Vascular ring anomalies in cats: 20 cases (2000‐2018)

Abstract

ObjectiveTo report the clinical characteristics, types of vascular ring anomalies (VRA), operative findings, complications, and survival after surgical treatment of cats with VRA.Study designRetrospective, multi‐institutional case series.AnimalsClient‐ or shelter‐owned cats presenting to academic, referral veterinary institutions.MethodsMedical records of cats with VRA that underwent surgical treatment were reviewed. Signalment, relevant medical history, clinical signs, diagnostic imaging, surgical findings, complications, and survival were recorded.ResultsTwenty cats with VRA were included. Vascular ring anomalies were most commonly (75% [15/20]) diagnosed in cats less than 1 year old, with no breed or sex predilection. Regurgitation was the most common clinical sign, present in 18 of 20 (90%) cats. A persistent right aortic arch was diagnosed in 17 of 20 (85%) cats, with concurrent aberrant left subclavian artery in four of the cats. Surgical treatment was associated with survival to discharge in 18 of 20 (90%) cats. Persistent clinical signs were reported in nine of 13 (69%) cats, and radiographic evidence of megaesophagus persisted in four of 13 (31%) cats, with a median follow‐up of 275 days after discharge.ConclusionPersistent right aortic arch was the most commonly diagnosed VRA in cats in this series, although multiple anomalies were observed. Surgical treatment of VRA in cats was associated with a high survival to discharge, although persistence of clinical signs and megaesophagus was noted in 69% and 31% of the cats, respectively.Clinical significanceSurgical treatment of VRA in cats is associated with a high survival rate; however, persistence of clinical signs is an expected outcome.

Surgical correction of a persistent right aortic arch in a kitten with concurrent mitral and tricuspid valve insufficiency and long‐term post‐operative management of residual megaoesophagus

“…Reports vary from introducing solid food a day after surgery, to feeding small, blended diets fed from a height for up to three months after surgery before introducing solid food 17,19,21,23,24,26 . It has however been shown, that some cats may need to remain on a gruel diet for the remainder of their lives to manage clinical signs 7,10,17,21,23 . It is important that owners should be warned of the possibility of failure of surgical treatment and a need for lifelong management of clinical signs.…”

“…In a recent case study of 20 cats diagnosed with VRAs, 85% (17/20) had PRAA as the primary VRA, with four of these cats presenting with concurrent aberrant left subclavian artery 7 . A total of 43 other cases (that the authors are aware of) of VRAs in cats has been described in scientific literature dating as far back as 1960 1–3,5,6,8–28,32–33,36,37 .…”

“…PRAA is one the most frequently described and most commonly diagnosed congenital heart abnormalities in the cat 9 . In a recent case series of 20 cats, PRAA was also found to be the most commonly diagnosed VRA in cats 7 . A PRAA develops when the right fourth arch, instead of the left fourth arch, becomes the functional adult aorta and the left ductus arteriosus forms a band between the left pulmonary artery and the anomalous right aorta causing an oesophageal constriction 2…”

“…Oesophageal enlargement with a narrowed strictured area at the heart base along with tracheal deviation is highly suggestive of a compressive VRA 30 . While survey radiography or contrast radiography is sensitive for diagnosing a VRA, computed tomography with angiographic studies is recommended to identify the type of VRA and aberrant vessels and to assist with surgical planning 7,8,32,33 . Oesophagoscopy is often not used as a diagnostic modality in suspected VRA cases.…”

“…Owners may report swelling of the cervical region while eating followed by regurgitation 11,16–18 . Kittens generally present under 6 months of age, underweight for their age and reportedly smaller than the rest of the littermates 5,7,8,11,12,15,16,19–28 …”