Page 209 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

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(a) (b)
a left fourth intercostal thoracotomy in a dog ith persistent
15.7 right aortic arch. The trachea T is visible in the cranial thora along
ith thymus Th ventrally. The aorta is not immediately visible but the
pulmonary artery (PA) can be seen through the pericardium just ventral to the
phrenic nerve . b In this dog the ligamentum arteriosum oins the left main
pulmonary artery L to an aberrant left subclavian artery L . c ith
silk ligatures tied around the ligamentum it is divided and a large-bore
stomach tube is passed through the narrowed oesophagus (O). Any restricting
fibrous bands are sectioned. The course of the L should also be e amined
and if it causes narro ing of the oesophagus in the cranial thora it too can be
divided between ligatures.

(c)

Other conditions/techniques

Although intracardiac treatment of pulmonic stenosis, cor
triatriatum dexter and selected septal defects can be done
without CPB, these are techniques that are beyond the
scope of this chapter. Similarly, the modified Blalock–
Taussig shunt to palliate dogs with tetralogy of Fallot,
which is an entirely extracardiac procedure, is not covered
in this text. There are, however, rare circumstances where
additional techniques may be useful.

Right atrial mass
When managing a dog with haemorrhagic pericardial effu-
sion of unknown aetiology, and if the right atrium/auricular
appendage has not or cannot be interrogated echocardio-
graphically, the author prefers to do open pericardectomy
via a right lateral approach so that the right atrium can be
inspected. The right atrium is a well known site for haem-
angiosarcoma and the primary tumour may be very small.
Removing the pericardium will alleviate tamponade but if
the tumour is actively bleeding it will have to be removed
too. Theoretically, this is no different from removing a
bleeding splenic mass, although technically there are some
differences. The goals of resection of a bleeding right
lthough most dogs are significantly improved after surgery
15.8 auricular mass are: to stabilize the animal by arresting
some may need to be fed from an elevated position and ill
need to remain in that position for several minutes in order to allo active haemorrhage; to achieve a definitive diagnosis; and
gravity to assist ith the passage of food through the oesophagus to reduce the total body tumour burden to improve the
throughout their lives. efficacy of follow-up anti-cancer drug therapy.

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