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Objective: To assess the efficacy of an open patch-graft technique under cardiopulmonary bypass (CPB) in small dogs., Design and Methods: A retrospective analysis of 10 dogs with pulmonic stenosis. Records between 1992 and 2002 were reviewed. The effect of surgical correction was evaluated and perioperative parameters were compared between survivors and non-survivors., Results: The postoperative pulmonary pressure gradient was reduced in all seven surviving patients. Mean +/- SE was 21.5 +/- 7.4 mmHg (range 3.0-54.2 mmHg) and 6/7 dogs were < 40 mmHg at 3 months postoperatively. Comparing the data between those patients that survived and those that did not, the preoperative pressure gradient (P = 0.04) and volume of the Glucose-Insulin-Kalium solution used (P = 0.001) were significantly higher in those that did not survive., Conclusion: Open patch-grafting can be performed in small-breed dogs and decreased the pulmonary pressure gradient in survivors at 3 months postoperatively. However, this technique is more invasive than balloon valvuloplasty and should be used cautiously in severely stenosed patients.

The clinical, radiographic and echocardiographic features of two cases of pulmonic stenosis in cats are presented. A rarely reported combination of pulmonic stenosis and tricuspid valve dysplasia is described.

Closed pericardial patch-grafting has been advocated for the treatment of severe pulmonic stenosis. In this study pre- and postoperative echocardiography was used to determine if the transvalvular pressure gradient was successfully lowered by this surgery and whether it remained lowered long term. The valvulotomy-ventriculectomy wire was passed using a blunt needle in four dogs (Bresnock technique1) and via a soft catheter in five dogs (Shores and Weirich modification). Eight of nine patients survived the perioperative period. These dogs were assessed up to 40 months following surgery for clinical and echocardiographic changes. Five cases showed significant decrease in peak pulmonic pressure gradient immediately after surgery (decreasing by 50-81%, P < 0.05), and six cases showed significant decrease 2 to 40 months postoperatively (decreasing by 31-80%, P < 0.005) when compared to preoperative values. There was no significant change in pulmonic pressure gradient from immediately postoperatively to 2 to 40 months postoperatively (P < 0.48). Six dogs showed clinical improvement postoperatively, however persistent right ventricular hypertrophy was observed in all cases. One dog died with symptoms of congestive heart failure 16 months postoperatively. Closed pericardial patch grafting can improve clinical signs in symptomatic patients, however the surgery has significant risks, long term prognosis for these patients is guarded and recurrence of clinical signs and development of congestive heart failure is possible. Cardiac changes can be monitored with Doppler flow echocardiography. Patients with extremely elevated preoperative pressure gradients may be expected to have poorer outcomes.

A modified open patch-graft technique was used to correct congenital pulmonic stenosis in 8 dogs. Pulmonary valve dysplasia was moderate to severe in all cases, based upon clinical and echocardiographic criteria, and 3 dogs were in right-sided congestive heart failure at the time of surgery. Seven of the 8 dogs survived the surgery. One surviving dog displayed cerebral cortical dysfunction, the remaining 6 had no detectable neurological sequelae. Right ventricular failure was alleviated in all 7 surviving dogs, but right ventricular dilatation persisted post-operatively. Pulmonary valvulectomy and open patch-grafting provides an effective means of alleviating signs of congestive heart failure caused by pulmonary valve dysplasia, even in the presence of severe infundibular hypertrophy and dynamic outflow obstruction.