Case Report: Aortic Regurgitation of Postocclusion and Long-Term Outcome Following PDA Correction in an Adult Dog

Woong-Bin Ro,Hee-Myung Park,Chan-Ho Jo,Heyong-Seok Kim,Jin-Ho Kang,Ga-Won Lee,Min-Hee Kang,Doo-Won Song

doi:10.3389/fvets.2022.848313

Woong-Bin Ro, Hee-Myung Park + Show 6 more

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https://doi.org/10.3389/fvets.2022.848313

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Abstract

A 9-year-old intact female Maltese dog was admitted for further evaluation of previously diagnosed patent ductus arteriosus (PDA). The dog showed severe coughing and exercise intolerance. On physical examination, a grade VI/VI continuous heart murmur was auscultated. Thoracic radiography demonstrated cardiomegaly, pulmonary overcirculation, and moderate bronchointerstitial pattern. Echocardiography revealed severe dilation of the left ventricle and atrium, decreased left ventricular contractility, and left-to-right PDA. On electrocardiography (ECG), R amplitude was increased. Computed tomographic angiography revealed type IIA PDA. The serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration was >10,000 pmol/L. Transarterial occlusion was performed and the Amplatz® Canine Duct Occluder was successfully deployed. On echocardiography 48 h after the procedure, aortic regurgitation (AR) and residual ductal flow were noted. Long-term follow-up on clinical signs, physical examination, radiography, echocardiography, ECG, and serum NT-proBNP were evaluated until 30 months after correction of PDA. The clinical indices of physical examination, thoracic radiography, echocardiography, ECG, and serum NT-proBNP concentration were improved, although the postocclusion AR and residual ductal flow persisted. The dog followed up without clinical signs for 41 months following the correction. To our knowledge, this is the first case report to demonstrate quite a long time of follow-up (41 months) in an older dog with transarterial occlusion of PDA with postocclusion AR and residual flow.

Highlights

Patent ductus arteriosus (PDA) is one of the most common congenital cardiac disease in dogs, in which persistent fetal ductal structure between the aorta and main pulmonary artery (PA) results in left-sided cardiac volume overload, congestive heart failure, and eventually death [1, 2]
In dogs, PDA has poor prognosis with a high mortality rate within 1 year if untreated, but long-term survival is possible if corrected at an early age [1, 16]
In case of dogs that presented at older age, PDA correction is frequently avoided because of the risk of anesthesia, PDA occlusion and subsequent clinical improvement have been previously reported in older dogs as well [17, 18]

Summary

INTRODUCTION

Patent ductus arteriosus (PDA) is one of the most common congenital cardiac disease in dogs, in which persistent fetal ductal structure between the aorta and main pulmonary artery (PA) results in left-sided cardiac volume overload, congestive heart failure, and eventually death [1, 2]. Aortic Regurgitation After PDA Occlusion procedure include high complete occlusion rate, easy deployment, minimal invasiveness, and low complication rate [4, 5] Complications such as residual PDA shunt, device embolization, device migration, and endocarditis have been reported after ACDO procedure in dogs [4, 6–8]. The present report describes clinical indices of long-term follow-up of AR following transarterial PDA occlusion using ACDO in an older dog, including physical examination, blood work, radiography, echocardiography, electrocardiography (ECG), and cardiac biomarker. A turbulent flow coming from PDA toward main PA (left-to-right shunt) was observed (peak velocity = 5.49 m/s), with minimal ductal diameter (MDD) of 5.15 mm (Figure 2). Compared with the preprocedural TTE, LV internal dimensions, LV volume indices, LA dimension, PA diameter, and LV contractility were decreased, whereas the Ao diameter and MR flow velocity were increased (Table 1).

DISCUSSION

Findings

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