01142: Cutting Balloon Valvuloplasty for Dogs with Subaortic Stenosis
Grant Status: Closed
Treatment for subaortic stenosis (SAS) in canine clinical patients is frustrating and there exists a great need from both the veterinary community and the dog owner/breeder population for better treatment options. Balloon dilation is a type of interventional procedure used very commonly, and effectively, in veterinary medicine for dogs with stenosis of the pulmonary valve. Balloon dilation in dogs with SAS however, has not been proven effective or beneficial. A new balloon dilation catheter has been developed for use in the management of resistant coronary artery and peripheral pulmonary artery lesions in humans. The balloon has been modified to have very small blades, approximately 2mm, which are used to score or cut the stenotic, or narrowed, tissue when the balloon is maximally inflated. This technique has proven successful in children and young adults with lesions previously resistant to balloon dilation. Another type of new balloon dilation catheter can achieve very high pressures and is currently used in the management of aortic valve stenosis and interventional aortic valve replacement in humans. This study uses these new techniques and procedures in dogs with severe SAS, in hopes of providing a new treatment option for this currently untreated disease in dogs. To date, we have safely used cutting balloon and high pressure balloon valvuloplasty in twelve dogs with severe SAS. All dogs had improvement in the parameters of their echocardiogram, or ultrasound of their heart. There was an average successful outcome of a 33% decrease in the pressure gradient associated with the abnormal area below the aortic valve. This success has been maintained for 6 months in 10 dogs. We continue to monitor and recheck all twelve dogs to obtain further recheck information. All dogs continue to do well clinically at home and nine dogs reportedly have a dramatic increase in their energy level. None of the dogs sustained any lasting complications or injuries as a result of this experimental interventional procedure. All twelve dogs did have arrhythmias, or abnormal heart rhythms, during the procedure. These arrhythmias were transient and did not require follow-up treatment in eight dogs. Four dogs required intravenous medication post-operatively, an additional night of hospitalization, and were discharged with oral anti-arrhythmic therapy. It is unknown whether these dogs were having these arrhythmias prior to the procedure. One patient developed an infection in the small incision, which was treated aggressively with surgical removal of the infected skin and antibiotic therapy. He has since completely recovered and is doing very well at home. We continue to enroll patients with severe subaortic stenosis for balloon valvuloplasty.
Kleman, M. E., Estrada, A. H., Maisenbacher, H. W., Prošek, R., Pogue, B., Shih, A., & Paolillo, J. A. (2012). How to perform combined cutting balloon and high pressure balloon valvuloplasty for dogs with subaortic stenosis. Journal of Veterinary Cardiology, 14(2), 351–361. https://doi.org/10.1016/j.jvc.2011.11.008
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