Long‐Term Outcome in Dogs with Patent Ductus Arteriosus: 520 Cases (1994–2009)

Abstract

BackgroundPublished information regarding survival and long‐term cardiac remodeling after patent ductus arteriosus (PDA) closure in dogs is limited.ObjectivesTo report outcome and identify prognostic variables in dogs with PDA, and to identify risk factors for persistent remodeling in dogs with a minimum of 12 months of follow‐up after closure.AnimalsFive hundred and twenty client‐owned dogs.MethodsRetrospective review of medical records of 520 dogs with PDA. Outcome was determined by contacting owners and veterinarians. Dogs with PDA closure and ≥ 12 months of follow‐up were asked to return for a re‐evaluation.ResultsIn multivariable analysis of 506 dogs not euthanized at the time of diagnosis, not having a PDA closure procedure negatively affected survival (HzR = 16.9, P < .001). In 444 dogs undergoing successful PDA closure, clinical signs at presentation (HzR = 17, P = .02), concurrent congenital heart disease (HD) (HzR = 4.8, P = .038), and severe mitral regurgitation (MR) documented within 24 hours of closure (HzR = 4.5, P = .028) negatively affected survival. Seventy‐one dogs with ≥ 12 months follow‐up demonstrated a significant reduction in radiographic and echocardiographic measures of heart size (P = 0) and increased incidence of acquired HD (P = .001) at re‐evaluation. Dogs with increased left ventricular size and low fractional shortening at baseline were more likely to have persistent remodeling at re‐evaluation.Conclusions and Clinical ImportancePatent ductus arteriosus closure confers important survival benefits and results in long‐term reverse remodeling in most dogs. Clinical signs at presentation, concurrent congenital HD, and severe MR negatively affect survival. Increased left ventricular systolic dimensions and systolic dysfunction at baseline correlated significantly with persistent remodeling.

Management of incidentally detected heart murmurs in dogs and cats

“…In 1 retrospective study, 36 dogs with severe pulmonic stenosis that did not undergo balloon-valve dilation had a worse outcome than those that did; the same results have been found for dogs with corrected versus uncorrected patent ductus arteriosus in multiple studies. 37,38 Failure to identify advanced cardiac disease prior to general anesthesia or IV fluid therapy can result in unexpected signs of CHF. Conversely, failure to identify a murmur as nonpathological (and therefore clinically benign) can lead to needless owner anxiety and an unjustifiably guarded prognosis.…”

Incidence of postoperative implant-related bacterial endocarditis in dogs that underwent trans-catheter embolization of a patent ductus arteriosus without intra- and post-procedural prophylactic antibiotics

“…Despite the large number of dogs whose PDA is embolized with an implant worldwide, only 3 cases have been reported with device-related infective endocarditis, of which one had an ACDO and 2 had coils (Wood et al, 2006;Fine and Tobias, 2007;Saunders et al, 2014). The single study that describes the frequency of PDA-occlusion-device-related infection in dogs reported an incidence of 4.3% (2 of 47 dogs) (Fine and Tobias, 2007).…”

“…Publications about the short-and long term results of trans-catheter closure of canine PDAs either do not mention the use of intra-procedureal prophylactic antibiotics (Achen et al, 2008;Gordon et al, 2010;Saunders et al, 2014), or they state that the use of prophylactic antibiotics is an integrated part of the institutional or personal protocol (Fine and Tobias, 2007;Caivano et al, 2012;Singh et al, 2012;Stauthammer, 2015).…”

“…Because of the high mortality rate when left untreated, elective closure of left-to-right shunting PDAs is generally recommended at the earliest age possible (Saunders et al, 2014). Several techniques have been described for closure of a PDA (Cambell et al, 2006;Glaus et al, 2003;Goodrich et al, 2007;Singh et al, 2012).…”

“…Prophylactic antibiotics are routinely administered in a number of centers in the perioperative period to dogs that undergo therapeutic cardiac catheterization for embolization of a PDA (Fine and Tobias, 2007;Caivano et al, 2012;Saunders et al, 2014). In the absence of canine studies or veterinary guidelines for cardiac catheterization procedures regarding antibiotic prophylaxis (Vasseur et al, 1985;Daude-Lagrave et al, 2001;Boothe and Boothe, 2015), the routine use of primary antibiotic prophylaxis is presumably based on human recommendations.…”