Case Of the Month

Mitral valve repair due to severe DMVD in a 6-year old Cavalier King Charles Spaniel: Our Case Of The Month February 2015

A 6-year-old MN Cavalier King Charles Spanial was referred for mitral valve repair because of severe DMVD. At that time he was already on Pimobendan, Furosemide (12 mg/kg/d) and ACEI. He presented with increased respiratory effort and mild pulmonary edema.

Outcome

Because of his rapid deterioration and the poor prognosis with medical therapy alone, mitral valve repair under CPB was discussed with the owners. Even though the prognosis was guarded given the marked systolic dysfunction (large enddiastolic diameter in the face of severe volume overload, FS 38%, hyperkinesia of the septum, severe hypokinesia of the free wall) the owners decided for the surgery. The procedure was scheduled four weeks later. In the mean time Pimobendan was increased to tid, and Spironolactone was added. On the day of surgery, Henri still had some degree of pulmonary edema. Thus,Torasemide was given 6 hrs before surgery. Systolic dysfunction had increased and some ventricular runs were noted on the Sono-ECG. Open heart mitral valve repair was performed (mitral annuloplasty, chordal replacement with Gore-Tex) on cardiopulmonary bypass. Cross-Clamp time was 85 min. After clamp removal and electrical defibrillation the heart started spontaneously in a sinus rhythm and blood pressure was immediately restored. The patient woke up 5 hrs after surgery and was able to walk a short distance after 7 hrs.He is now doing quite well, starts eating and walks around in the yard. The mitral valve coadaption has increased with mild residual regurgitation. Systolic function is markedly impaired but is improving day to day.

Comments

“The prognosis for this patient is still guarded given the number of possible complications and the fact that it is uncertain if systolic function will improve. Still, for the population of dogs suffering from MMVD it might be a step in the right direction. Ideally, this surgery should be done in dogs at high risk of rapid progression and before systolic dysfunction begins. Increasing surgical experience will hopefully enable us to optimise mitral leaflet coadaption and improve long time survivial.” Peter Modler DVM, Dipl.-Tzt.

Surgical series of photos and post surgical patient of Dr.Peter Modler, DVM, Dipl.-Tzt. Traunkreis Vet Clinic and staff as they perform the revolutionary surgical mitral valve repair in Sattledt, Austria this January, 2015. Dr. Modler is one of a handful of revolutionary veterinary cardio-surgeons that perform this procedure worldwide through collaboration with Dr. Masami Uechi of Kanagaw, Japan (author of the original JVC article see reference below in last video clip). Dr. Modler is eternally grateful to Dr. Masami Uechi and Dr. Dan Brockman (Royal Veterinary College, London) for their collaboration.

Image Interpretation

There was severe MMVD and severe mitral regurgitation. The left atrium was severely enlarged and systolic dysfunction was evident.