Page 16 - eclipse - Autumn 2018

CLINICAL NEWS
World-first heart surgery combination saves puppy
In July this year the RVC鈥檚 cardiothoracic surgery team successfully carried out tricuspid valve repair surgery along with repair of the common atrium of a puppy. It is the first time these procedures have been carried out on a dog in the same operation.
Lottie, an 11-month-old Labrador puppy, appeared full of life with no problems until her owners took her to their local vets to be spayed. During a routine check before that procedure a grade VI/VI right apical pansystolic murmur was auscultated.
A subsequent echocardiogram, conducted by Emily Dutton, Director of Cheshire Cardiology and Specialist in Veterinary Cardiology, identified a large atrial septal defect and tricuspid valve dysplasia.
Lottie was referred to the RVC鈥檚 cardiothoracic team for further evaluation and to see if there was anything that could be done to help her. The team, which is led by Dan Brockman, Professor of Small Animal Surgery, is notable for performing several cutting-edge cardiac surgeries, including a world-first treatment to save the life of a dog born with a malformed tricuspid valve.
At the RVC Lottie underwent 2D
and 3D echocardiogram and a CT angiogram. She was diagnosed with severe tricuspid valve dysplasia with a tethered septal leaflet and abnormal right ventricular papillary muscle anatomy causing torrential tricuspid regurgitation. Her atrial septal defect was so large it was classed as
a common atrium and she had
a persistent left cranial vena cava.
Repair of the tricuspid valve has only been performed a handful of times and has not been done at the same time as repair of a common atrium. Nevertheless, Lottie鈥檚 owners decided to proceed
with a surgical correction to try and help extend Lottie鈥檚 otherwise limited life and to preserve a good quality of life.
Commenting on the surgery and
the number of different practitioners involved, Poppy Bristow, Fellow
in Cardiothoracic Surgery, said: 鈥淎ltogether 10 people were involved in her operation and many more for her care before and after surgery, including veterinary specialists, veterinary nurses and veterinary specialists-in-training from surgery, cardiology, anaesthesia and emergency and critical care, as well as Lottie鈥檚 referring cardiologist and her local veterinary practice.
鈥淟ottie鈥檚 heart was stopped for an hour and a half, with the whole operation taking four hours. Her malformed tricuspid valve was released by cutting its abnormal attachments, and artificial chords using Gore-Tex material were placed. A tricuspid annuloplasty was performed and her single atrium was then divided into two using a large patch of Gore-Tex.鈥�
Dan Brockman added: 鈥淭he repair was complex but incorporated a combination of surgical manoeuvres that we had done before. With careful pre-operative planning and using our previous experience, we were able to design and execute the surgical treatment. It is still 鈥榚arly days鈥� but the initial signs suggest that Lottie is going to enjoy an excellent quality of life, following this operation and, we all hope, a normal lifespan.鈥�
See the November edition of Clinical Connections for a detailed account of the surgery.
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