRI (50 μg kg-1 minute-1; group LD) or a saline placebo (group SL) during balloon valvuloplasty. All dogs were premedicated with methadone (0.3 mg kg-1) intramuscularly and a digital three-lead Holter monitor was applied. Anaesthetic co-induction was performed with administration of alfaxalone (2 mg kg-1) and diazepam (0.4 mg kg-1), and anaesthesia was maintained with isoflurane vaporised in 100% oxygen. CRIs were started on positioning of the dog in theatre and discontinued as the last vascular catheter was removed from the heart. All dogs recovered well and were discharged 24 hours postoperatively. Blinded Holter analysis was performed by an external veterinary cardiologist using commercially available dedicated analysis software; p < 0.05. RESULTS Of the 70 dogs enrolled in the study, 61 were included in the final analysis: 31 in group LD and 30 in group SL. There was no significant difference between sinus beats (p = 0.227) or VECs (p = 0.519) between groups. In group LD, 19/31 (61.3%) dogs had a maximum ventricular rate ≥250 units and 20/30 (66.7%) dogs in group SL (p = 0.791). CONCLUSION AND CLINICAL RELEVANCE In this study, the use of a prophylactic lidocaine bolus followed by CRI in dogs undergoing balloon valvuloplasty for management of pulmonic stenosis did not significantly decrease the incidence nor the malignancy of VECs during right heart catheterization compared with a saline CRI.
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Affiliation(s)
| | | | | | - Joao Neves
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | | | | | - Simon Swift
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - Tim Sparks
- Waltham Petcare Science Institute, Leicestershire, UK
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Wieser M, Ringer SK, Baron Toaldo M. Pericardial tamponade during balloon pulmonary valvuloplasty in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Manuela Wieser
- Department of Clinical Diagnostics and Services Section of Anaesthesiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Simone Katja Ringer
- Department of Clinical Diagnostics and Services Section of Anaesthesiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Marco Baron Toaldo
- Clinic for Small Animal Internal Medicine Division of Cardiology Vetsuisse Faculty University of Zurich Zurich Switzerland
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LeBlanc NL, Agarwal D, Menzen E, Nomi K, Sisson DD, Scollan KF. Prevalence of major complications and procedural mortality in 336 dogs undergoing interventional cardiology procedures in a single academic center. J Vet Cardiol 2019; 23:45-57. [PMID: 31174729 DOI: 10.1016/j.jvc.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Overall complication rates associated with a wide range of diagnostic and therapeutic interventional cardiac procedures in a contemporary academic setting have not been reported. ANIMALS, MATERIALS AND METHODS Consecutive interventional procedures performed for client-owned dogs were retrospectively analyzed to characterize procedural complications and mortality. RESULTS Three hundred sixty-four procedures were performed on 336 dogs. Interventions included attempted or completed transvenous pacemaker (PM) implantation (n = 134) with subsequent pacing system revision (n = 8), pulmonic balloon valvuloplasty (BVP) (n = 117) with a subset of patients undergoing an additional BVP (n = 14), transarterial closure of left-to-right shunting patent ductus arteriosus (PDA) (n = 66), diagnostic angiography and/or cardiovascular pressure measurement (n = 9), transvenous temporary pacing (n = 7), septal defect occlusion (n = 5), heartworm extraction (n = 3), and BVP catheter fragment retrieval (n = 1). The prevalence of major perioperative and postoperative complications for all procedures was 5% and 6%, respectively, and the procedural mortality rate was 2%. The overall rate of major complications was 12% for the PM group, 11% for the BVP group, and 2% for the PDA occlusion group. Both PM implantation and BVP have higher rates of major complications overall compared with PDA occlusion (p=0.0151). CONCLUSIONS The results of this study indicate that the prevalence of major complications and mortality associated with interventional cardiac procedures is low; however, significant differences exist in complication rates between procedures.
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Affiliation(s)
- N L LeBlanc
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA.
| | - D Agarwal
- MedVet Medical and Cancer Center for Pets, Cardiology Department, 3964 Red Bank Road, Cincinnati, Ohio 45227, USA
| | - E Menzen
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K Nomi
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - D D Sisson
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K F Scollan
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
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Abstract
BACKGROUND PBV is the treatment of choice for humans with pulmonic stenosis and whilst this procedure has been used in dogs the longer term benefits remain to be evaluated. OBJECTIVES The purpose of this study was to evaluate the long term effects of pulmonary balloon valvuloplasty (PBV) in dogs with congenital pulmonic stenosis, with respect to clinical signs, echocardiographic parameters and survival time. Methods - Pulmonic stenosis was diagnosed in 24 dogs between 1990-1999. Eighteen cases were treated with PBV, six were not treated. RESULTS Twelve of the treated cases were alive and asymptomatic at the time of writing. Follow up periods ranged from six months to nine years post PBV. Prior to treatment the mean Doppler pressure gradient across the pulmonic valve was 98mmHg, 24 hours post treatment the mean was 65mmHg and in the long term this was maintained at 64mmHg. Three of the dogs (17 per cent) treated with PBV restenosed during the follow up period. Four of the six untreated dogs were alive at the time of writing, two to four and a half years after presentation. The mean Doppler gradient for this group was 89 mm Hg on presentation. CONCLUSION At this stage in the follow up period there is no significant difference in survival times between the treated and untreated groups. However, symptomatic dogs with pulmonic stenosis treated with PBV have experienced a reduction in clinical signs and therefore an improved quality of life.
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Tobias AH, Stauthammer CD. Minimally invasive per-catheter occlusion and dilation procedures for congenital cardiovascular abnormalities in dogs. Vet Clin North Am Small Anim Pract 2010; 40:581-603. [PMID: 20610013 DOI: 10.1016/j.cvsm.2010.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
With ever-increasing sophistication of veterinary cardiology, minimally invasive per-catheter occlusion and dilation procedures for the treatment of various congenital cardiovascular abnormalities in dogs have become not only available, but mainstream. Much new information about minimally invasive per-catheter patent ductus arteriosus occlusion has been published and presented during the past few years. Consequently, patent ductus arteriosus occlusion is the primary focus of this article. Occlusion of other less common congenital cardiac defects is also briefly reviewed. Balloon dilation of pulmonic stenosis, as well as other congenital obstructive cardiovascular abnormalities is discussed in the latter part of the article.
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Affiliation(s)
- Anthony H Tobias
- Veterinary Clinical Sciences Department, University of Minnesota, St Paul, MN 55108, USA.
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Estrada A, Moïse NS, Erb HN, McDonough SP, Renaud-Farrell S. Prospective Evaluation of the Balloon-to-Annulus Ratio for Valvuloplasty in the Treatment of Pulmonic Stenosis in the Dog. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01799.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sun F, Usón J, Crisóstomo V, Maynar M. Interventional cardiovascular techniques in small animal practicediagnostic angiography and balloon valvuloplasty. J Am Vet Med Assoc 2005; 227:394-401. [PMID: 16121605 DOI: 10.2460/javma.2005.227.394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Fei Sun
- Endoluminal Therapy and Diagnosis Department, Minimally Invasive Surgery Centre, Cáceres, Spain
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Estrada A, Moïse NS, Renaud-Farrell S. When, how and why to perform a double ballooning technique for dogs with valvular pulmonic stenosis. J Vet Cardiol 2005; 7:41-51. [DOI: 10.1016/j.jvc.2004.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Revised: 11/01/2004] [Accepted: 12/01/2004] [Indexed: 10/25/2022]
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Johnson MS, Martin M, Edwards D, French A, Henley W. Pulmonic Stenosis in Dogs: Balloon Dilation Improves Clinical Outcome. J Vet Intern Med 2004. [DOI: 10.1111/j.1939-1676.2004.tb02602.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Percutaneous catheter-based treatment of pulmonic stenosis and patent ductus arteriosus in a dog. J Vet Cardiol 2002; 4:29-34. [DOI: 10.1016/s1760-2734(06)70036-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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MacLean HN, Abbott JA, Pyle RL. Balloon Dilation of Double-Chambered Right Ventricle in a Cat. J Vet Intern Med 2002. [DOI: 10.1111/j.1939-1676.2002.tb01268.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Martin JM, Orton EC, Boon JA, Mama KR, Gaynor JS, Bright JM. Surgical correction of double-chambered right ventricle in dogs. J Am Vet Med Assoc 2002; 220:770-4, 768. [PMID: 11918270 DOI: 10.2460/javma.2002.220.770] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Double-chambered right ventricle (DCRV) is possibly an emerging congenital cardiac anomaly in dogs. The defect causes clinical and pathophysiologic signs similar to those of congenital pulmonic stenosis in dogs but has distinct diagnostic features, breed predilections, and implications for treatment. The defect is often associated with clinical signs early in life. Surgical correction of DCRV can be undertaken with the aid of cardiopulmonary bypass and offers the prospect of an improved clinical outcome.
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Affiliation(s)
- Julie M Martin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins 80523, USA
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Kunze SP, Abbott JA, Hamilton SM, Pyle RL. Balloon valvuloplasty for palliative treatment of tricuspid stenosis with right-to-left atrial-level shunting in a dog. J Am Vet Med Assoc 2002; 220:491-6, 464. [PMID: 11860245 DOI: 10.2460/javma.2002.220.491] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 3.75-year-old castrated male Chesapeake Bay Retriever was referred for evaluation of tachypnea, exercise intolerance, and cyanosis. Echocardiographically, there was severe tricuspid stenosis and right-to-left atrial-level shunting of blood. Marked compensatory polycythemia had developed; the PCV was 75%. Balloon dilation of the tricuspid stenosis was performed. Subsequent echocardiographic examinations demonstrated a reduction in the pressure gradient across the tricuspid valve. The PCV returned to the reference range, and the dog's clinical status improved during the 12 months after the procedure. Tricuspid stenosis is an uncommon lesion in dogs and, in the dog of this report, was assumed to have resulted from tricuspid dysplasia. Cyanosis was a result of right-to-left shunting of blood. Limited treatment is available for dogs with cyanotic heart disease. In this dog, balloon dilation of the stenotic tricuspid valve was palliative.
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Affiliation(s)
- stopher P Kunze
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg 24061, USA
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Bussadori C, DeMadron E, Santilli RA, Borgarelli M. Balloon Valvuloplasty in 30 Dogs with Pulmonic Stenosis: Effect of Valve Morphology and Annular Size on Initial and 1-Year Outcome. J Vet Intern Med 2001. [DOI: 10.1111/j.1939-1676.2001.tb01590.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Matsumoto H, Sugiyama S, Shibazaki A, Tanaka R, Takashima K, Noishiki Y, Yamane Y. Experimental study of materials for patch graft on right ventricular outflow tract under extracorporeal circulation in dogs--comparison between Denacol EX-313-treated bovine jugular vein graft and expanded polytetrafluoroethylene (EPTFE) graft. J Vet Med Sci 2001; 63:961-5. [PMID: 11642283 DOI: 10.1292/jvms.63.961] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A comparison between a bovine jugular vein treated with a hydrophilic polyepoxy compound cross-linker (Denacol), and expanded polytetrafluoroethylene (EPTFE), an artificial material, as a patch graft for the reconstruction of the right ventricular outflow tract under extracorporeal circulation in dogs, as if they had pulmonic stenosis, was made. Hemodynamic and histological examinations were conducted two weeks after the transplantation. Hemodynamic problems were not observed in either the Denacol or EPTFE groups. Macroscopically, organization of new tissue on the graft surface was more marked in the EPTFE group than in the Denacol group, and newly-formed tissue was seen surrounding the border of the graft and burying it in the EPTFE group. In the Denacol group, microscopic findings revealed the presence of inflammatory cells and fibroblasts, and an invasion of the graft by collagen fibers and elastic fibers. In the EPTFE group, there was minimal cellular infiltration of the graft and a thick layer consisting of collagen fibers and fibroblasts was observed around the graft. These results indicated that two weeks after transplantation the graft was better assimilated and organized with blood vasculature in the patch graft in the Denacol group than in the EPTFE group.
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Affiliation(s)
- H Matsumoto
- Animal Clinical Research Foundation, Kurayoshi-shi, Tottori, Japan
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Oguchi Y, Matsumoto H, Masuda Y, Takashima H, Takashima K, Yamane Y. Balloon dilation of right ventricular outflow tract in a dog with tetralogy of Fallot. J Vet Med Sci 1999; 61:1067-9. [PMID: 10535516 DOI: 10.1292/jvms.61.1067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Balloon dilation was performed on a dog with tetralogy of Fallot. Immediately following balloon dilation, the peak systolic pressure gradient across the pulmonic valve declined from 97 to 63 mmHg. Doppler echocardiography following balloon dilation revealed increased pulmonary blood flow. Clinical symptoms obviously improved and the dog's improved condition was maintained for 4 months. There were no serious complications in performing the procedure. It was concluded that balloon dilation was a safe and effective treatment for a dog case with tetralogy of Fallot. Long-term follow-up studies will be required to identify the exact indications of balloon dilation for tetralogy of Fallot.
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Affiliation(s)
- Y Oguchi
- Tottori Animal Clinical Research Foundation, and Tokyo University of Agriculture and Technology, Japan
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Grifka RG, Miller MW, Frischmeyer KJ, Mullins CE. Transcatheter occlusion of a patent ductus arteriosus in a Newfoundland puppy using the Gianturco-Grifka vascular occlusion device. Vet Med (Auckl) 1996; 10:42-4. [PMID: 8965268 DOI: 10.1111/j.1939-1676.1996.tb02023.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R G Grifka
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, USA
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Abstract
Balloon dilation during cardiac catheterization was evaluated for the treatment of congenital subaortic stenosis (SAS) in nine dogs. Under general anesthesia, bilateral cardiac catheterization was performed through the right jugular vein and carotid artery. Thermodilution cardiac output, and left ventricular and aortic root pressures and angiograms were obtained before and after balloon dilation. Balloons measuring 18-20 mm in diameter and 30-40 mm in length were positioned across the stenosis and three inflations 4-5 minutes apart were performed. There was no significant change in cardiac output, aortic pressure, or degree of aortic regurgitation after balloon dilation. For the entire group balloon dilation resulted in significant decreases in left ventricular systolic pressure (-61.2 +/- 37.2 mm Hg [mean change +/- SD], range -14 to -123), mean systolic pressure gradient (-39.6 +/- 24.4 mm Hg, range -8.4 to -72.2), and peak systolic pressure gradient (-64.3 +/- 46.5 mm Hg, range -17 to -143). Calculated left ventricular outflow cross-sectional area increased significantly (+.4 +/- .5 cm2, range -.06 to + 1.30). Clinical signs improved in the five symptomatic dogs. Individual hemodynamic responses varied widely, but the magnitude of improvement correlated with the severity of obstruction. Three dogs showed a decrease of 60% or greater (> or = 100 mm Hg), and six dogs showed a decrease of 25-50% (17-71 mm Hg) in peak systolic gradient after balloon dilation. Complications were frequent but most were transient and manageable. These preliminary results suggest that balloon dilation can acutely decrease outflow resistance in dogs with SAS and may be effective therapy for some affected dogs.
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Affiliation(s)
- L A DeLellis
- Department of Veterinary Medicine, University of California, Davis
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Martin MWS, Godman M, Fuentes VL, Clutton RE, Haight A, Darke PGG. Assessment of balloon pulmonary valvuloplasty in six dogs. J Small Anim Pract 1992. [DOI: 10.1111/j.1748-5827.1992.tb01200.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brownlie SE, Cobb MA, Chambers J, Jackson G, Thomas S. Percutaneous balloon valvuloplasty in four dogs with pulmonic stenosis. J Small Anim Pract 1991. [DOI: 10.1111/j.1748-5827.1991.tb00537.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Orton EC, Bruecker KA, McCracken TO. An open patch-graft technique for correction of pulmonic stenosis in the dog. Vet Surg 1990; 19:148-54. [PMID: 2333687 DOI: 10.1111/j.1532-950x.1990.tb01157.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- E C Orton
- Veterinary Teaching Hospital, Colorado State University, Fort Collins 80523
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