MITRAL VALVE REPAIR EXPERTS
Doctors Sabine and Jean-Hugues Bozon, who are the only 2 vets diplomate of cardiopulmonary bypass sciences, belong to the very private circle of wordly renowned open-heart surgery team. Thanks to their many years practising in this field, they set up a 100% French team of professionals (surgeon, instrumentalists, cardiologist, perfusionists, anaesthetists, highly trained nurses…).
Drs Sabine and JH Bozon are focusing more and more on open-heart surgeries and interventional cardiology by having purchased (November 2018) a brand new digital C-Arm for fluoroscopy, angiography and minimally invasive cardiac procedures (OEC ELITE CFD 21 CARDIAC from GE HealthCare).
Dog going for a walk 2 days after mitral valve surgery at HOPia
WHICH DOGS ARE AT RISK OF DEVELOPING DMVD?
DEGENERATIVE MITRAL VALVE DISEASE (DMVD)?
WHAT ARE THE CLINICAL SIGNS OF DMVD?
Pulmonary oedema is a major cause of dyspnoea (difficulty to breathe) because the lungs are filled with fluid instead of air. The clinical signs associated with CHF are: lethargy, exercise intolerance, cough, increase in respiratory rate and amplitude in respiratory motions. If one of those clinical signs is identified, a veterinarian must be contacted urgently.
THE ACVIM CLASSIFICATION
ACVIM STAGE B
This class comprises dogs with a heart murmur without any other clinical signs. This stage is further subdivided into Stage B1 and B2.
Open heart surgery planning is a 2-month process – here are the 10-key steps in chronological order
Candidacy evaluation (heart status)
Please send us, through the contact formulary OR at firstname.lastname@example.org, your dog’s latest heart-scan (pictures + video loops) and chest radiographs, his relevant medical history and his ongoing treatment plan.
Detailed recent physical examination and relevant history
Latest detailed cardiac ultrasound scan (images and more important the video loops including colour)
Latest chest radiographs
- Electrocardiogram (ECG)
Arterial blood pressure measurement
- NT-ProBNP dosage
Ask your veterinarian to perform the following tests (please send the complete digital version of these tests) 2 months prior to the presumed date of surgery
NT-ProBNP and Cardiac Troponin I dosages
Full abdominal ultrasound scan (must be particularly closely examined : adrenal glands for features of Cushing’s disease, pancreas for signs of pancreatitis, search an occult tumour present)
Blood tests : haematology, complete biochemistry panel, electrolytes, C-Reactive Protein, SDMA, cPLi, T4, TSH, 4DX
Urinalysis including UPC ratio and bacterial culture (sampling by cystocentesis)
Full coagulation profile including antithrombin III dosage, D-dimer and fibrinogen
Blood type (DEA 1.1)
Interpretation of the results, validation that your dog fits the criteria for open heart surgery
Date scheduling for your dog’s surgery
Possible refinement of the therapeutic plan in order to optimise preoperative conditions
Additional exams potentially necessary before surgery
Plan to arrive between 1 and 3 days prior to surgery at HOPia
Pre-operative full check-up at HOPia the day before surgery
MACHINES AND CONSUMABLES
Apart from the extracorporeal circulation machine, key pieces to the procedure, the necessary equipment is as follows:
Heart-lung bypass machine – centerpiece of the intervention
The technical and human platform are important, the team must have a perfect cohesion but the most crucial point is the heart-lung bypass machinery which represents quite a challenge in small individuals.
THE DIFFERENT STEPS OF THE PROCEDURE
The next steps are the following:
The post-operative care is a real challenge!
It is a very critical phase during which the dog may die because many organs have suffered from the extracorporeal circulation, even the blood, to start with, because it has flown outside of its usual body. A complete blood panel, urinalysis, radiographic and ultrasonographic scans are performed daily during the week following surgery.
Apart from thrombosis (clot formation), the possible complications are: