The development of ventricular fibrillation as a complication of pericardiectomy in 16 dogs

Abstract

Objective To describe the clinical characteristics, perioperative protocols, and outcomes in dogs diagnosed with ventricular fibrillation (VF) while undergoing pericardiectomy. Study design Retrospective, multi‐institutional study. Animals Sixteen client‐owned dogs. Methods Cases were accrued through a listserve request posted to 3 subspecialty veterinary societies. Dogs were included if they developed VF during a pericardiectomy performed through an open or thoracoscopic approach. Data collected included signalment, history and physical examination, surgical approach, histopathology, treatment, and outcome. Results Indications for pericardiectomy included idiopathic chylothorax (n = 7), neoplasia (4), idiopathic pericardial effusion (4), and foreign body granuloma (1). Surgical approaches included thoracoscopy (12), intercostal thoracotomy (3) and median sternotomy (1). Electrosurgical devices were used to complete at least part of the pericardiectomy in 15 of 16 dogs. Ventricular fibrillation appeared to be initiated during electrosurgical use in 8/15 dogs. However, in 5/15 dogs it was not obviously associated with electrosurgical use. In 3/16 dogs the timing of initiation of VF was unclear. In 7/16 dogs, cardiac arrhythmias were noted prior to the development of VF. Fourteen of 16 dogs died from intraoperative VF. Conclusion In most dogs ventricular fibrillation was a fatal complication of pericardiectomy. Ventricular fibrillation might be associated with the use of electrosurgical devices and cardiac manipulation during pericardiectomy although a causal link could not be established from the data in this study. Clinical significance Surgeons must be aware of the risk of VF during pericardial surgery. Electrosurgery might need to be used judiciously during pericardiectomy, particularly in dogs exhibiting cardiac arrythmias.

Resolution, recurrence, and chyle redistribution after thoracic duct ligation with or without pericardiectomy in dogs with naturally occurring idiopathic chylothorax

“…This generally fatal complication was recently highlighted in a report of 16 dogs that developed ventricular fibrillation during pericardiectomy, of which 7 were being treated for IC. 21 In addition to the potential morbidity associated with pericardiectomy, in this study, the procedure added a median of 73 minutes of surgical time over TDL alone, a difference which was statistically significant. On the basis of these findings, there does not appear to be very good evidence to support the use of pericardiectomy in dogs without evidence of CPP.…”

Percutaneous Thoracic Duct-Cistena Chyli Coil and Glue Embolization via Antgrade Sublumbar Cisterna Chyli Access in a Cat with Chylothorax

“…In a study by Mayhew et al [7] perioperative mortality for TDL-SP cases was 11% (1/9), whereas TDL cases had 0% (0/17) perioperative mortality. A recent article [30] described 16 canine cases of periprocedural ventricular fibrillation (VF) after pericardiectomy, seven of the pericardiectomies were performed due to IC. Development of VF was associated with high mortality in this cases series.…”

Oncología: Diagnóstico de casos clínicos

“…Otras opciones de tratamiento son la radioterapia y quimioterapia sistémica o terapia alvo, este último aún requiere de más estudios. [13][14][15] .…”