Your success rates for balloon valvuloplasty for pulmonary valve stenosis

Dog is 1.5 y/o un-neutered male German Spaniel.  Dog was a rescue dog from a local shelter who clearly had not been seen by a vet before adoption.  Dog was seriously underweight at adoption (< 15kg against normal of 20-22kg).

At the first post-adoption checkup (ca. 15 Dec 09) at our normal vet, she found a prominent murmur.  X-rays showed a hugely enlarged heart.  Diuretics were started pending an appointment with a veterinary cardiologist.  Cardiologist confirmed murmur, cardiomegaly; Doppler u/s showed severe pulmonary valve stenosis (sorry, don't have pressure gradients).  Treatment with dilatiazem and pimobendan was started 04 Jan 2010 and diuretics were stopped; follow-up visit scheduled for week beginning 08 Feb.

Dog is largely asypmtomatic (no coughing, wheezing, or shortness of breath).  Some panting is seen after extensive running off the leash.  Exercise tolerance continues to improve since adoption and with improved nutrition.

If medical treatment fails to substantially improve the dog's condition, the alternative offered is balloon valvuloplasty.

Questions: what has been your experience with this procedure in terms of valve repair?  Mortality pre-op, intra-op and post-op?

[Arnold L Goldman, D.V.M.]

Dear FDO,

Very glad to hear this news! Continue to followup with your cardiologist as you have.
Sorry I could not have been more helpful personally in this forum, but you are very much on the right track for this type of condition.

Sincerely,

Dr. G

[Arnold L Goldman, D.V.M.]

Dear FDO,

I have chosen to comment rather than answer, as I do not personally have the information you seek.

I suspect you will be unable to obtain an answer to your questions on this forum as the procedure you are contemplating is generally accomplished only in large referral centers by board certified cardiologists. Each doctor who does these procedures likely has their own experiences and statistics to report to you and may have nuances to their techniques that make each unique. The place to get the information you seek is the doctor who has proposed the procedure.

If still in doubt and to compare apples to apples, if you seek a second opinion you should do so from another board certiifed cardiologist. We general practiitoners are in no position to comment. Even if we have referred for this procedure, we would not alone have the numbers of cases to make generalizations and draw conclusions that had statistical validity.

The credential of the specialist cardiologist is Diplomate of the ACVIM - cardiology.
Learn more at www.acvim.org.

Good luck and let us know what you find out.

Sincerely,

Arnold L. Goldman DVM, MS
MedHelp & PDOC

[FrenchDogOwner]

Dear Dr. Goldman,

apologies for the late reply to your post.  Our dog had his one-month follow-up earlier in February and progress is good.

He is responding well to the dilatiazem and pimobendan regimen in my first post and, according to the most recent doppler u/s, his cardiac function has improved at least 50%.  (I wasn't present during the exam, so I don't have specific pressures.)

He continues to be asymptomatic (no coughing, wheezing, gasping, fainting, etc).

Furthermore, in the 4 weeks since start of treatment, he had gained 700g.  He is still well underweight for a dog his size but progress is being made.

His exercise tolerance and strength continue to improve, and we have noticed within the last 10 days another jump in energy and strength.  Whether that's due to improved nutrition, medication, exercise, or a combination of all three is hard to say.  But it is clear that he is a much happier, healthier dog than when we first adopted him.

We were fortunate that one of the three only board-certified canine cardiologists in Switzerland has his practice a mile away from my office.  He was delighted to see how well our dog had progressed, and the dog's scheduled only for a six-month check-up.  

In the meantime we source our dilatiazem (90 mg retard, b.i.d.) (human formulation) generically from the local pharmacist at a bearable price (generics are much less expensive in France); the pimobendan (5 mg b.i.d. veterinary formulation) isn't available generically but it's not breaking the bank.

We are also relieved that, for the time being, balloon valvuloplasty seems off the cards....

Kind regards,
Jim M.
near Geneva, Switzerland