Macedonian Veterinary Review

Case Report

Hybrid surgical approach using amplatzer occluder for treatment of VSD in a cat

Akiko Uemura ,

Ryou Tanaka *

Mac Vet Rev 2017; 40 (2): 183 - 187

10.1515/macvetrev-2017-0022

Received: 03 April 2017

Received in revised form: 27 May 2017

Accepted: 08 June 2017

Available Online First: 04 July 2017

Published on: 15 October 2017

Correspondence: Ryou Tanaka, ryo@vet.ne.jp

PDF HTML

Abstract

Ventricular septal defect (VSD) is among the most common feline congenital heart malformations. Although usually treated by pulmonary artery banding or pharmacotherapy, neither method is curative. Curative procedures have been performed in humans. Treatment of VSD is usually not required in dogs and cats, but is necessary in cases of non-restrictive VSD. Dogs with non-restrictive VSD are treated either using surgical correction under open-heart surgery, or percutaneous insertion of an occluder under interventional radiation. In our experience, neither method alone is appropriate for treating ventricular septal defect in cats with non-restrictive VSDs. We have applied a hybrid surgical method in a 13-month-old, female Maine Coon cat weighing 3.5 kg. A catheter was inserted and an occluder placed directly at the defect through thoracotomy. This method is less invasive than open-heart surgery and requires no special equipment, using direct puncture of the heart to minimize the distance to the defect and improving maneuverability. By combining the advantages of both surgical defect closure and occlusion guided by interventional ultrasound, treatment that could not be performed with either method alone became possible. In this case, the VSD could not be embolized, but some important points were suggested regarding surgical treatment of VSD in cats. One is that a sizing balloon catheter may be the most accurate method to measure VSD in cats. Amplatzer occlusion of a large non-restrictive VSD in a cat is currently not an option, but the described hybrid technique may still be an option for smaller non-restrictive VSDs. However, criteria and adjustments must be considered carefully.

Keywords: VSD, cat, hybrid technique, defect closure, Amplatzer occluder, sizing balloon

References

1. Tidholm, A., Ljungvall, I., Michal, J., Haggstrom, J., Hoglund, K. (2015). Congenital heart defects in cats:A retrospective study of 162 cats (1996-2013). J Vet Cardiol. 17, Suppl 1. S215-219. https://doi.org/10.1016/j.jvc.2014.09.004 PMid:26776580

2. Cote Kam, E., Meurs, K.M., Sleeper, M.M. (2011). Feline cardiology. (pp.85-100). Wiley-Blackwell. https://doi.org/10.1002/97811187ↂ2

3. Bomassi, E., Misbach, C., Tissier, R., Gouni, V., Trehiou-Sechi, E., et al. (2015). Signalment, clinical features, echocardiographic findings, and outcome of dogs and cats with ventricular septal defects:109 cases (1992-2013). J Am Vet Med Assoc. 247 (2):166-175. https://doi.org/10.2460/javma.247.2.166 PMid:26133216

4. Eyster, G.E., Whipple, R.D., Anderson, L.K., Evans, A.T., O'Handley, P. (1977). Pulmonary artery banding for ventricular septal defect in dogs and cats. J Am Vet Med Assoc. 170 (4):434-438. PMid:557030

5. Sheridan, J.P., Mann, P.G., Stock, J.E. (1971). Pulmonary artery banding in the cat:a case report. J Small Anim Pract. 12 (1):45-48. https://doi.org/10.1111/j.1748-5827.1971.tb05633.x PMid:5103104

6. Warden, H.E., Cohen, M., Read, R.C., Lillehei, C.W. (1954). Controlled cross circulation for open intracardiac surgery:physiologic studies and results of creation and closure of ventricular septal defects. J Thorac Surg. 28(3):331-341; PMid:13192880

7. Breznock, E.M., Hilwig, R.W., Vasko, J.S., Hamlin, R.L. (1970). Surgical correction of an interventricular septal defect in the dog. J Am Vet Med Assoc. 157 (10):1343-1353. PMid:5529824

8. Fujii, Y., Fukuda, T., Machida, N., Yamane, T., Wakao, Y. (2004). Transcatheter closure of congenital ventricular septal defects in 3 dogs with a detachable coil. J Vet Intern Med. 18(6):911-914. https://doi.org/10.1111/j.1939-1676.2004.tb02643.x PMid:15638280

9. Shimizu, M., Tanaka, T., Hirao, H., Kobayashi, M., Shimamura, S., et al. (2005). Percutaneous transcatheter coil embolization of a ventricular septal defect in a dog. J Am Vet Med Assoc. 226 (1):52-63, 69-72. https://doi.org/10.2460/javma.2005.226.69

10. Margiocco, M.L., Bulmer, B.J., Sisson, D.D. (2008). Percutaneous occlusion of a muscular ventricular septal defect with an Amplatzer muscular VSD occluder Amplatzer J Vet Cardiol 10(1):61-66. https://doi.org/10.1016/j.jvc.2008.01.001 PMid:184⇑9

11. Lock, J.E., Block, P.C., McKay, R.G., Baim, D.S., Keane, J.F. (1988). Transcatheter closure of ventricular septal defects. Circulation 78 (2):361-368. https://doi.org/10.1161/01.CIR.78.2.361 PMid:3396173

12. Uechi, M., Hirada, K., Mizukoshi, T., Mizuno, T., Mizuno, M., et al. (2011). Surgical closure of an atrial septal defect using cardiopulmonary bypass in a cat. Vet Surg. 40 (4):413-417. https://doi.org/10.1111/j.1532-950X.2011.00798.x PMid:21466564

13. Borenstein. N, Gouni, V., Behr, L., Trehiou-Sechi, E., Petit, A., et al. (2015). Surgical treatment of cor triatriatum sinister in a cat under cardiopulmonary bypass. Vet Surg. 44 (8):964-969. https://doi.org/10.1111/vsu.12403 PMid:26414173

14. Schneider, M., Hildebrandt, N. (2003). Transvenous embolization of the patent ductus arteriosus with detachable coils in 2 cats. J Vet Intern Med. 17 (3):349-353. https://doi.org/10.1111/j.1939-1676.2003.tb02460.x PMid:12774978

15. Saunders, A.B., Carlson, J.A., Nelson, D.A., Gordon, S.G., Miller, M.W. (2013). Hybrid technique for ventricular septal defect closure in a dog using an Amplatzer (R) Duct Occluder II. J Vet Cardiol. 15 (3):217-224. https://doi.org/10.1016/j.jvc.2013.06.003 PMid:23962683

16. Koneti, N.R., Sreeram, N., Penumatsa, R.R., Arramraj, S.K., Karunakar, V., et al. (2012). Transcatheter retrograde closure of perimembranous ventricular septal defects in children with the Amplatzer duct occluder II device. J Am Coll Cardiol. 60 (23):2421-2422. https://doi.org/10.1016/j.jacc.2012.08.1004 PMid:23141497

17. Zhou, D., Pan, W., Guan, L., Ge, J. (2012). Transcatheter closure of perimembranous and intracristal ventricular septal defects with the SHSMA occluder. Catheter Cardiovasc Interv. 79 (4):666-674. https://doi.org/10.1002/ccd.23344 PMid:22109986

Copyright

© 2017 Uemura A. This is an open-access article publishedunder the terms of the Creative Commons Attribution License whichpermits unrestricted use, distribution, and reproduction in any medium,provided the original author and source are credited.

Conflict of Interest Statement

The authors declared that they have no potential conflict of interest with respect to the authorship and/or publication of this article.

Citation Information

Macedonian Veterinary Review. Volume 40, Issue 2, Pages 183-187, p-ISSN 1409-7621, e-ISSN 1857-7415, DOI: 10.1515/macvetrev-2017-0022, 2017