Successful closure of left-to-right patent ductus arteriosus in three dogs with concurrent pulmonary hypertension

doi:10.1016/j.jvc.2009.12.002

Journal of Veterinary Cardiology

Volume 12, Issue 1, April 2010, Pages 67-73

https://doi.org/10.1016/j.jvc.2009.12.002 Get rights and content

Abstract

Closure of reversed patent ductus arteriosus (PDA) is generally accepted to be contraindicated due to case based evidence of worsened outcomes, but little is known about closure of left-to-right PDA with concurrent pulmonary hypertension (PH). This report describes three dogs presenting with varying severity of PH and clinical signs, all with documented left-to-right PDA. The PDA was closed in each case; either by surgical ligation or transarterial device occlusion, and follow up was available for a minimum of 8 months. Every case had a successful outcome with improvement or resolution of PH and associated clinical signs.

Section snippets

Case 1

A 5-month-old 0.9 kg female Chihuahua presented to the University of Florida Veterinary Medical Center (UFVMC) for evaluation of a murmur, which had been detected during routine examination at 3 months of age. The owner reported that the dog was clinically normal at the time of presentation. On physical examination, a grade IV/VI left basilar continuous murmur was ausculted and the remainder of physical examination was within normal limits. Thoracic radiographs revealed severe generalized

Case 2

A 3-month-old 1.25 kg female Pomeranian, was referred to the UFVMC for evaluation of a previously diagnosed left-to-right PDA. The dog had clinical and radiographic signs of congestive heart failure which were controlled with furosemide^e (3.2 mg/kg PO q12 h). On initial presentation to the UFVMC, physical examination findings included a grade V/VI continuous left basilar murmur and bounding femoral pulses. The

Case 3

A 3-year-old 22.8 kg cryptorchid male Golden Retriever was referred to the UFVMC after being diagnosed 3 weeks previously with a left-to-right PDA, PH, and atrial fibrillation. Additionally, right-sided congestive heart failure was diagnosed based on the findings of hepatomegaly with mild ascites, mild pleural effusion, and mild pericardial effusion. He was treated with furosemide^h (2.4 mg/kg PO q12 h), enalaprilⁱ

Discussion

Failure of the ductus arteriosus to close at birth classically results in left-to-right shunting, but in a reversed PDA, blood shunts right-to-left due to increased pulmonary vascular resistance. This may occur from birth due to persistence of fetal pulmonary physiology, or alternatively, it may develop later in life. Exposure of the pulmonary vasculature to high flow, especially with large diameter shunts, may induce progressive pulmonary microvascular changes, including medial hypertrophy,

Acknowledgements

The authors thank the Small Animal Surgery Service at the UFVMC for successful surgical PDA ligation and assistance in post-operative management of cases 1 and 2.

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Cited by (12)

Transarterial correction of patent ductus arteriosus in small dogs with the Amplatz™ Vascular Plug 4: A pilot study
2021, Journal of Veterinary Cardiology
Citation Excerpt :
All dogs in this study exhibited subjective or objective volume overload of the left ventricle except for the dog with pulmonary hypertension. This dog had a partial response to sildenafil, and occlusion was performed due to the possibility that pulmonary hypertension may reduce following closure of the PDA [22]. Unfortunately, pulmonary hypertension did not improve even with complete closure of the PDA.
Determine if the Amplatz™ Vascular Plug 4 (AVP4) can be used to occlude left-to-right shunting patent ductus arteriosus (PDA) in dogs with inadequate arterial vascular access for the Amplatz Canine Duct Occluder (ACDO).
Six adolescent dogs with PDA whose femoral artery was too small for insertion of a 4 Fr vascular access sheath.
Standard femoral arterial vascular access and a 4 Fr diagnostic catheter were used to deploy an appropriately sized AVP4 into the PDA of each dog. Successful occlusion was defined as no residual ductal flow and determined by color Doppler echocardiography and angiography.
The AVP4 was successfully deployed, and complete occlusion of the PDA was achieved in all dogs. There were no complications encountered in any of the dogs.
The AVP4 is a viable option for the correction of PDA in dogs with inadequate arterial vascular access for the ACDO and should be considered as one of the options available for PDA correction in this challenging animal population.
Echocardiographic Evaluation of Congenital Cardiopathies Before and After Intervention
2015, Clinical Echocardiography of the Dog and Cat
Effect of the phosphodiesterase type 5 inhibitor tadalafil on pulmonary hemodynamics in a canine model of pulmonary hypertension
2014, Veterinary Journal
Citation Excerpt :
In veterinary medicine, PAH in dogs is defined by a systolic/mean PAP of >30/20 mmHg at rest (Johnson, 1999; Johnson et al., 1999). PAH can occur secondary to multiple abnormalities of the pulmonary or cardiovascular systems, such as left-sided heart failure, left-to-right cardiac shunting, heartworm disease, and pulmonary disease (Johnson, 1999; Glaus et al., 2004; Uchide and Saida, 2005; Bach et al., 2006; Zabka et al., 2006; Kellum and Stepien, 2007; Seibert et al., 2010; Nakamura et al., 2011). In severe cases, PAH can lead to right-sided heart failure and death (Johnson, 1999; Johnson et al., 1999; Zabka et al., 2006).
Phosphodiesterase type 5 (PDE5) inhibitors are used for treating pulmonary arterial hypertension (PAH) in dogs. The long-acting PDE5 inhibitor tadalafil was recently approved for treatment of PAH in humans. Basic information related to the pharmacological and hemodynamic effects of tadalafil in dogs is scarce. In this study, the hemodynamic effects of tadalafil after intravenous (IV) and oral administration were investigated in a healthy vasoconstrictive PAH Beagle dog model induced by U46619, a thromboxane A₂ mimetic. Six healthy Beagle dogs were anesthetized with propofol and maintained with isoflurane. Fluid-filled catheters were placed into the descending aorta to measure systemic arterial pressure and in the pulmonary artery to measure pulmonary arterial pressure (PAP). U46619 was infused via the cephalic vein to induce PAH.
IV infusion of U46619 significantly elevated PAP from baseline in a dose-dependent manner. U46619-elevated PAP and pulmonary vascular resistance was significantly attenuated by the simultaneous infusion of tadalafil at 100 and 200 µg/kg/h. Likewise, oral administration of tadalafil at 1.0, 2.0, and 4.0 mg/kg significantly attenuated U46619-elevated PAP in a dose-dependent manner. U46619-elevated systolic and mean PAP decreased significantly 1 h after oral tadalafil administration at 4.0 mg/kg, and this effect was maintained for 6 h. In conclusion, tadalafil had a pharmacological effect in dogs and IV infusion of tadalafil induced pulmonary arterial relaxation, while oral administration of tadalafil decreased PAP. These results suggest that tadalafil may offer a new therapeutic option for treating dogs with PAH.
Patent ductus arteriosus in an adult cat with pulmonary hypertension and rightsided congestive heart failure: Hemodynamic evaluation and clinical outcome following ductal closure
2014, Journal of Veterinary Cardiology
Citation Excerpt :
Less frequently, PVR equals or exceeds systemic resistance creating a reversed PDA (rPDA). Generally these are patients with a large ductus,6 and shunt reversal occurs early in life.4,7–13 The development of PH secondary to a PDA has been described in 1–6% of all PDA cases in dogs.4,5
Right-sided congestive heart failure (CHF) developed secondary to severe pulmonary hypertension (PH) in an 8-year-old cat with a left-to-right shunting patent ductus arteriosus (PDA). Vascular reactivity was tested prior to shunt ligation by treatment with oxygen and sildenafil. This treatment was associated with a significant decrease in pulmonary artery pressure as assessed by echocardiography. Subsequently surgical shunt ligation was planned. During thoracotomy, digital occlusion of the PDA was performed for 10 min with simultaneous catheter measurement of right ventricular pressure, which did not increase. Permanent shunt ligation resulted in a complete and sustained clinical recovery. A lung biopsy sample obtained during thoracotomy demonstrated histopathological arterial changes typical of PH. Cats can develop clinically severe PH and right-sided CHF secondary to a left-to-right PDA even at an advanced age. Assuming there is evidence of pulmonary reactivity, PDA occlusion might be tolerated and can potentially produce long-term clinical benefits.
Anaesthetic management of a dog with a bidirectionally shunting patent ductus arteriosus and concurrent pulmonary hypertension
2022, Veterinary Record Case Reports
ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs
2020, Journal of Veterinary Internal Medicine

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Case ReportSuccessful closure of left-to-right patent ductus arteriosus in three dogs with concurrent pulmonary hypertension☆

Abstract

Section snippets

Case 1

Case 2

Case 3

Discussion

Acknowledgements

J Vet Cardiol

J Am Coll Cardiol

Chest

Allometric scaling of M-mode cardiac measurements in normal adult dogs

J Vet Intern Med

Patent ductus arteriosus with pulmonary hypertension in the dog

J Am Vet Med Assoc

Hereditary patent ductus arteriosus and its sequelae in the dog

Circ Res

Patent ductus arteriosus in the dog: characteristics of occurrence and results of surgery in one hundred consecutive cases

J Am Vet Med Assoc

Evaluation of survival rate and prognostic indicators for surgical treatment of left-to-right patent ductus arteriosus in dogs: 52 cases (1995–2003)

J Am Vet Med Assoc

Immediate and late outcomes of transarterial coil occlusion of patent ductus arteriosus in dogs

J Vet Intern Med

Patent ductus arteriosus and pulmonary hypertension in related Pembroke Welsh Corgis

J Am Vet Med Assoc

Clinical characteristics of 53 dogs with Doppler-derived evidence of pulmonary hypertension: 1992–1996

J Vet Intern Med

Case Report
Successful closure of left-to-right patent ductus arteriosus in three dogs with concurrent pulmonary hypertension☆