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1.
J Vet Cardiol ; 53: 52-59, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38688090

ABSTRACT

Transcatheter pulmonary valve implantation (TPVI) is indicated for use in the management of failing pulmonary valves in humans. We report here the long-term follow-up of the first documented transcatheter pulmonary valve implanted in a client-owned dog. A one-year-old Beagle dog with severe congenital type A valvular pulmonic stenosis first underwent percutaneous balloon pulmonary valvuloplasty, leading two years later to severe pulmonary regurgitation. A TPVI using a Melody™ bioprosthetic valve was then successfully performed, with normalization of the right heart cavities. Repeated two- and three-dimensional transthoracic echocardiographic examinations combined with Doppler modes confirmed the appropriate position and function of the valve for four years. Mitral myxomatous valvular degeneration led to refractory left-sided congestive heart failure, and the dog was humanely euthanized. After postmortem examination, X-ray imaging and histopathological evaluation of the stent and the valve were performed. Ex-vivo imaging of the implanted valve using a Faxitron® Path radiography system and microscopic evaluation of the implanted stent and bioprosthetic leaflets did not show any relevant leaflet or stent alterations. This case provides a proof of concept in interventional veterinary cardiology, showing that TPVI can be performed in dogs with subsequent long-term maintaining normal pulmonary valve function.


Subject(s)
Dog Diseases , Heart Valve Prosthesis Implantation , Pulmonary Valve Stenosis , Pulmonary Valve , Animals , Dogs , Dog Diseases/surgery , Dog Diseases/diagnostic imaging , Dog Diseases/pathology , Pulmonary Valve Stenosis/veterinary , Pulmonary Valve Stenosis/diagnostic imaging , Pulmonary Valve Stenosis/surgery , Pulmonary Valve/surgery , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/pathology , Heart Valve Prosthesis Implantation/veterinary , Heart Valve Prosthesis Implantation/instrumentation , Echocardiography, Three-Dimensional/veterinary , Pulmonary Valve Insufficiency/veterinary , Pulmonary Valve Insufficiency/surgery , Pulmonary Valve Insufficiency/diagnostic imaging , Echocardiography/veterinary , Bioprosthesis/veterinary , Male , Heart Valve Prosthesis/veterinary , Female
2.
Vet Clin North Am Small Anim Pract ; 53(6): 1343-1352, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37798048

ABSTRACT

Both open surgical repair and a hybrid-interventional option are now available for mitral valve repair (MVR) at select veterinary centers worldwide, making the need for awareness of options and the intricacies around case selection of increasing importance. This article will overview both options currently available and their current stages of progress.


Subject(s)
Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Animals , Mitral Valve/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/veterinary , Heart Valve Prosthesis Implantation/veterinary , Treatment Outcome
3.
J Vet Cardiol ; 26: 10-18, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31785529

ABSTRACT

Transcatheter pulmonary valve (TPV) implantation is a therapeutic approach approved by the United States Food and Drug Administration for human patients with failing pulmonary conduits in 2010 and for failing bioprosthetic surgical pulmonary valves in 2017. We report here the first successful transcatheter implantation of a stented valve in a pulmonary position in a dog with congenital pulmonary valve disease. A 3-year-old, 10.9 kg, client-owned Beagle dog was referred for a follow-up visit after a percutaneous balloon valvuloplasty performed 22 months before for treatment of a severe type A valvular pulmonary stenosis. The Doppler-derived peak pressure gradient was 348 mmHg before the procedure and 66 mmHg 24 h after. The dog was lethargic. Echocardiography revealed a mild pulmonary stenosis (pressure gradient-43 mmHg), severe pulmonary regurgitation, and secondary severe right ventricular and right atrial dilation. Worsening of right heart dilation was observed 2 months later despite medical therapy. A TPV implantation was performed using a prestented Melody bovine jugular bioprosthetic valve. The dog recovered uneventfully and was discharged 10 days after the procedure. Right heart dilation resolved within 15 days. The dog was doing well 7 months after valve implantation. This case demonstrates that TPV implantation with a stented valve is technically feasible in dogs with severe pulmonary valve disease. Stringent postoperative care, with particular attention to thrombosis and infectious endocarditis, and appropriate sizing and positioning of the valve stent are keys to the success of this procedure.


Subject(s)
Cardiac Catheters/veterinary , Dog Diseases/surgery , Heart Valve Prosthesis Implantation/veterinary , Heart Valve Prosthesis/veterinary , Pulmonary Valve Insufficiency/veterinary , Animals , Cardiac Catheterization/methods , Cardiac Catheterization/veterinary , Dog Diseases/diagnostic imaging , Dogs , Female , Heart Valve Prosthesis Implantation/methods , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/surgery
5.
Article in English | MEDLINE | ID: mdl-28106960

ABSTRACT

Left ventricular assist device implantation disrupts the natural intracavitary blood flow path through the heart, introducing flow patterns potentially associated with thrombosis, especially around the inflow cannula. We describe a novel technique for completely excluding the left ventricle with an assist device by using a cone shaped ring-reinforced prosthesis.


Subject(s)
Heart Failure/surgery , Heart Valve Prosthesis Implantation/instrumentation , Animals , Cattle , Heart Failure/veterinary , Heart Valve Prosthesis Implantation/veterinary , Swine , Treatment Outcome
7.
J Vet Cardiol ; 14(1): 185-92, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22366571

ABSTRACT

Prognosis for dogs with severe mitral regurgitation is poor with medical therapy alone. Open surgical mitral valve repair consisting of circumferential mitral annuloplasty and artificial chordal replacement confers durability and improved long-term clinical outcome without a need for long-term antithrombotic therapies. This approach has been successfully used in canine patients, including small-breed dogs. Methods for mitral valve repair applicable to small dogs are described.


Subject(s)
Dog Diseases/surgery , Mitral Valve Insufficiency/veterinary , Animals , Cardiopulmonary Bypass/methods , Cardiopulmonary Bypass/veterinary , Dogs , Heart Valve Prosthesis Implantation/veterinary , Mitral Valve Insufficiency/surgery
8.
J Invest Surg ; 24(5): 222-6, 2011.
Article in English | MEDLINE | ID: mdl-21867392

ABSTRACT

BACKGROUND: The purpose of this study was to define an experimental model and a reproducible surgical technique for the preclinical assessment of safety and biocompatibility of a novel intra-annular internal aortic annulus repair device. METHODS: Adult sheep were implanted with HAART Inc's 19 mm aortic annulus repair device via a transverse aortotomy using standard anesthetic, surgical, and cardiopulmonary bypass techniques. Animals were closely monitored throughout the study period until the time of elective sacrifice at 30 or 60 days. RESULTS: Six adult sheep, mean age 63.2 weeks, mean weight 68.8 kg, underwent aortic annuloplasty with a 19 mm annuloplasty frame. Five of the sheep remained stable until scheduled sacrifice. The primary outcome of this study was animal mortality. Early mortality was seen in only one animal (16.7%), due to a surgical complication. Mild-to-moderate aortic insufficiency was observed in all animals upon echocardiographic examination at the time of elective sacrifice. CONCLUSIONS: Of the six animals that underwent aortic annuloplasty, there was one early death due to surgical complication. The remaining five subjects were clinically stable at the time of elective sacrifice. Any conclusions regarding the cause of the observed aortic insufficiency are beyond the scope of this feasibility study but would need to be fully evaluated in the preclinical assessment of any internal aortic annuloplasty device. We have shown that we have developed a reproducible surgical technique in a physiologically appropriate model for the preclinical assessment of internal aortic annulus repair devices.


Subject(s)
Aortic Valve/surgery , Heart Valve Prosthesis Implantation/methods , Animals , Aortic Valve Insufficiency/surgery , Feasibility Studies , Female , Heart Valve Prosthesis Implantation/veterinary , Male , Sheep/surgery , Treatment Outcome
9.
J Vet Cardiol ; 13(2): 91-9, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21640677

ABSTRACT

OBJECTIVE: To describe the surgical technique and report outcome of dogs undergoing bioprosthesis valve replacement for severe tricuspid regurgitation (TR) secondary to congenital tricuspid valve dysplasia (TVD). ANIMALS, MATERIALS AND METHODS: Twelve client-owned dogs (19-43 kg) with TVD underwent tricuspid valve replacement with a bovine pericardial or porcine aortic bioprosthesis with the aid of cardiopulmonary bypass. Anticoagulation with warfarin was maintained for 3 months after surgery and then discontinued. RESULTS: Ten of 12 (83.3%) dogs survived surgery and were discharged from the hospital. Seven dogs were alive with complete resolution of TR for a median period of 48 months (range 1-66 months) after surgery. Two dogs underwent euthanasia because of bioprosthesis failure due to inflammatory pannus at 10 and 13 months after surgery. Two dogs experienced valve thrombosis that was resolved by tissue plasminogen activator. One dog developed suspected endocarditis after surgery that was resolved with antibiotics. Serious cardiac complications included atrial fibrillation and flutter, right-to-left shunt through an uncorrected patent foramen ovale, complete atrioventricular block, and sudden cardiac arrest. Postoperative atrial fibrillation or flutter did not occur in 7 dogs treated prophylactically with oral amiodarone before surgery. CONCLUSIONS: Curative intermediate-term outcomes are possible in dogs undergoing open tricuspid valve replacement with a bioprosthesis. Prosthesis-related complications include inflammatory pannus, thrombosis, and endocarditis. Postoperative atrial fibrillation or flutter can be reduced or prevented by prophylactic preoperative treatment with amiodarone. Several identified complications are avoidable or can be reduced with increased awareness and experience with these techniques.


Subject(s)
Bioprosthesis/veterinary , Dog Diseases/surgery , Heart Valve Prosthesis Implantation/veterinary , Heart Valve Prosthesis/veterinary , Tricuspid Valve Insufficiency/veterinary , Tricuspid Valve/surgery , Animals , Dog Diseases/congenital , Dogs , Female , Heart Valve Prosthesis Implantation/methods , Male , Postoperative Complications/epidemiology , Postoperative Complications/veterinary , Treatment Outcome , Tricuspid Valve/abnormalities , Tricuspid Valve Insufficiency/congenital , Tricuspid Valve Insufficiency/surgery
10.
Vet Surg ; 36(3): 190-8, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17461942

ABSTRACT

OBJECTIVES: To describe an open, beating heart surgical technique and use of a bovine pericardial prosthetic valve for mitral valve replacement (MVR) in the dog. STUDY DESIGN: Clinical case report. ANIMALS: Male Bull Terrier (17-month-old, 26 kg) with mitral valve dysplasia and severe regurgitation. METHODS: A bovine pericardial bioprosthesis was used to replace the mitral valve using an open beating heart surgical technique and cardiopulmonary bypass. RESULTS: Successful MVR was achieved using a beating heart technique. Mitral regurgitation resolved and cardiac performances improved (left ventricular end-diastolic diameter decreased from 57.6 to 48.7 mm, and left atrium/aorta ratio returned to almost normal, from 1.62 to 1.19). Cardiopulmonary by-pass time and total surgical duration were decreased compared with standard cardioplegic techniques. Surgical recovery was uneventful and on echocardiography 6 months later valve function was excellent. CONCLUSION: Considering the technique advantages (no cardiac arrest, ischemic reperfusion injury, and hypothermia, or the need for aortic dissection and cannulation for administration of cardioplegic solution), short-term mortality and morbidity may be reduced compared with standard cardioplegic techniques. CLINICAL RELEVANCE: Based on experience in this dog, beating heart mitral valvular replacement is a seemingly safe and viable option for the dog and bovine pericardial prosthesis may provide better long-term survival than mechanical prostheses.


Subject(s)
Bioprosthesis/veterinary , Dog Diseases/surgery , Heart Valve Prosthesis Implantation/veterinary , Heart Valve Prosthesis/veterinary , Mitral Valve Stenosis/veterinary , Mitral Valve , Pericardium/transplantation , Animals , Cattle , Dog Diseases/diagnostic imaging , Dog Diseases/pathology , Dogs , Male , Mitral Valve Stenosis/surgery , Ultrasonography
11.
Rev. colomb. cienc. pecu ; 19(4): 415-425, dic. 2006. ilus, tab
Article in Spanish | LILACS | ID: lil-462968

ABSTRACT

En el ámbito mundial, las investigaciones sobre la patología valvular porcina se limitan casi enteramente a la válvula mitral y existe muy poca información sobre alteraciones   de la válvula aórtica. Las válvulas aórticas porcinas son utilizadas comúnmente como bioimplantes en humanos. Por esta razón en este estudio se propusieron los siguientes objetivos: caracterizar la patología valvular aórtica en cerdos seleccionados para la elaboración de bioprótesis valvulares cardíacas, discutir los mecanismos involucrados en el desarrollo de dichas lesiones y analizar los criterios de selección para determinar la confiabilidad del implante. Para esto se recolectaron al azar 50 corazones con lesiones evidentes de la válvula aórtica y 50 sin lesiones evidentes. Las válvulas se procesaron por el método histopatológico de rutina y se realizaron las tinciones de Hematoxilina-Eosina y azul alciano-PAS. Los resultados se evaluaron mediante estadística descriptiva e inferencia estadística; además, se realizó un análisis mediante la prueba de Chi-cuadrado utilizando el programa SPSS versión 1.0 para determinar asociaciones entre las variables macroscópicas y microscópicas. Las lesiones microscópicas y su frecuencia en los dos grupos estudiados fueron, respectivamente, las siguientes: trastornos vasculares 84 por ciento y 38 por ciento; endocardiosis 80 por ciento y 4 por ciento; fenestraciones 48 por ciento, únicamente en las que tenían lesiones obvias; valvulitis 42 por ciento y 24 por ciento. Se presentan y se correlacionan las principales alteraciones macro y microscópicas; así como los posibles mecanismos implicados en su desarrollo. Este estudio es el primero, en Colombia, que caracteriza las alteraciones patológicas de la válvula aórtica porcina.


Subject(s)
Aortic Valve , Bioprosthesis , Heart Valve Prosthesis Implantation/veterinary , Pathology, Veterinary , Swine , Transplants/veterinary
12.
J Am Vet Med Assoc ; 226(9): 1508-11, 1500, 2005 May 01.
Article in English | MEDLINE | ID: mdl-15882001

ABSTRACT

Eight dogs with naturally occurring severe mitral regurgitation underwent mitral valve replacement with a mechanical valve prosthesis during cardiopulmonary bypass. Dogs received warfarin orally after surgery to maintain a prothrombin time-based international normalized ratio from 2.5 to 3.5. Seven dogs survived surgery. Left ventricular diastolic volume index decreased significantly from 206 +/- 91 mL/m2 before surgery to 121 +/- 47 mL/m2 after surgery. Left atrium-to-aorta ratio decreased significantly from 2.66 +/- 0.4 before surgery to 1.73 +/- 0.65 after surgery. Left ventricular systolic volume index was not significantly different after surgery (56 +/- 36 mL/m2), compared with before surgery (40 +/- 32 mL/m2). Median survival after surgery was 4.5 months (range, 0.75 months to 5.25 years). Six dogs died of confirmed or suspected thrombosis of the valve prosthesis. Dogs with severe mitral regurgitation tolerated mitral valve replacement well, but a high incidence of prosthetic valve thrombosis limited long-term outcome.


Subject(s)
Dog Diseases/surgery , Heart Valve Prosthesis Implantation/veterinary , Heart Valve Prosthesis/veterinary , Mitral Valve Insufficiency/veterinary , Mitral Valve , Animals , Anticoagulants/administration & dosage , Dog Diseases/mortality , Dogs , Heart Valve Prosthesis Implantation/mortality , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/mortality , Mitral Valve Insufficiency/surgery , Surgery, Veterinary/instrumentation , Surgery, Veterinary/methods , Survival Analysis , Thrombosis/etiology , Thrombosis/mortality , Thrombosis/veterinary , Treatment Outcome , Warfarin/administration & dosage
13.
Contemp Top Lab Anim Sci ; 39(5): 20-5, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11040870

ABSTRACT

Increased use of the ovine animal model in cardiovascular surgical research has created a salient need for standardized echocardiography techniques. To demonstrate a reproducible image in this species and confirm the validity of echocardiography as a diagnostic tool, we implanted 10 sheep with a pulmonary valve homograft and monitored them through weekly echocardiographic examinations until 20 weeks after implantation. We obtained good images from the left cranial and the left caudal transducer windows without needing to sedate the animals. Sedated sheep yielded adequate views from the right apical window. Echocardiographic data on the implanted homografts (including functional capacity, presence of calcification, and hemodynamic information and measurements), completely agreed with the results of the post-explantation examinations.


Subject(s)
Echocardiography, Doppler, Color/veterinary , Heart Valve Prosthesis Implantation/veterinary , Pulmonary Valve/surgery , Sheep/surgery , Animals , Disease Models, Animal , Female , Heart Valve Prosthesis Implantation/methods , Male , Pulmonary Valve/physiology , Reproducibility of Results , Sheep/physiology
14.
Contemp Top Lab Anim Sci ; 39(4): 43-6, 2000 Jul.
Article in English | MEDLINE | ID: mdl-11487230

ABSTRACT

A female Dorset-cross sheep developed labored respirations and was anorexic, weak, ataxic and febrile (42.0 degrees C) 15 days after implantation of a cardiac device. Clinical pathologic evaluation identified a mild leukocytosis (11,800 cells/microl), neutrophilia (8,969 cells/microl), and hypokalemia (2.9 mmol/L). Despite intensive therapy, the animal was euthanized 7 days later. Necropsy of the sheep revealed meningitis and vegetative endocarditis associated with the cardiac device. Blood cultures collected antemortem and tissue cultures collected at necropsy yielded Streptococcus suis. Histopathology confirmed the diagnosis of bacterial valvular endocarditis and meningoencephalitis. A variety of environmental and host factors are proposed as contributing to the infection, and the zoonotic potential of S. suis is discussed.


Subject(s)
Endocarditis, Bacterial/veterinary , Heart Valve Prosthesis Implantation/veterinary , Heart Valve Prosthesis/adverse effects , Meningitis, Bacterial/veterinary , Sheep Diseases/microbiology , Streptococcal Infections/veterinary , Streptococcus suis/pathogenicity , Animals , Endocarditis, Bacterial/etiology , Endocarditis, Bacterial/pathology , Female , Heart Valve Prosthesis/microbiology , Heart Valve Prosthesis Implantation/adverse effects , Meningitis, Bacterial/etiology , Meningitis, Bacterial/pathology , Sheep , Sheep Diseases/etiology , Sheep Diseases/pathology , Streptococcal Infections/etiology , Streptococcal Infections/pathology , Streptococcus suis/isolation & purification
16.
ASAIO J ; 43(5): M382-6, 1997.
Article in English | MEDLINE | ID: mdl-9360066

ABSTRACT

Clotting mechanisms, the coagulation cascade, platelet function, and platelet-leukocyte-endothelial cell interactions are all very similar in humans and pigs. Because of these similarities, the authors concluded that the pig would be an ideal model for the study of thromboembolism resulting from prosthetic heart valves. To date, they have successfully recovered a total of 11 pigs (52.9 +/- 8.1 kg), 3 with bioprosthetic valves and 8 with mechanical valves, all in the mitral position (25 mm od). The normal presence of high numbers of pulmonary endothelial macrophages and other unique aspects of porcine cardiovascular and pulmonary function dictate somewhat different surgical protocols than those normally used for human patients and ruminant species. Some of these special procedures include 1) crystalloid prime without the use of plasma volume expanders, especially those with a starch base; 2) pharmacologic protection against arrhythmias (lidocaine, 4 mg/kg); 3) special attention to adequate hypothermic cardioprotection during the time of cross-clamp; 4) the use of shock doses of corticosteroid (prednisolone sodium succinate, 0.5 mg/kg) before removal of the aortic cross-clamp; and 5) positive inotropic support (dopamine, 0.008 mg/kg) while weaning from cardiopulmonary bypass. Gamma camera images of 111In tagged autologous platelets 24 hours after surgery show most thrombi located on the sewing ring with fewer on the pledgets and anchor sutures. The latter observations were confirmed by quantification of platelet deposition using a gamma counter.


Subject(s)
Bioprosthesis/veterinary , Heart Valve Prosthesis Implantation/veterinary , Mitral Valve , Swine/surgery , Animals , Bioprosthesis/adverse effects , Blood Platelets/physiology , Disease Models, Animal , Female , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis/veterinary , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/methods , Humans , Indium Radioisotopes , Male , Mitral Valve/pathology , Platelet Adhesiveness , Thromboembolism/etiology , Thromboembolism/pathology , Thromboembolism/physiopathology
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