Case Report
Open Access
Non-Descriptive Puppy and its Successful
Surgical Correction
M. Madeena Begum* and V. Bhuvaneshwari
Heart2Heart Veterinary Hospital No.3, Leith Castle Center Street, Santhome, Chennai-600028
*Corresponding author: M. Madeena Begum, Heart2Heart Veterinary Hospital No.3, Leith Castle Center Street, Santhome, Chennai-600028; Email address:
@
Received: 19 July, 2018; Accepted: 16 August, 2018; Published: 2 October, 2018
Citation: Madeena Begum M, Bhuvaneshwari V (2018) Non-Descriptive Puppy and its Successful Surgical Correction. SOJ Vet Sci 4(3): 1-2. DOI: 10.15226/2381-2907/4/3/00159
Abstract
A 50 day old Non-Descriptive puppy weighing 0.9 kg was brought
to the hospital, for evaluation of regurgitation of 6 day. The puppy
began regurgitating 6 days before at the time of weaning to solid
food. The puppy was thin, underweight and had distended abdomen,
contrast radiograph revealed megaoesophagus and constriction of the
oesophagus at the base of the heart and the condition was diagnosed
as Persistent Right Aortic Arch (PRAA). Left lateral thoracotomy was
performed and PRAA was surgically corrected. Long term follow-up
for 6 months was conducted, pet recovered uneventfully.
Keywords: Persistent Right Aortic Arch (PRAA); Megaoesophagus; Thoracotomy
PRAA is a congenital anomaly which occurs commonly in larger breed dogs like German Shepherd and Irish Setter but rare in Non-Descriptive dogs [1,3,4]. Puppies with vascular ring anomaly like PRAA usually have histories of postprandial regurgitation of solid foods after weaning. In this condition the oesophagus becomes trapped by the ligament which extends from pulmonary artery and the aorta at the level of base of the heart, which leads to regurgitation of solid food and megaoesophagus in case of puppies and it can be diagnosed with the help of contrast radiography using barium swallow [2,5,6].
Keywords: Persistent Right Aortic Arch (PRAA); Megaoesophagus; Thoracotomy
PRAA is a congenital anomaly which occurs commonly in larger breed dogs like German Shepherd and Irish Setter but rare in Non-Descriptive dogs [1,3,4]. Puppies with vascular ring anomaly like PRAA usually have histories of postprandial regurgitation of solid foods after weaning. In this condition the oesophagus becomes trapped by the ligament which extends from pulmonary artery and the aorta at the level of base of the heart, which leads to regurgitation of solid food and megaoesophagus in case of puppies and it can be diagnosed with the help of contrast radiography using barium swallow [2,5,6].
Case History and Observations
A 50 day old Non-Descriptive puppy weighing 0.9 kg was
brought to the hospital, for continues regurgitation of solid foods
for past 6 day from the time of weaning to solid food. On physical
examination puppy was thin, underweight and had distended
abdomen, contrast radiograph revealed megaoesophagus and
constriction of the oesophagus at the base of the heart (Figure 1)
and the condition was diagnosed as persistent right aortic arch
and surgery was fixed[5,6].
Treatment and Discussion
Puppy was pre-anesthetized with diazepam at the dose
rate of 0.25mg / kg body weight and butorphanol tartrate3
at the dose rate of 0.1mg / kg body weight intravenously and
then pre-oxygenated with a mask for 5 minutes. Induction of
anaesthesia was done with 4 per cent Isoflurane in oxygen by
mask induction technique and intubation of the trachea was
Figure 1: Pre-operative contrast radiograph shows megaoesophagus
which constrict at the level of base of the heart
done with the cuffed endotracheal tube size 4.5mm, which was
connected to a anaesthesia machine by Bain’s circuit. Anesthesia
was maintained with 2-3 per cent Isoflurane in oxygen. Puppy
was mechanically ventilated (20 breaths/min) using intermittent
positive pressure ventilation and left lateral thoracotomy was
performed by making incision on fourth intercostals space and
a retractor was fixed between 4th and 5th rib [7]. The phrenic,
vagus and recurrent laryngeal nerves were indentified and
protected then the ligamentum arteriosum which constricting
the oesophagus was identified and isolated by dissection (Figure
2). The constricting band was cut and released after placing two
sutures, 1cm apart each other with 3-0 non absorbable suture
material [Figure 3]. The fibrous tissue on the constricted site
of esophagus was dissected off. A foley’s catheter was inserted
in to the esophagus and additional constriction was ruled out.
Rib cage was closed with Poly Glycolic Acid No.1 by interrupted
cricumcostal sutures. Elimination of pneumothorax and reestablishment
of negative intrathoracic pressure was achieved
by inflation and expansion of lung by compressing reservoir bag,
just before suturing the final suture. Subcutaneous tissue sutured
using Poly Glycolic Acid No.2-0 and skin apposed using Polyamide
No. 3-0. Postoperatively, puppy was maintained with intravenous
cephalosporin (Intacef Tazo) at the dose rate of 22 mg/kg body
weight for one week, intravenous fluid therapy for 48 hours and
elevated feed was carried for first two weeks, wound dressing
with antibiotic ointment were continued for up to 10 days. Skin
suture was removed after healing on 10th postoperative day. A
long term follow-up of six month revealed complete recovery
of the pet happened within a month and no complications
were noticed even after six month of the surgery. Successful
post operative recovery is mainly due to the earlier diagnosis
and surgical correction which is generally recommended to
minimize permanent dilation of the esophagus due to loss of
neuromuscular function and peristalsis of the esophagus [7,8,9].
Surgical treatment is the best option whereas most of the medical
treatment of PRAA cases where unsuccessful with a poor longterm
prognosis [5,6,8].
Figure 2: Intra-operative picture shows persistent ligamentum arteriosum
Figure 3: Intra-operative picture shows double suturing of ligamentum
arteriosum
Summary
Persistent Right Aortic Arch was successfully corrected by
surgery and no complications were evident under long term
follow-up.
ReferencesTop
- Ashrafian H, Tsang V, Kostolny M. Rare presentation of subclavian artery isolation in a neonate with a family history of aortic arch anomalies. Ann Thorac Surg. 2007;83(6):2226–2228. DOI: 10.1016/j.athoracsur.2006.11.037
- Bottorff B, Sisson D. Hypoplastic aberrant left subclavian artery in a dog with a persistent right aortic arch. J Vet Cardiol. 2012;14(2):381-385. DOI: 10.1016/j.jvc.2012.01.013
- Christiansen KJ, Snyder D, Buchanan JW, Holt DE. Multiple vascular anomalies in a regurgitating german shepherd puppy. J Small Anim Pract. 2007;48(1):32-35.
- Du Plessis C J, Keller N, Joubert KE. Symmetrical Double Aortic Arch in a Beagle Puppy. J Small Anim Pract. 2006;47(1):31-34.
- Harari J. Small Animal Surgery. William and Wilkins. Pennsylvania. 1996;127-128.
- Jung J, Cho Y, Jung Y, Jeong J, Lee K. Diagnosis and treatment of an aberrant right subclavian artery with persistent right ligamentum arteriosum in a kitten. Pak Vet J. 2015;35(1):119-122.
- . Jurado O M, Mosing M, Bettschart-Wolfensberger R. Anaesthetic management of a 1-month-old puppy undergoing lateral thoracotomy for vascular ring anomaly correction. Case Reports. Vet Med. 2011;1-6.
- Koc Y, Turgut K, Sen I, Alkan F, Birdane MF. Persistent Right Aortic Arch and its Surgical Correction in a Dog. Turk. J Vet Anim Sci. 2004;28:441-446.
- Plesman R, Johnson M, Rurak S, Ambrose B, Shmon C. Thoracoscopic correction of a congenital persistent right aortic arch in a young cat. Can Vet J. 2011;52(10):1123-1128.