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Surgical treatment of pulmonic stenosis
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Introduction:
Pulmonic stenosis (PS) is the most common congenital cardiac disease in the dog (Oliveira and others 2011). The treatment options reported in the veterinary literature include the interventional radiological technique balloon valvuloplasty (BV) along with several operations including partial pulmonary valvectomy, patch grafting the right ventricular outflow tract (RVOT) (Orton and others 1990, Hunt and others 1993), and conduits that bypass the stenosis completely (Buchanan and others 1990, Saida and others 2009). The ideal therapy for symptomatic and/ or severe pulmonic stenosis would: 1. simultaneously and permanently treat supravalvular, valvular, valve annular and infundibular muscular components of the stenosis, 2. be safe for the dog, 3. be cost effective for the client, 4. not cause undue pain and suffering and finally 5. be curative rather than palliative. None of the treatments for PS that have been described in the veterinary literature to date, fulfil all of these criteria. The clinician treating dogs with symptomatic or severe VPS has to make a subjective risk: benefit assessment for each dog along with a cost: effectiveness assessment with the owners, before a final decision can be made.
Commonly, the severity of pulmonic stenosis is graded as mild, moderate or severe, based on the pressure gradient estimated, by calculation, from the velocity of blood flow across the stenosis, derived by Doppler ultrasound interrogation. Generally, animals affected clinically or that have “severe” disease on the basis of their pressure gradient, are considered as candidates for intervention. [...]
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