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Open heart closure of an atrial septal defect by use of an atrial septal occluder in a dog

Sonya G. GordonDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.
Michael E. DeBakey Institute for Comparative Cardiovascular Sciences and Biomedical Devices, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.

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David A. NelsonDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.

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Sarah E. AchenDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.

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Matthew M. MillerDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.
Michael E. DeBakey Institute for Comparative Cardiovascular Sciences and Biomedical Devices, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.

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Risa M. RolandDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.

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Ashley B. SaundersDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.
Michael E. DeBakey Institute for Comparative Cardiovascular Sciences and Biomedical Devices, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.

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Lori T. DrourrDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474.

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Abstract

Case Description—A 3-year-old sexually intact male Standard Poodle was admitted to the veterinary teaching hospital for transcatheter closure of a large atrial septal defect (ASD).

Clinical Findings—The dog had exercise intolerance and was thin. Findings on physical examination were within normal limits with the exception of a left base systolic heart murmur (grade 5/6). The dog was not receiving any medications. Echocardiography and thoracic radiography confirmed the diagnosis of ASD and revealed compensatory changes consistent with a large left to right shunting ASD. Results of serum biochemical analysis and CBC were within reference range limits.

Treatment and Outcome—Transcatheter ASD closure with an atrial septal occluder (ASO) was performed and failed. An open heart surgical approach under cardiopulmonary bypass was declined by the dog's owners. The dog underwent a novel hybrid approach involving active device fixation under temporary inflow occlusion after transatrial device deployment. The dog recovered with some manageable postoperative complications. As of the last follow-up examination, the dog had 10 months of event-free survival.

Clinical Relevance—Transcatheter closure by use of an ASO and open heart patch repair with cardiopulmonary bypass to surgically treat dogs with ASD has been reported. Transcatheter closure is not possible in dogs with large ASD. The novel hybrid procedure reported herein represented a viable alternative to euthanasia.

Abstract

Case Description—A 3-year-old sexually intact male Standard Poodle was admitted to the veterinary teaching hospital for transcatheter closure of a large atrial septal defect (ASD).

Clinical Findings—The dog had exercise intolerance and was thin. Findings on physical examination were within normal limits with the exception of a left base systolic heart murmur (grade 5/6). The dog was not receiving any medications. Echocardiography and thoracic radiography confirmed the diagnosis of ASD and revealed compensatory changes consistent with a large left to right shunting ASD. Results of serum biochemical analysis and CBC were within reference range limits.

Treatment and Outcome—Transcatheter ASD closure with an atrial septal occluder (ASO) was performed and failed. An open heart surgical approach under cardiopulmonary bypass was declined by the dog's owners. The dog underwent a novel hybrid approach involving active device fixation under temporary inflow occlusion after transatrial device deployment. The dog recovered with some manageable postoperative complications. As of the last follow-up examination, the dog had 10 months of event-free survival.

Clinical Relevance—Transcatheter closure by use of an ASO and open heart patch repair with cardiopulmonary bypass to surgically treat dogs with ASD has been reported. Transcatheter closure is not possible in dogs with large ASD. The novel hybrid procedure reported herein represented a viable alternative to euthanasia.

Contributor Notes

Dr. Achen's present address is Michigan Veterinary Specialists, 29080 Inkster Rd, Southfield, MI 48034.

Dr. Roland's current address is Metropolitan Veterinary Associates, 2626 Van Buren Ave, Norristown, PA 19403.

Dr. Drourr's present address is Ontario Veterinary College, University of Guelph, Guelph, ON, NIG 2W1, Canada.

Supported in part by AGA Medical Corporation, the manufacturers of Amplatzer Atrial Septal Occluders.

The authors thank Kathy Glaze, Katy Waddell, and Kate Nelson for technical assistance and Drs. Terry Fossum and Brian Saunders for surgical assistance.

Address correspondence to Dr. Gordon (sgordon@cvm.tamu.edu).