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PDA: What's the evidence? Coils v Ampaltz v surgery
Pelosi A.
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Introduction
Patent Ductus Arteriosus represents one of the most common congenital cardiac conditions in dogs. Because of the likelihood of completely resolving the cardiac long-term consequences produced by this condition, it is also one of the most common extracardiac interventions a veterinary surgeon encounters.
Pathophysiology and ductus morphology
Aorto-to-pulmonary communications in the form of a postnatal patent ductus are the result of aberrant distribution of smooth muscles and elastic fibers. Normal ductus wall is composed of 98% smooth muscle with remainder elastic fibers and loose collagen in adventitia. After birth, muscle constricts in response to increased arterial oxygen tension and closes within minutes to hours. Non-inflammatory muscle lysis begins within 48 hours in dogs and usually complete within one month leaving elastic fiber remnant of ligamentum arteriosum. Histologically, the PDA can be classified into 6 grades, based on presence and extent of abnormal elastic tissue where it should have been muscular. The aberrant distribution of fibers also affects the shape of the ductus. However, it is important to consider that, when we refer to the shape of the ductus, we refer to its internal shape and diameter, rather than the outer shape, which is the only part visible to the surgeon. Proper assessment of internal shape can only be done via angiogram. According to Miller et al. inner morphology of the ductus varies allowing classification of the ductus in dogs into 3 types (see picture). The inner diameter of type III is significantly larger compared to type I and II. Type I presents a progressive decrease in diameter between the aortic and the pulmonary attachment. In type II ducti the variation in diameter is less progressive and the narrowest diameter is on the pulmonic side. Type II can then be subdivided into IIA and IIB. Type III shows minimal alteration in ductal diameter between the aortic and the pulmonic attachment. The most commonly observed type is IIA, accounting for up to 54.5 % of cases, while type I was recorded in 5%, IIB in 32.5%, and type III 8%, respectively. [...]
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