Surgical repair for canine tricuspid valve dysplasia: Technique and case report.

Tricuspid valve dysplasia (TVD) is a congenital malformation of the right atrioventricular valve characterized by restricted leaflet motion, annular dilation, and tricuspid regurgitation (TR). Severe cases typically exhibit progressive right-sided congestive heart failure, affecting the quality of life and survival. This article describes a technique for surgical repair of TVD and a case report with long-term follow-up. A 1.5-year-old intact male Labrador retriever with severe TR underwent surgical repair for TVD. Valve repair was performed under cardiopulmonary bypass and consisted of neochord mobilization of the valve leaflets and partial band annuloplasty. Transthoracic echocardiogram performed 5 days after surgery showed mild TR, a 93% decrease in anatomic regurgitant orifice area, and decreased right chamber dimensions. Forty-eight months after repair, the patient was free of clinical signs, did not have a heart murmur, and was receiving no cardiac medications. Based on this case, surgical repair of TVD is feasible with long-term durability, and the outcome suggests that the described technique may be a viable treatment option for patients with severe TVD.

Successful management of acute bilirubin encephalopathy in a dog with immune-mediated hemolytic anemia using therapeutic plasma exchange.

OBJECTIVE: To describe the successful management of acute bilirubin encephalopathy in a dog with immune-mediated hemolytic anemia (IMHA) treated with therapeutic plasma exchange (TPE) in conjunction with conventional medical management. CASE SUMMARY: A 6-year-old neutered male Australian Cattle Dog diagnosed with IMHA developed severe hyperbilirubinemia and stupor within the first 48 hours of implementing immunosuppressive therapy consisting of corticosteroids and mycophenolate. The patient received 4 blood transfusions during this period, but remained severely anemic PCV (18%) and experienced a subsequent increase in total bilirubin from 78 µmol/L (4.6 mg/dL) to a peak value of 1,563 µmol/L (91.4 mg/dL). The patient's neurological status rapidly deteriorated, resulting in lateral recumbency, vertical nystagmus, extensor rigidity, and stuporous mentation. Over the next 3 days, TPE was provided once every 24 hours, decreasing serum bilirubin, immunoglobulin G (IgG), and immunoglobulin M (IgM). The patient's red blood cell (RBC) transfusion requirements decreased immediately, requiring only 1 transfusion over the next 7 days that was required due to procedure-associated blood loss. Gradual neurological improvement was noted as serum bilirubin decreased. A brain magnetic resonance imaging (MRI) did not reveal any structural abnormalities and the patient was discharged after 11 days of hospitalization. Following discharge, the patient had complete remission of IMHA without any residual neurological deficits. Therapeutic plasma exchange played an integral role in case management and was successful in reducing bilirubin, IgG, and IgM. NEW OR UNIQUE INFORMATION PROVIDED: Bilirubin encephalopathy has been rarely reported in small animal medicine and cases have been limited to postmortem documentation. This is the first suspected case of acute bilirubin encephalopathy in a dog that survived and describes the clinical course of disease. The kinetics of serum bilirubin, IgG, and IgM concentrations before and after TPE and throughout the hospitalization period are also described.

Evaluation of freshwater submersion in small animals: 28 cases (1996-2006).

OBJECTIVE: To determine clinical characteristics, treatments, and outcome in dogs and cats evaluated after submersion in freshwater. DESIGN: Retrospective case series. ANIMALS: 25 dogs and 3 cats. PROCEDURES: Medical records were reviewed for signalment; causes, location, and month of submersion; physical examination findings at admission; results of blood gas analysis; treatments administered; duration of hospitalization; and outcome, including evidence of organ failure or compromise. RESULTS: All submersions involved bodies of freshwater. Fourteen animals were submerged in man-made water sources, 13 were submerged in natural water sources, and the body of water was not recorded in 1 case. Twenty (71%) submersions occurred from May through September. Cause was identified in 16 animals and included extraordinary circumstances (n = 6), falling into water (5), breaking through ice (3), and intentional submersion (2). Twelve animals were found submerged in water with unclear surrounding circumstances. Treatment included administration of supplemental oxygen, antimicrobials, furosemide, corticosteroids, and aminophylline and assisted ventilation. Respiratory dysfunction was detected in 21 animals. Neurologic dysfunction was detected in 12 animals, hepatocellular compromise was detected in 6 animals, and cardiovascular dysfunction was detected in 4 animals. Three dogs had hematologic dysfunction, and 2 dogs had acute renal dysfunction. Eighteen (64%) animals survived to hospital discharge, but all of the cats died. In 9 of 10 nonsurvivors, respiratory tract failure was the cause of death or reason for euthanasia. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that submersion is an uncommon reason for veterinary evaluation but is associated with a good prognosis in dogs in the absence of respiratory tract failure.