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Case Description—A 5-year-old male German Shepherd Dog was evaluated because of a 5-month history of progressive lethargy, weight loss, and heart failure.
Clinical Findings—On physical examination, bounding femoral pulses and systolic and diastolic murmurs were detected. Echocardiography revealed severe aortic valve insufficiency (AVI) and a large vegetative lesion on the aortic valve consistent with aortic valve endocarditis. The AVI velocity profile half-time was 130 milliseconds; the calculated peak systolic pressure gradient across the aortic valve was 64 mm Hg. Left ventricular diameter during diastole was 63.6 mm (predicted range, 40.2 to 42 mm) and during systole was 42.9 mm (predicted range, 25.4 to 27 mm). Systolic, diastolic, and mean arterial blood pressures were 120, 43, and 65 mm Hg, respectively.
Treatment and Outcome—To palliate severe AVI, the descending aorta was occluded (duration, 16.75 minutes) and heterotopic implantation of a porcine bioprosthetic heart valve in that vessel was performed. After surgery, systolic, diastolic, and mean arterial blood pressures were 115, 30, and 61 mm Hg, respectively, in the forelimb and 110, 62, and 77 mm Hg, respectively, in the hind limb. Within 6 months, the AVI velocity profile half-time had increased to 210 milliseconds, indicating diminished severity of AVI. After 24 months, the dog was able to engage in vigorous exercise; no pulmonary edema had developed since surgery.
Clinical Relevance—Heterotopic bioprosthetic heart valve implantation into the descending aorta during brief aortic occlusion appears feasible in dogs and may provide substantial palliation for dogs with severe AVI.
To determine long-term outcomes and factors associated with those outcomes in dogs with gastroesophageal intussusception (GEI).
36 dogs with GEI evaluated at 16 veterinary hospitals from January 2000 through January 2018.
Medical records of included dogs were reviewed to collect information regarding signalment, clinical signs, physical examination findings, blood work and diagnostic imaging results, surgical findings, and outcome. Factors were evaluated for associations with various outcomes.
Median age of dogs with GEI was 13.2 months, and males (72% [26/36]) and German Shepherd Dogs (33% [12/36]) were most common. Vomiting (67% [24/36]) and regurgitation (33% [12/36]) were the most common clinical signs. Ten of 36 (28%) dogs were euthanized without treatment, and 26 (72%) underwent treatment (25 surgically and 1 endoscopically). Twenty-three of the 26 (88%) treated dogs survived to discharge; median survival time was 995 days. At last follow-up, 15 of the 23 (65%) surviving dogs remained alive and 8 (35%) had died for reasons related to persistent regurgitation (n = 6) or reasons unrelated to GEI (2). Of the 10 dogs for which owners were contacted, 7 had persistent regurgitation, the severity of which was reduced through managed feedings. Dogs with acute (≤ 7 days) clinical signs or a previous diagnosis of megaesophagus were more likely to have persistent regurgitation than were dogs without these factors.
CONCLUSIONS AND CLINICAL RELEVANCE
Treatment should be considered for dogs with GEI given the high rate of survival to discharge and median survival time. Although persistent regurgitation was common after treatment, a satisfactory outcome was possible with medical management, including managed feedings and medications.