Page 2 - Clinical Connections - Summer 2022

 

 

 

 

 

Page 2 - Clinical Connections - Summer 2022
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 RESEARCH    STUDY    VETERINARY SERVICES       .AC.UK
         vascular malformation; and concluded a   Brockman said: “Because of the history of
         CT scan would be an invaluable additional   trauma and the high probability that Lorna
         investigation.                     had an acquired traumatic kink in her caudal
          Lorna had CT of her thorax and abdomen   vena cava that was responsible for the post-
         on returning to the hospital in May. At that   sinusoidal venous hypertension, we elected
         point the combined cardiology and surgery   to explore the cava through a right sixth
         teams  were  able  to  confirm  that  Lorna   intercostal thoracotomy. At surgery, the scar
         had an extremely rare malformation of her   tissue responsible for the ‘kink’ was very
         caudal vena cava, resulting in high pressure   obvious and incorporated the right phrenic   Lorna's surgery was led by Professor Dan
         in her caudal vena cava (Budd-Chiari   nerve, which was discontinuous.   Brockman, Director of the Cardiothoracic
                                                                                Surgery Programme
         like syndrome), that was the cause of her   “Having released the cava from the scar
         ascites. Her heart was found to be otherwise   tissue, the caudal caval pressure remained   Recovery and progress
         normal in structure.               slightly above cranial caval pressure, so   Lorna recovered from surgery uneventfully
          Lorna’s  clinical  presentation  was  a patch of pericardium was sutured into a   and was discharged on antiplatelet drugs
         comparable to other dogs reported in the   longitudinal incision across the stricture,   (aspirin and clopidogrel) for one month,
         veterinary literature describing kinking and   made  in  the  caudal  cava  made  inside  a   to reduce the risk of clots forming on the
         tortuosity of the caudal vena cava. Previously   carefully  positioned  Satinsky  clamp.  This   pericardial patch. The owners were asked
         documented dogs often presented in young   reduced  the  caudal  caval  pressure  such   to go to the referring practice for staple
         adulthood following blunt thoracic trauma.   that it was just above mean cranial caval   removal and then return to the  for
         Lorna's  history  of a possible altercation   pressure.”               check-up.
         with a deer, and imaging evidence of rib                                 She returned for her check-up towards
         fractures, mirrored these cases.                                       the end of  August, prior to which she
          Possible treatments included surgical                                 had been doing very well at home. On
         exploration and resection of the scar tissue                           examination she was bright, alert and
         causing obstruction, resection of the narrow                           responsive. Her mucous membranes were
         part of the caudal cava and catheter-guided                            pink  and  moist  with  a  capillary  refill  time
         balloon dilation of the lesion with stent                              of under two seconds. Her heart rate was
         placement. No one on the  team had                                  92, with synchronous pulses. Her thoracic
         performed  treatment  on  such  a  lesion  but                         auscultation and abdominal palpation were
         we suspected that balloon dilation and/or                              unremarkable,  with  no  evidence  of  a  fluid
         stenting would be a less appropriate option                            thrill. Doppler echocardiography revealed
         as the kinking of the vena cava was likely                             a structurally normal heart, as before.
         associated  with  fibrous  tissue  causing                             there was no evidence of congestion of the
         extra-luminal compression and there would                              abdominal aorta or hepatic veins and no
         be a high risk of recurrence of the stricture                          ascites so strong evidence that caudal caval
         and we preferred to avoid an intravascular                             hypertension had been relieved. Lorna went
         implant in such a young dog.                                           on to come 4th in her category at Crufts.
          Lorna’s owners decided to go ahead with   Lorna's surgery for an acquired obstruction to
         surgery, and she returned for admission on   her caudal vena cava
         July 6th.  Outlining the  process,  Professor






















         CT angiogram reconstruction of kinked vena cava

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