Use of total venous inflow occlusion to enable correction of an atrial septal defect in a dog

ABSTRACT

Background: Atrial septal defects are generally classified into three types ostium secundum, ostium primum, and sinus venosus. Diagnose is normaly confirmed with Doppler echocardiography, which can identify and classify atrial septal defects types. This cardiac anomaly may be corrected by different surgical approaches, such as cardiopulmonary bypass or transvenous approaches. Therefore, we chose to close the atrial septal defect using a total venous inflow occlusion technique (TIVO), which has been successfully used in other procedures without major postoperative complications, and are notably cheaper and requires no specialized equipment, been able to be done in different places.Case An American Pit Bull Terrier was referred to our surgical service for ostium secundum atrial septal defect correction, by the time of surgery the patient presented dyspneic; normal capillary refill time and rectal temperature; the owner mentioned the patient exhibited exercise intolerance and delayed development compared to other dogs of the same age or from the same litter. Cardiac auscultation revealed a systolic murmur at the left base, femoral pulse was normokinetic, and patient was emaciated and prostrated at the time of clinical evaluation. Atrial septal defect was suspected and then confirmed by Doppler echocardiography that revealed a discontinuous area in the interatrial septum, and by color doppler images an aliased signal, that extended through the interatrial septum and shunted from the left to the right atria, was visualized, confirming an ostium secundum atrial septal defect. After a right intercostal thoracotomy, a subphrenic pericardiectomy was performed to provide access to the heart. Cranial and caudal vena cava as well as the azygos vein, were dissected, which allowed placement of a Satinsky’s clamp to proceed with TIVO. Before TIVO initiation, a pursestring suture with 3-0 polypropylene was applied to the right atrium.[...]