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Successful transcatheter pulmonary valve implantation in a dog: first clinical report

Borenstein, N., Chetboul, V., Passavin, P., Morlet, A., Fernandez-Parra, R., Carazo Arias, L.E., Giannettoni, G., Saponaro, V., Poissonnier, C., Ghazal, S., Lefort, S., Trehiou-Sechi, E., Marchal, C.R., Delle Cave, J., Vannucci, E., Behr, L., Verwaerde, P.
Journal of veterinary cardiology 2019 v.26 pp. 10-18
Beagle, cattle, dogs, echocardiography, endocarditis, heart, heart valve diseases, postoperative care, prostheses, surgery, thrombosis
Transcatheter pulmonary valve (TPV) implantation is a therapeutic approach approved by the United States Food and Drug Administration for human patients with failing pulmonary conduits in 2010 and for failing bioprosthetic surgical pulmonary valves in 2017. We report here the first successful transcatheter implantation of a stented valve in a pulmonary position in a dog with congenital pulmonary valve disease. A 3-year-old, 10.9 kg, client-owned Beagle dog was referred for a follow-up visit after a percutaneous balloon valvuloplasty performed 22 months before for treatment of a severe type A valvular pulmonary stenosis. The Doppler-derived peak pressure gradient was 348 mmHg before the procedure and 66 mmHg 24 h after. The dog was lethargic. Echocardiography revealed a mild pulmonary stenosis (pressure gradient—43 mmHg), severe pulmonary regurgitation, and secondary severe right ventricular and right atrial dilation. Worsening of right heart dilation was observed 2 months later despite medical therapy. A TPV implantation was performed using a prestented Melody bovine jugular bioprosthetic valve. The dog recovered uneventfully and was discharged 10 days after the procedure. Right heart dilation resolved within 15 days. The dog was doing well 7 months after valve implantation. This case demonstrates that TPV implantation with a stented valve is technically feasible in dogs with severe pulmonary valve disease. Stringent postoperative care, with particular attention to thrombosis and infectious endocarditis, and appropriate sizing and positioning of the valve stent are keys to the success of this procedure.