Left atrial decompression as a palliative minimally invasive treatment for congestive heart failure caused by myxomatous mitral valve disease in dogs: 17 cases (2018–2019)

Abstract

OBJECTIVE To determine whether left atrial decompression (LAD) would reduce left atrial pressure (LAP) in dogs with advanced myxomatous mitral valve disease (MMVD) and left-sided congestive heart failure (CHF) and to describe the LAD procedure and hemodynamic alterations and complications. ANIMALS 17 dogs with advanced MMVD and left-sided CHF that underwent LAD. PROCEDURES The medical record database was retrospectively reviewed for all LAD procedures attempted in dogs with MMVD and left-sided CHF between October 2018 and June 2019. Data were collected regarding signalment (age, breed, weight, and sex), clinical signs, treatment, physical examination findings, and diagnostic testing before and after LAD. Procedural data were also collected including approach, technique, hemodynamic data, complications, and outcome. RESULTS 18 LAD procedures performed in 17 patients were identified. Dogs ranged in age from 7.5 to 16 years old (median, 11 years) and ranged in body weight from 2.9 to 11.6 kg (6.4 to 25.5 lb) with a median body weight of 7.0 kg (15.4 lb). Minimally invasive creation of an atrial septal defect for the purpose of LAD was successful in all dogs without any intraoperative deaths. Before LAD, mean LAP was elevated and ranged from 8 to 32 mm Hg with a median value of 14 mm Hg (reference value, < 10 mm Hg). Following LAD, there was a significant decrease in mean LAP (median decrease of 6 mm Hg [range, 1 to 15 mm Hg]). Survival time following LAD ranged from 0 to 478 days (median, 195 days). CONCLUSIONS AND CLINICAL RELEVANCE For dogs with advanced MMVD and left-sided CHF, LAD resulted in an immediate and substantial reduction in LAP.

Double Outlet Right Atrium in an American Domestic Shorthair Cat

“… 20 Once CHF has developed, minimally invasive procedures such as atrial septostomy of the deviated IAS could potentially be considered as a palliative treatment option, as it may delay the progression of CHF as it has in other types of cardiac disease, resulting in elevated LA pressure in veterinary medicine. 21 …”

Self-Reported Utilization of International (ACVIM Consensus) Guidelines and the Latest Clinical Trial Results on the Treatment of Dogs with Various Stages of Myxomatous Mitral Valve Degeneration: A Survey among Veterinary Practitioners

“…Another reason could be cultural, in that Dutch veterinarians do not expect Dutch owners to spend large amounts of money on cardiac surgery, especially abroad, in elderly dogs. Similarly, nobody mentioned left atrial decompression as a palliative and minimally invasive interventional procedure using transseptal puncture [ 23 ]. The most likely reason for this finding is that the application of this technique in dogs is fairly new, and therefore, it is not widely known nor used.…”

“…The clinical stage of the disease, caused by CHF, is divided into an early (stage C) and a therapy-resistant late stage (stage D) [ 4 ]. The primary goal of treatment in stages C and D is to improve the quality of life by resolving the clinical signs [ 4 , 5 , 7 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Prospective evaluation of complications associated with transesophageal echocardiography in dogs with congenital heart disease

“…As the applications have expanded in the veterinary field to include small dogs, diagnostic imaging and intraoperative monitoring techniques have evolved. 2 , 3 Transesophageal echocardiography (TEE) allows clinicians to collect superior high‐resolution images of the heart during procedures that is not otherwise possible with routine transthoracic echocardiography. 4 Transesophageal echocardiography is an indispensable tool in both the more common procedures, such as patent ductus arteriosus (PDA) occlusion and balloon valvuloplasty (BV) of pulmonary valve stenosis (PS), as well as in the management of less common and complex CHD before occlusion and repair.…”

“…Minimally invasive and hybrid interventional procedures have emerged as successful treatment options for many congenital cardiac anomalies. As the applications have expanded in the veterinary field to include small dogs, diagnostic imaging and intraoperative monitoring techniques have evolved 2,3 . Transesophageal echocardiography (TEE) allows clinicians to collect superior high‐resolution images of the heart during procedures that is not otherwise possible with routine transthoracic echocardiography 4 .…”