Mitral Valve Repair in a 12-Year-Old FS Yorkshire Terrier Mixed Breed: Our Case Of the Month December 2017
The patient was presented for a pre-surgical cardiac evaluation. The patient was suffering from a rapidly progressing degenerative mitral valve. At the time of presentation the patient was on a regimen of Furosemide (8mg/kg/SID), Pimobendan (0.25 mg/kg/BID), Benazepril (0.25 mg/kg/SID), and Spironolactone (2mg/kg/SID). Despite her treatments, she was still experiencing exercise intolerance, mildly increased resting respiratory rate, and was coughing. Thoracic radiographs showed severe cardiomegaly, an increased lung opacity due to a bronchio-interstitial pattern, elevation of the trachea with possible left mainstem compression (possible airway collapse) and mildly dilated pulmonary veins.
The left ventricle appeared severely dilated. However, systolic function seemed to be only mildly impaired. Both mitral valve leaflets showed a significant prolapse and thickening. Chordal rupture affecting the anterior leaflet was visible. The left atrium was severely enlarged. Mitral inflow profiles revealed significantly increased filling pressures and volume overload. Mild tricuspid regurgitation due to valvular degeneration was also visible. Systolic pressure gradients across the tricuspid valve indicated moderate pulmonary hypertension (50 mm Hg).
The first days after surgery were challenging for the intensive care team because the patient was suffering from significant airway collapse which became more evident due to the increased post-surgical respiratory effort. Still, the patient stabilized and was finally released from hospital without any need for diuresis. The patient received Sildenafil for the first month to decrease pulmonary resistance, along with antibiotics and NSAIDS as routine post-op treatment. Theophylline was initiated as well to address the chronic airway disease.
*To see Dr. Modler's other Case Of the Month mitral valve repair, please click on this link: https://sonopath.com/resources/cases-month/mitral-valve-repair-due-severe-dmvd-6-year-old-cavalier-king-charles-spaniel-o