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Yoshida T, Matsuura K, Chieh‐Jen C, Aboshi Y, Yamada S, Yotsuida H, Hasegawa M, Hendawy HA, El‐Husseiny HM, Takahashi Y, Oonuma Y, Yaginuma Y, Fukuzumi S, Tanaka R. Surgical treatment for left atrial rupture due to myxomatous mitral valve disease in three dogs: A case report. Vet Med Sci 2022; 8:2261-2267. [PMID: 36031776 PMCID: PMC9677371 DOI: 10.1002/vms3.915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Myxomatous mitral valve degeneration (MMVD) is an acquired heart disease which sometimes result in pulmonary oedema and left atrial rupture. In previous reports, left atrial rupture has been non‐surgically controlled and its prognosis investigated. There is, however, no report concerning surgically treated left atrial rupture with mitral valvuloplasty and follow‐up results. Objectives This report aimed to develop a surgical strategy for a case of left atrial rupture caused by MMVD. Materials and methods Three dogs were presented at a private hospital for surgical treatment of MMVD. All three dogs had a previous history of left atrial rupture due to MMVD. The left atrium rapture was diagnosed from indicating that characteristics of the drained pericardial effusion consistent with blood. Mitral valvuloplasty was performed in all dogs using an extracorporeal circulation machine, and the surgical procedure was modified according to each case. In cases with severe adhesion between the pericardial and left atrial appendage, suturing of the left atrial appendage was performed strategically. Additionally, in cases with severe hypotension caused by left atrial rupture, cardiopulmonary bypass was started as soon as possible during the surgical procedure. Discussion and Conclusion Since the haemodynamics of all dogs had improved, and the owner reported no cardiac‐related clinical signs, all drugs were withdrawn 3 months after surgery. Since left atrial rupture due to MMVD can cause hypotension, cardiopulmonary bypass should be started as soon as possible during the surgical procedure to maintain the blood pressure and suturing of the left atrial appendage should be performed strategically.
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Affiliation(s)
- Tomohiko Yoshida
- VCA Japan Shiraishi Animal Hospital Saitama Japan
- Department of Veterinary Surgery Tokyo University of Agriculture and Technology Tokyo Japan
| | - Katsuhiro Matsuura
- VCA Japan Shiraishi Animal Hospital Saitama Japan
- Department of Veterinary Surgery Tokyo University of Agriculture and Technology Tokyo Japan
| | | | - Yuki Aboshi
- VCA Japan Shiraishi Animal Hospital Saitama Japan
| | | | - Hideki Yotsuida
- Department of Clinical Engineering National Cerebral and Cardiovascular Center Osaka Japan
| | | | - Hanan A. Hendawy
- Department of Veterinary Surgery Tokyo University of Agriculture and Technology Tokyo Japan
| | - Hussein M. El‐Husseiny
- Department of Veterinary Surgery Tokyo University of Agriculture and Technology Tokyo Japan
- Faculty of Veterinary Medicine Department of Surgery Anesthesiology, and Radiology Benha University, Moshtohor, Toukh, Elqaliobiya Egypt
| | | | - Yuki Oonuma
- VCA Japan Shiraishi Animal Hospital Saitama Japan
| | | | - Shou Fukuzumi
- Department of Veterinary Surgery Tokyo University of Agriculture and Technology Tokyo Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery Tokyo University of Agriculture and Technology Tokyo Japan
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Yoshida T, Matsuura K, Mandour AS, Aboshi Y, Yamada S, Yotsuida H, Hasegawa M, Cheng CJ, Yaginuma Y, Watanabe M, Fukuzumi S. Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty. Vet Sci 2022; 9:vetsci9040178. [PMID: 35448675 PMCID: PMC9031179 DOI: 10.3390/vetsci9040178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
Protamine, an antagonizing agent to heparin, is indispensable for dogs undergoing cardiopulmonary bypass. Protamine-induced hypotension (PIH) during cardiac anesthesia has been reported in humans. The purpose of this study was to describe the hemodynamic effect of protamine administration in dogs during cardiac surgery in clinical cases. Study design: Retrospective, clinical, cohort study. A total of 14 client-owned dogs who suffered heart failure due to medically uncontrolled myxomatous mitral valve disease (MMVD) were included in this study. The severity of MMVD was classified according to American College of Veterinary Internal Medicine staging (ACVIM: stage B2, C, D) and dogs undergoing mitral valve surgery. Records with clinical data for dogs treated between July 2019 to August 2020 were examined for age, sex, breed, body weight, concurrent diseases, hospitalization, anesthetic record, and mortality within 3 months after the operation. PIH was defined as mean arterial pressure (MAP) lowered by 20% of that before protamine infusion. To evaluate the effect of protamine on hemodynamic variables, each of the other values was compared with values at the beginning of protamine infusion. MAP decreased by 41.0 and 45.7% in two dogs (14.3%) compared with pressure before protamine infusion. Others did not show obvious alteration in hemodynamic variables. Epinephrine treatment alleviated hypotension in one dog. Another dog with systemic hypotension concomitant with elevated central venous pressure did not respond to epinephrine treatment and a reboot of extracorporeal circulation was required. Reheparinization and reinstitution of cardiopulmonary bypass successfully resuscitate the second dog. In conclusion, clinicians should alert the incidence of severe hypotension even with slow protamine infusion following canine cardiac surgery. This study also provides two effective treatments for catastrophic hypotension during protamine infusion.
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Affiliation(s)
- Tomohiko Yoshida
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
| | - Katsuhiro Matsuura
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
- Correspondence: (K.M.); (A.S.M.)
| | - Ahmed S. Mandour
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
- Department of Animal Medicine, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: (K.M.); (A.S.M.)
| | - Yuki Aboshi
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Shusaku Yamada
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Hideki Yotsuida
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan;
| | - Mizuki Hasegawa
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Chieh-Jen Cheng
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
| | - Youta Yaginuma
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Momoko Watanabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
| | - Shou Fukuzumi
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
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