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Mitral valve repair
Uechi M.
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Mitral regurgitation (MR) associated with secondary to degenerative mitral valve disease (DMVD) is an acquired cardiac disease that most commonly occurs in dogs. The severity of DMVD is related to age, the degree of MR (murmur or countercurrent jet), and the degree of valvular degeneration. Deterioration of clinical signs and worsening prognosis of DMVD occurs because of advancing mitral valve degeneration, development of mitral valve prolapse, and progressive thickening and eventual rupture of the chordae tendineae. When compensatory functions of the pulmonary vasculature for MR fail, cough and dyspnea due to pulmonary congestion and pulmonary edema occur. Dyspnea due to severe pulmonary edema is treated with diuretics, oxygen inhalation, nitrates, cardiotonics, and vasodilators. Recently, pimobendan has been shown to have beneficial response to MR dogs with improvements in quality of life and survival. However, survival following DMVD and/or rupture of the chordae tendineae is no longer than 2 years. Because medical treatment of MR with cardiovascular drugs is palliative, MR generally progresses to severe disease. Therefore, a more radical cure to reduce MR requires surgical intervention.
Mitral valve repair was developed as an alternative treatment option for mitral regurgitation and has demonstrated results superior to mitral valve replacement in humans. Valve replacement and long term survival have been reported in dogs. However, the primary issue associated with mitral valve replacement is the subsequent need for life-long antithrombotic treatment, which is not required following mitral valve repair. At present, the long-term outcome in dogs after mitral valve repair is poorly documented. We present the long-term outcome of small-breed dogs after mitral valve repair. We evaluated cardiac reverse remodeling after mitral valve repair under cardiopulmonary bypass (CPB) for mitral regurgitation in small breed dogs. [...]
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