Coronary Angiogram on Dogs

Dogs in the Cardiac Cath Lab

Opening up human cath labs to our furry friends

A Cardiac Catheterisation suite is an environment full of expensive technology and staffed with highly qualified people. But what about the patients? Are they all the same? Are gender, ethnicity or socio-economic background relevant factors which might influence our behaviour? Do we sometimes give VIP services to patients?

I have, during the course of my work, witnessed VIP treatment offered to patients. The irony is that the recipients of this first class service were not requesting such a level of attention. In fact, although the patients were by no means intellectually challenged, they could not understand what the procedure was all about. This was due simply to the fact that they all belong to the canine species.

Balloon valvuloplasty on dogs is a proper technique for relief of valvular pulmonic stenosis which is occasionally performed in “Homo Sapien” Cath Labs.

Cardiologists are, from time to time, approached by Veterinarians requesting access to their Cath Lab to treat dogs requiring pulmonic valvuloplasty. I had the opportunity to be involved in one of these cases. While working in general radiography I had in the past x-rayed cats and dogs (usually performed after-hours and with a certain level of discretion), nevertheless a valvuloplasty under GA is not a procedure that can go unnoticed.

Balloon valvuloplasty of pulmonic stenosis is a minimally invasive procedure associated with fewer complications and a shorter recovery time than other surgical options. This procedure often has an excellent outcome. The ideal result is a gradient that is to near normal pressures (<20 mmHg); this is achieved approximately 70-80% of the time.

Case Study

An 11 month old Kelpie (Narla) initially presented with two episodes of collapse while doing minimal exercise. On her first visit her pressure gradient across the pulmonic valve was 100 mmHg compared to 120 mmHg 4 months later. She had been on atenolol for 3 months.

Brief Technical Description
Narla was anaesthetised and placed on left lateral decubitus position. The initial plan was to perform a cut down to gain access to the RJV but after discussion with the Interventional Cardiologist a percutaneous approach was selected and a 9 F introducer sheath was inserted. A Swan Ganz/balloon catheter was then introduced and haemodynamic measurements were made in the RVOT. Pull back from PA to RV to RA was performed. The next step was to use a Maxi LD balloon from Cordis 18 x 40 mm to reduce the pulmonic stenosis. Repeat pull back was done followed by a second inflation with a Maxi LD 20 x 40 and a final inflation with a 22 x 40 mm Maxi LD balloon. The sheath was removed and the dog was awake without any complications.

Staff involved
1 Interventional Cardiologist
3 Veterinarians (Cardiologist, Anaesthetist, Internist)
1 Veterinary Nurse
1 Radiographer
1 Monitoring Technician

Outcome
The pressure gradient was reduced by half (from 100 mmHg to 50 mmHg) immediately following the procedure. Narla is now doing wonderfully well! Her pressure gradient is 55 mmHg.

Anecdotal

Narla is a farm dog and her male owner was not keen to spend money on expensive procedures but luckily the daughter and wife of the farmer were able to secretly save money for Narla’s treatment. All the Cath Lab staff donated their time and Cordis Australia supplied the balloons free of charge. This VIP patient will be remembered for a long time and has made me discover an interesting facet of interventional cardiology.


Narla Arrives Above from left to right: Dr xxx xxx (interventional Cardiologist) and his daughter, Narla (patient), and Dr xxx xxx (Cardiologist Veterinarian)

Narla Arrives Above from left to right: Dr xxx xxx (interventional Cardiologist) and his daughter, Narla (patient), and Dr xxx xxx (Cardiologist Veterinarian)

Above: Narla anaesthetised on the cath lab table

Above: Narla anaesthetised on the cath lab table

Swan-Ganz in PA

Swan-Ganz in PA

Injection of contrast media in RV

Injection of contrast media in RV

Dilatation of pulmonic valve with 22 x 40 mm Maxi LD balloon

Dilatation of pulmonic valve with 22 x 40 mm Maxi LD balloon


 

Author details and location withheld upon request

 

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