![]() ![]() Biochemical parameters revealed increased blood urea nitrogen (38.2 mg/dl, reference range: 9.2–29.9 mg/dl) and decreased Na (132.4 mmol/L, reference range: 142–152 mmol/L), and Cl (103.9 mmol/L, reference range: 105–117 mmol/L). An electrocardiogram showed sinus arrest with a 2 to 3-second period of asystole. Echocardiography revealed MMVD with prolapse of the anterior and posterior leaflets, severe left atrial enlargement (LA/Ao 2.84), a normalized left ventricular internal dimension in diastole (LVIDDN) of 2.37, and an elevated E velocity (178 cm/s) (Fig. A grade IV/VI systolic murmur over the left cardiac apex was noted on presentation. The patient was in good health except for mild polydipsia. Osaka, Japan,10 mg/kg, BID) due to history of pulmonary edema and syncope had been prescribed. Pimobendan (Vetmedin Boehringer Ingelheim, Ingelheim, Germany, 0.5 mg/kg, BID), torasemide (Luprac Mitsubishi Tanabe Pharma Corporation, Osaka, Japan, 0.25 mg/kg, BID), enalapril (Enacard Boehringer Ingelheim, Ingelheim, Germany, 0.5 mg/kg, BID), and cilostazol (Cilostazol Sawai Pharmaceutical Co., Ltd. LAA closure with an AtriClip was also performed to reduce the postoperative risk of thrombosis.Īn 11-year-old castrated male 7.5-kg Miniature Schnauzer was brought to Shiraishi Animal Hospital, Saitama, Japan, for surgical treatment of MMVD ACVIM stage C. After the intracardiac procedure, a pacemaker was implanted to treat an emergency cardiac arrest. We performed mitral valvuloplasty for a case of severe MMVD accompanied by bradyarrhythmia. Since severe arrhythmia promotes thrombi, LAA closure is frequently needed to prevent thrombus formation in the left atrium. A pacemaker is occasionally required for severe arrhythmia during surgery for valvular disease. In particular, the incidence of postoperative thrombosis and arrhythmia is very high and can be fatal. Mitral valvuloplasty outcomes have improved in recent years, but postoperative complications such as thromboembolism, arrhythmia, and renal failure, in some cases, have resulted in death. On the other hand, in small animal medicine, mitral valvuloplasty is often superior to valve replacement when considering the need for permanent antithrombotic therapy and the issues of biocompatibility of the latter. For humans with congestive heart failure, medical care includes surgical mitral valvuloplasty and valve replacement to treat mitral regurgitation. However, in MMVD cases with congestive heart failure prognosis may be poor. Medical treatment can improve a dog’s clinical condition and prolong its lifespan with congestive heart failure, as shown in several recent clinical trials and studies. Myxomatous mitral valve disease (MMVD) is the most common acquired heart disease in dogs. LAA closure may be considered to protect against decreased atrial function after mitral valvuloplasty and prevent intra-atrial thrombus formation. Conclusionsįor surgical MMVD cases complicated with impaired sinus function, the chances of spontaneous sinus rhythm are low, requiring pacemaker implantation. The owner reported no postoperative complications (i.e., thrombosis), and the patient was brought for a check-up 4 months after the operation in good health. ![]() All cardiac drugs were discontinued 3 months after surgery. Sinus rhythm was restored 5 days postoperatively however, the patient continued pacemaker dependent. Cardiac remodeling and congestion were ameliorated after surgery. In addition, LAA closure with an AtriClip was performed to prevent intra-atrial thrombus formation. Based on this surgical outcome, a permanent pacemaker was implanted. After coronary reperfusion, there was no spontaneous electrical activity. Mitral valvuloplasty was performed with cardiopulmonary bypass to treat the MMVD. ![]() Sinus arrest with 2 to 3-second periods of asystole was identified by electrocardiogram. Echocardiography revealed an enlarged left atrium and ventricle secondary to MMVD. Case presentationĪn 11-year-old castrated 7.5-kg male Miniature Schnauzer with a history of congestive heart failure was brought to Shiraishi Animal Hospital for MMVD surgical treatment. Also, due to an intrinsic procoagulant state and severe arrhythmia after the MVP, left atrial appendage (LAA) closure was performed to reduce the postoperative risk of thrombosis. We treated a dog with severe MMVD complicated by impaired sinus function with MVP and pacemaker implantation. However, postoperative complications such as thromboembolism, arrhythmia, and pancreatitis in some cases have resulted in death. Mitral valvuloplasty (MVP) has been widely recognized as a treatment option for myxomatous mitral valve disease (MMVD). ![]()
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