Abstract
A 1-year-old female Maine Coon cat presented with a history of labored breathing and intermittent cough. Thoracic radiography revealed a diaphragmatic hernia; echocardiography showed adhesions of a hepatic lobe and gall bladder to the left myocardium. After a final diagnosis of peritoneopericardial diaphragmatic hernia (PPDH), a surgical treatment was successfully done to repair the congenital PPDH. Blood transfusion was performed during surgical correction to ameliorate the excessive blood loss during liver lobectomy. This surgical technique can close the diaphragmatic defect and be used as a treatment option to prevent further herniation and reduce compliance with heart failure complications. Surgical treatment provides an excellent outcome for cats with a congenital pericardial-diaphragmatic anomaly. However, severe hemorrhage may occur with the abdominal organ’s adhesion to the pericardium, such as the liver. This study described the diagnosis and surgical treatment. The surgical procedure may provide the information for further successful treatment in the feline congenital pericardial defect.
Highlights
Peritoneopericardial diaphragmatic hernia (PPDH) is a common congenital pericardial defect encountered in cats (Khan et al, 2019; Hodgkiss-Geere et al, 2015; Banz and Gottfried., 2010; Margolis et al, 2018)
Thoracic radiography and echocardiography may aid in diagnosis and rule out any other anomalies such as hypertrophic cardiomyopathy, dilated cardiomyopathy, and pericardial effusion (Barrett and Kittrell, 1966)
Due to the small amount of pericardial lubricant in the pericardial sac, ultrasonography images can clearly distinguish the pericardial region from the liver lobe
Summary
Peritoneopericardial diaphragmatic hernia (PPDH) is a common congenital pericardial defect encountered in cats (Khan et al, 2019; Hodgkiss-Geere et al, 2015; Banz and Gottfried., 2010; Margolis et al, 2018). PPDH is an abnormal development of the dorsolateral septum transversum or the lateral pleuro-peritoneal folds that cause the communication between the peritoneal and pericardial sac through the diaphragm (Berry et al, 1990) This diaphragmatic defect resulted in the herniation of the abdominal organs into the pericardial cavity. Previous studies have reported that the overall incidence of congenital PPDH in cats was 0.59%, with the age range from 2-138 months (Banz and Gottfried, 2010) This congenital defect is usually presented in long-haired breeds cats. The cat showed improvement in clinical symptoms after surgical treatment, and thoracic radiography revealed the extent of the diaphragm and found the separation of the abdominal and thoracic organs. Thoracic radiography was used to aid the diagnosis of PPDH, such as enlarge caudal cardiac silhouette, coexisting with diaphragmatic discontinuity, and irregular soft tissue over the caudal heart was observed. After the diaphragmatic defect correction, the abdomen was closed with 3-0 monofilament absorbable sutures, and the skin was sutured with 3-0 surgical nylon
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