Han, Donghyun
(Section of Heart Clinic, Choi youngmin Animal Medical Center)
,
Jung, Dong-In
(Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University)
A 14-year-old intact female Cocker Spaniel dog, weighing 6.8 kg, presented with chief complaints of severe cough, dyspnea, anorexia, and exercise intolerance. It had the characteristics of a blood clot, the evidence of mitral regurgitation, a high left atrial/aortic root ratio, and pericardial effus...
A 14-year-old intact female Cocker Spaniel dog, weighing 6.8 kg, presented with chief complaints of severe cough, dyspnea, anorexia, and exercise intolerance. It had the characteristics of a blood clot, the evidence of mitral regurgitation, a high left atrial/aortic root ratio, and pericardial effusion with a left atrial rupture due to myxomatous mitral valve degeneration (MMVD) was strongly suspected. Traditional therapy (pimobendan, furosemide, enalapril, and spironolactone) for heart failure with MMVD was provided twice a day orally, and partial pericardiectomy was performed for pericardial effusion. The medical prescriptions for MMVD were continued, and the patient's heart disease was well-controlled. However, it suddenly died 3 months after the operation.
A 14-year-old intact female Cocker Spaniel dog, weighing 6.8 kg, presented with chief complaints of severe cough, dyspnea, anorexia, and exercise intolerance. It had the characteristics of a blood clot, the evidence of mitral regurgitation, a high left atrial/aortic root ratio, and pericardial effusion with a left atrial rupture due to myxomatous mitral valve degeneration (MMVD) was strongly suspected. Traditional therapy (pimobendan, furosemide, enalapril, and spironolactone) for heart failure with MMVD was provided twice a day orally, and partial pericardiectomy was performed for pericardial effusion. The medical prescriptions for MMVD were continued, and the patient's heart disease was well-controlled. However, it suddenly died 3 months after the operation.
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가설 설정
Initial thoracic radiography of the present patient with pericardial effusion. A: The right lateral view shows severe cardiomegaly, a globoid-shaped heart, and tracheal elevation. B: The ventrodorsal view shows severe cardiomegaly and a globoid-shaped heart.
5 m/s is observed from the ventricle to the atrium during ventricular systole. B: The M-mode image at the papillary muscle level in the right parasternal view shows pericardial effusion (white arrows) under the free wall of the left ventricle. C: The right parasternal view at the pulmonary artery level shows pericardial effusion (white arrows) over the right side of the pulmonary trunk and an enlarged left atrium (left atrial/aortic root ratio > 2.
A: The right lateral view shows severe cardiomegaly, a globoid-shaped heart, and tracheal elevation. B: The ventrodorsal view shows severe cardiomegaly and a globoid-shaped heart.
C: The left parasternal view shows mitral regurgitation > 4 m/s from the ventricle to the atrium during ventricular systole.
C: The right parasternal view at the pulmonary artery level shows pericardial effusion (white arrows) over the right side of the pulmonary trunk and an enlarged left atrium (left atrial/aortic root ratio > 2.0).
제안 방법
During the operation, the patient was positioned right lateral, and an incision was created between the fifth and sixth intercostal spaces of the left chest wall. During the operation, large and flat blood clots (Fig 3)were grossly visible in the pericardial space, along with clear and transparent pericardial effusion.
Moreover, enrofloxacin (5 mg/kg, SC) (Baytril®, Bayer Korea, Korea) and cefazolin (25 mg/kg, IV) (Chong Kun Dang Cefazolin®, Chong Kun Dang Pharmaceutical, Korea) were administered twice a day to prevent infection, and the incision site dressing was changed once daily for 7 days of hospitalization.
대상 데이터
A 14-year-old intact female Cocker Spaniel dog, weighing 6.8 kg, presented with chief complaints of severe cough, dyspnea, anorexia, and exercise intolerance. History taking revealed that although the patient had been diagnosed with MMVD at the local veterinary clinic and prescribed with medication for heart disease with MMVD, the aforementioned symptoms had worsened over the week prior to visiting our heart clinic.
성능/효과
Fig 5. A: Radiography of the present patient 1 month after partial pericardiectomy shows severe cardiomegaly with left atrial enlargement (white arrows), which is characteristic of myxomatous mitral valve degeneration, but pulmonary infiltration is not observed. B:Echocardiography of the present patient 1 month after partial pericardiectomy shows a left atrial/aortic root ratio of 2.
However, in the veterinary literature, cases of LAR caused by MMVD are still rare (1,4,9,11). Reports of the clinical presentation are rare, and the overall prognosis of LAR secondary to MMVD is poor. Symptoms include collapse, cough, and dyspnea (11).
참고문헌 (12)
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Kittleson MD, Kienle RD. Pericardial disease and cardiac neoplasia. In: Small animal cardiovascular medicine. St. Louis: Mosby. 1998: 413-432.
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Prosek R, Sisson DD, Oyama MA. What is your diagnosis? Pericardial effusion with a clot in the pericardial space likely caused by left atrial rupture secondary to mitral regurgitation. J Am Vet Med Assoc 2003; 222: 441-442.
Sadanaga KK, MacDonald MJ, Buchanan JW. Echocardiography and surg ery in a dog with l eft atrial rupture and h emopericardium. J Vet Intern Med 1990; 4: 216-221.
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