Key result
Mitral valvuloplasty combined with pacemaker implantation and left atrial appendage closure successfully ameliorated cardiac remodeling and congestion in a dog with severe myxomatous mitral valve disease and sinus arrest.
Why the study?
Mitral valvuloplasty treats myxomatous mitral valve disease, but postoperative complications such as thromboembolism and arrhythmia can result in death.
Case Report (n=1)
No
In a dog with severe myxomatous mitral valve disease and sinus dysfunction, mitral valvuloplasty combined with pacemaker implantation and LAA closure successfully ameliorated heart failure and prevented thrombosis.
Supports feasibility of combined MVP, pacemaker, and LAA closure in complex canine MMVD; leaves open need for prospective safety and efficacy data.
BACKGROUND: Mitral valvuloplasty (MVP) has been widely recognized as a treatment option for myxomatous mitral valve disease (MMVD). However, postoperative complications such as thromboembolism, arrhythmia, and pancreatitis in some cases have resulted in death. We treated a dog with severe MMVD complicated by impaired sinus function with MVP and pacemaker implantation. Also, due to an intrinsic procoagulant state and severe arrhythmia after the MVP, left atrial appendage (LAA) closure was performed to reduce the postoperative risk of thrombosis. CASE PRESENTATION: An 11-year-old castrated 7.5-kg male Miniature Schnauzer with a history of congestive heart failure was brought to Shiraishi Animal Hospital for MMVD surgical treatment. Echocardiography revealed an enlarged left atrium and ventricle secondary to MMVD. Sinus arrest with 2 to 3-second periods of asystole was identified by electrocardiogram. Mitral valvuloplasty was performed with cardiopulmonary bypass to treat the MMVD. After coronary reperfusion, there was no spontaneous electrical activity. Cardiac arrest continued. Based on this surgical outcome, a permanent pacemaker was implanted. In addition, LAA closure with an AtriClip was performed to prevent intra-atrial thrombus formation. Cardiac remodeling and congestion were ameliorated after surgery. Sinus rhythm was restored 5 days postoperatively; however, the patient continued pacemaker dependent. All cardiac drugs were discontinued 3 months after surgery. The owner reported no postoperative complications (i.e., thrombosis), and the patient was brought for a check-up 4 months after the operation in good health. CONCLUSIONS: For surgical MMVD cases complicated with impaired sinus function, the chances of spontaneous sinus rhythm are low, requiring pacemaker implantation. LAA closure may be considered to protect against decreased atrial function after mitral valvuloplasty and prevent intra-atrial thrombus formation.
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Yoshida et al. (2022) conducted a case report in Myxomatous mitral valve disease (MMVD) (n=1). Mitral valvuloplasty, pacemaker implantation, and left atrial appendage closure was evaluated on Clinical outcome and cardiac remodeling. Mitral valvuloplasty combined with pacemaker implantation and left atrial appendage closure successfully ameliorated cardiac remodeling and congestion in a dog with severe myxomatous mitral valve disease and sinus arrest.
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