Page 132 - Small Animal Internal Medicine, 6th Edition

104 PART I Cardiovascular System Disorders

VetBooks.ir

A B

C

FIG 5.3
Lateral (A) and dorsoventral (DV) (B) radiographs from a dog with a patent ductus
arteriosus. Note the large and elongated heart and prominent pulmonary vasculature.
A large bulge is seen in the descending aorta on the DV view (arrowheads in B).
(C) Angiocardiogram obtained using a left ventricular injection outlines the left ventricle,
aorta, patent ductus (arrowheads), and pulmonary artery.

diagnosis, although it is important during interventional occluding device within the ductus, such as the Amplatz
procedures. Angiocardiography shows left-to-right shunting canine ductal occluder (ACDO) or wire coils with attached
through the ductus and facilitates measurement of the thrombogenic tufts. Vascular access usually is via the femoral
minimal ductal diameter (see Fig. 5.3, C). artery, although some have used a venous approach to the
ductus. Where available, transcatheter PDA occlusion offers
Treatment and Prognosis a much less invasive alternative to surgical ligation. Overall,
Closure of a left-to-right PDA is recommended as soon as is ACDO occlusion has shown the highest success and lowest
feasible in almost all cases, either by surgical or transcatheter complication rates among occlusion methods and is consid-
methods. Surgical ligation via left lateral thoracotomy is suc- ered the treatment of choice; however, the minimal device
cessful in most cases. A perioperative mortality of about 5% size (3 mm) is a limitation for very small puppies. Complica-
has been reported. Several methods of transcatheter PDA tions can occur with both surgical and interventional closure,
occlusion are available and involve placement of a vascular including hemorrhage, residual ductal flow, and aberrant