What you can do to protect your small animal patients from reflux and regurgitation during anaesthesia will be explored at BSAVA this year in a lecture hosted by Docsinnovent for veterinary surgeons and nurses with an interest in anaesthesia.

The lecture, which will take place at 4:30pm on Friday 6th April in the Premier Lounge, Arena Birmingham, is presented by Dr Ivan Crotaz BVetMed MRCVS and human anaesthesiologist Dr Muhammed Nasir MBBS BSc FFARCSI MRCA (pictured right).

Chris Geddes MRCVS, Marketing Manager for Docsinnovent, says the lecture is not to be missed for two reasons: "Firstly, the topic is very current – a lot of new information is emerging about regurgitation and reflux in our veterinary patients. We are learning that the starving times we have all been recommending for years may not be ideal after all.

"Secondly, the lecture will be presented by both a vet with an interest in airway management (Dr Crotaz) and a renowned human anaesthesiologist (Dr Nasir) – so we as a profession can learn from what is happening in the field of human medicine."

The session will include a review of the situation in human anaesthesia. The anatomy of the upper airway and oesophagus of the major small animal veterinary species will be examined as well as the pathogenesis, occurrence and disease associated with reflux. 

Pre-, intra- and post-operative management will be discussed, as well as current recommendations for starving veterinary patients.

The lecture is free for BSAVA attendees to attend and will be followed by drinks and nibbles supplied by Docsinnovent, who are also exhibiting at BSAVA congress on stand 1006.

White Cross Vets, the 18-practice group headquartered in Leeds, has introduced 'peternity leave', through which all its 220 staff are entitled to two paid days off work when they get a cat, dog or rabbit, to help them settle the animal in its new home.

The initiative was the idea of one of the practice's client care co-ordinators, who suggested it whilst she was acting as the managing director for the day, as part of White Cross Vets' 80 year anniversary celebrations. 

Managing director Tim Harrison said: "We believe we are the first veterinary practice in the UK to offer two full days paid peternity leave. Our ethos is all about caring for pets, and the first few days at home with a new addition are so special. It’s therefore essential that quality time can be dedicated to a new pet, in order to make sure they feel comfortable and safe in their new environment.

"As all of our team are all pet owners already, this time off will give them the chance to introduce and socialise any new family members with existing pets, which must be done carefully and under supervision.

"Bringing a new pet into the family takes a lot of patience and perseverance, and certain breeds or older pets can be harder to train or take longer to bond. Also there is a lot of preparation work that needs to be done in the home and garden when a young pet dog, cat or rabbit arrives, so this time off will hopefully make it easier for our team to give their new pets a safe and welcoming start in their new homes."

Other perks that White Cross Vets offers include five fully paid donation days a year to volunteer with chosen charities, a health care scheme, days off and cakes for birthdays, as well as subsidised Fitbits and gym memberships.

Boehringer Ingelheim Animal Health has launched Mind the Gap, an online tool for veterinary surgeons and farmers to collaboratively develop a bovine viral diarrhoea (BVD) vaccination schedule which avoids immunity gaps.

The idea for an interactive vaccination calendar was in fact first developed two years ago by Jon Reader MRCVS (pictured right) from Synergy Farm Health. With input and funding from Boehringer, it has now been developed into an online tool which highlights times when animals may be at risk if immunity has waned, without sufficient boosting of immunity by vaccination.

The transmission of BVD is complex and protecting the foetus from the virus is at the heart of any control programme. The virus is passed from dam to foetus and, if this occurs in the first third of pregnancy and the foetus goes to term, a persistently infected (PI) calf will be born. These will then go on to shed virus throughout their lives, so infecting herdmates and the next generation of calves.

Jon said: "The timing of when a vaccine is given is critical to the development of an immune response, which will protect the unborn foetus. 

"Working out when you want the dam to calve and then calculating back shows when either a primary course of BVD vaccine or a booster should be given but, get this wrong and you will end up with what is known as an 'immunity gap'.

"It is vital that both heifers and cows have maximum protection during the breeding period and in early pregnancy."

Boehringer says heifers must be fully protected before being served for the first time, and cows must have had immunity boosted before they are pregnant again. However, far too often heifers are adequately protected following an initial booster but given their age and date of service, do not receive further protection until they enter the adult herd.  

Jon said: "If heifers calve just after the herd booster, then there is a very real possibility that they will go for two years without a booster, and be severely exposed when they become pregnant as a first lactation heifer."

"This is termed the immunity gap; a period when the animal is not protected from the virus at all. The aim should be to eliminate this period completely, so that there is no immunity gap."

Matt Yarnall from Boehringer said: "Each BVD vaccine has its own timing protocol stating when the primary course should be given, as well as subsequent booster timing and when cows should be served. Moreover, some of these are not straightforward to follow, especially for year-round calving herds."

"Anyone using the Bovela vaccine has peace of mind that the one dose primary course combined with flexible booster regime and 12 months’ proven duration of immunity minimises the immunity gap." 

For more information, visit: makebvdhistory.co.uk.

Emerge Veterinary, a coaching project set up by Adrian Nelson-Pratt BVSc MRCVS to help veterinary professionals deal with personal challenges, has announced details of a new personal wellbeing retreat for veterinary surgeons, believed to the first of its kind for the profession.

The 2-day Change Catalyst Veterinary Retreat will take place at Roaches Hall on the Derbyshire/Staffordshire border from 15-17^th May 2018, after which participants will receive three months of personal one-to-one coaching.

The organisers say that during the retreat, which is provided in partnership with Natural Change, participants will take part in a series of largely outdoor activities that draw on the potential of nature. They will also be introduced to some simple nature-based techniques to look after their wellbeing and to reflect on their personal or professional journey. Post-retreat personal coaching is included to help reinforce and embed these changes or assist in developing the insights gained during the retreat. 

The retreat is aimed at veterinary surgeons who are at a career crossroads, making major decisions about the direction of their career or for those looking for an opportunity to help develop capacity, build resilience and to improve wellbeing. The organisers say it offers time and space to get away from everyday concerns, re-energise and focus on what really matters as well as helping vets reflect, refresh and reconnect with nature.

The retreat is open to a maximum of 16 participants who will work with two facilitators. The follow up coaching is one to one, personal, and confidential.

Director, Adrian Nelson-Pratt said: "Vets have well documented challenges with work-life balance that lead to a disconnection from the natural world. Feelings of isolation, loss of career direction or in the worst-case, deterioration in physical and mental health can follow.

"Having experienced the Natural Change process myself, I found it a deeply reflective and restorative experience. It allowed me the time and space to develop some new ideas and to re-invigorate myself.

"The Change Catalyst Vet Retreat is the result of this process for me and I think it’s a powerful tool to support vets on a personal and professional level. It’s also an appropriate contribution to your annual CPD requirement."

Tickets cost £1500 and are available at https://www.emerge-veterinary.com/join-us/the-change-catalyst/ or for more information contact: adrian@emerge-veterinary.com

Researchers from Ghent University (UGhent), Austria Veterinary Medicine School (Austria VetMed) and the Royal Veterinary College (RVC) have published the first systematic review of the evidence for the efficacy and safety of all anti-epileptic drugs (AEDs) in feline epilepsy.

The aim of the study was to assess the efficacy and adverse effect profile of each individual AED by analysing all available data published and then evaluating how reliable it was.

The researchers gathered, screened and assessed all the information published in peer-reviewed journals and publications. The individual studies were then evaluated based on the quality of evidence, study design, study group sizes, subject enrolment quality and overall risk of bias, as well as the efficacy and safety outcome measures.

Lead-author, Marios Charalambous from Ghent University, said: "We recruited systematic methods to combine, compare and summarise the results of independent studies and, therefore, create more objective and reliable conclusions based on the current evidence. It was a time-consuming, demanding and challenging process, and we hope we provided the clinicians now with essential information which they can use for daily practice." 

The researchers found that much of the evidence for the medical treatment of feline epilepsy was based on below-par reporting of efficacy and adverse effect, worse than what was formerly reported in dogs.

The lack of good quality evidence led authors to conclude that it would be: "...rather inaccurate to make definite statements on which one [AED] should be considered as a first or second choice in terms of both efficacy and safety profile. However, if clinicians focus on AED’s efficacy, phenobarbital can be used as first-choice monotherapy and if they focus on AED’s safety, imepitoin or levetiracetam can be used." 

Holger Volk, Head of the Department Clinical Science and Services and Professor of Veterinary Neurology and Neurosurgery at the RVC, said: "Not only does this study offer a new perspective on the management of feline epilepsy, but also highlights the importance of the need for trials which provide high quality evidence in order to have more reliable and objective results about the efficacy and safety of the AEDs in feline epilepsy."

The study was published in BMC Veterinary Research (https://doi.org/10.1186/s12917-018-1386-3).

A new pilot study on the effects of rider weight on equine performance, presented at the National Equine Forum this week, has shown that high rider: horse bodyweight ratios can induce temporary lameness and discomfort.

The researchers say that ultimately the study should help with the development of guidelines to help all riders assess if they are the right weight for the horse or pony they intend to ride, to enhance both equine welfare and rider comfort and enjoyment.¹

Dr Sue Dyson, Head of Clinical Orthopaedics at the Animal Health Trust’s Centre for Equine Studies, Newmarket, who led the study said: "While all the horses finished the study moving as well as when they started, the results showed a substantial temporary effect of rider weight as a proportion of horse weight.

"The results do not mean that heavy riders should not ride but suggest that if they do they should ride a horse of appropriate size and fitness, with a saddle that is correctly fitted for both horse and rider.

"We must remember that this is a pilot study: further work is required to determine if horse fitness, adaptation to heavier weights and more ideal saddle fit will increase the weight an individual horse can carry. This should help us further in our quest to develop guidelines for optimum rider: horse bodyweight ratios."

As the average weight and height of humans continues to increase there is growing debate about relative rider-horse sizes, with riding school horses epitomising the variety of weights of rider that a single horse may be exposed to. 

Numerous inter-related aspects are involved with the horse and rider combination including the age of the horse, its fitness and muscle development, the length of its back and the presence or absence of lameness. The rider’s skill, fitness, balance and coordination are important factors, as is the fit of the saddle to both the horse and rider. The type, speed and duration of work and the terrain over which the horse is ridden must also be considered.²

To date little research has been conducted on the effects of rider weight on equine welfare and performance. To address the shortfall World Horse Welfare, the Saddle Research Trust, the British Equestrian Federation and a number of other organisations helped to fund a pilot study last summer, the results of which have now been analysed.

The influence of rider to horse bodyweight ratios on equine gait and behaviour: a pilot study¹ assessed gait and behavioural responses in six horses ridden by four riders of similar ability but different sizes. The riders were all weighed in their riding kit and were subsequently categorised as being light, moderate, heavy and very heavy.  Their body mass index (BMI) was also calculated.

Each rider rode each horse in its usual tack and performed a set pattern of exercises comprising mainly trot and canter. Gait, horse behaviour, forces under the saddle, the response to palpation of the back, alterations in back dimensions in response to exercise, heart and respiratory rates, salivary cortisol levels and blink rate were assessed for each combination.

The riding tests for the heavy and very heavy riders were all abandoned, predominantly because of temporary horse lameness. This was likely to have been induced by bodyweight rather than BMI, given that the heavy and moderate riders had similar BMIs, both being classified as overweight, yet only one of the moderate rider’s tests had to be abandoned. An ethogram, developed by Dr Dyson specifically to assess behavioural markers which may reflect pain in ridden horses³, was applied. The scores which may reflect pain were significantly higher in the horses when ridden by the heavy and very heavy riders.

The study also raised the issue of rider height and saddle fit. The owner of one of the test horses had a similar bodyweight: horse bodyweight ratio to the heavy rider and was of similar weight, but significantly different in height (157.0 and 185.5 cm, respectively). This large difference in height has major potential implications for saddle fit for the rider and consequently the rider’s position and weight distribution. The taller rider sat on the back of the cantle, overloading the back of the saddle and making it more difficult to ride in balance, with the heel being in front of a vertical line between the shoulder and ‘hip’.

Roly Owers, Chief Executive of World Horse Welfare, said: "These pilot results are certainly not surprising but are very significant in adding vital evidence to inform an appropriate rider: horse weight ratio. It is common sense that rider weight impacts equine welfare however many might not fully understand or recognise this. What is desperately needed is basic guidance to help riders identify a horse or pony that is right for them and this research is a vital step in that direction.”

The study was generously supported by World Horse Welfare, the Saddle Research Trust, Frank Dyson, British Equestrian Federation, British Horse Society, Pony Club, Polocross, The Showing Council, The Showing Register, The Society of Master Saddlers, Riding for the Disabled, British Eventing, British Dressage, the British Horse Foundation, the Worshipful Company of Saddlers and Endurance GB.

References

1. The influence of rider to horse bodyweight ratios on equine gait and behaviour: a pilot study Dyson, S, Ellis, A, Guire, R, Douglas, J, Bondi, A, Harris, P.
2. Clayton, H, Dyson, S, Harris, P, Bondi, A. Horses, saddles and riders: Applying the science. Equine Vet Educ 2015; doi:1111/eve.12407
3. Dyson, S, Berger, J, Ellis, A, Mullard, J. Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. J Vet Behav: Clin Appl Res doi:10.1016/j.jveb.2017.10.008

Scarsdale Vets, the Midlands-based veterinary group, is marking International Women's Day today by celebrating the success of the women in its teams.

The group, which was founded over 70 years ago, now employs over 300 people, more than 85% of whom are female. Many occupy senior and leadership positions: 6 out of 13 of the partners are female.

Wendy Furness, a Partner at Scarsdale Vets said: "Scarsdale Vets represents a microcosm of how women’s roles could be in a world of gender equality in business.

"Here we have people in every role that you can imagine, from client-facing roles such as client care advisors, vets and nurses, to people that make the business function happen, such as marketing and finance managers. 

"We want women to be inspired to be who they want to be. There are many roles that some people still first think of as male dominated, such as surgeons and farm or equine vets.

"However, we at Scarsdale Vets are challenging assumptions like these and looking for opportunities to make all roles visible to women.”

Wendy added: "Having women in leadership and senior roles is essential if women at the start of their careers are to succeed. We can be there to inspire the next generation to strive for these positions, if that is what they want, and see that it is made possible. We can also stand up and be counted if and when bias based on gender is observed."

To mark International Women’s Day, Scarsdale Vets is filling its social media channels with positive images of women, working in the diverse roles within the practice, challenging stereotypes about the veterinary roles available to women, influencing others positively, and celebrating the successes of the women in their team.

https://www.facebook.com/ScarsdaleVets/posts/2097073290308906 

Photo: Rose Jackson MRCVS, a farm animal vet at Scarsdale Markeaton. Courtesy Scarsdale Vets. 

The Fédération Equestre Internationale (FEI) has announced that it supports the recommendation of its scientific partner the World Organisation for Animal Health (OEI) that equine influenza vaccination includes both Florida Clade 1 and 2 strains.

The OIE represents 178 Member countries and territories with international surveillance programmes that monitor antigenic drift among equine influenza viruses, and its Expert Surveillance Panel (ESP) for EIV makes annual recommendations for the composition of equine vaccines. 

ProteqFlu, manufactured by Merial Animal Health, is currently the only vaccine in Europe to meet these recommendations.

Brand manager Dr Clare Turnbull said: "These recommendations, which have been in place since 2011, call for the inclusion of both Florida Clade 1 and 2 strains; as these are representative of the EIV strains that competing horses encounter globally.

"Although all licensed vaccinations should give clinical protection to individuals when challenged with a heterologous strain, mathematical modelling demonstrates that when scaled up to population level, this mis-match between challenge strain and vaccine strain significantly increases the risk of an epidemic occurring."

The FEI imposes mandatory equine influenza vaccination for horses competing under their jurisdiction to improve equine welfare by reducing clinical disease in individuals; but also because of the financial losses that an outbreak could have on the equine sport industry.

Göran Akerstrom, veterinary director of the FEI said: "The FEI has been a part of a Public Private Partnership with OIE for many years and we admire the work that they do in disease surveillance and global animal health. 

"We stand behind their recommendations on vaccination for equine influenza and recommend our athletes to discuss these with their veterinary surgeons when considering their vaccination schedules."

For further information on FEI vaccination requirements visit https://inside.fei.org/node/3289

Abi Thompson, a final year student of veterinary nursing and practice management at Harper Adams University, is carrying out some interesting research to discover whether veterinary professionals’ perceptions of what is important to clients is the same as what clients say is important to them.

The surveys, which are part of Abi's honours research project, ask veterinary professionals and owners separately to place 'ability to see the same vet', 'staff friendliness', 'competency of vets and nurses', 'appointment availability' and 'appointment waiting times' in order of importance.

It also looks at whether veterinary professionals and owners think practice independence and nurses' clinics have an impact on client loyalty.

The surveys should take less than 10 minutes, and Abi has promised to share the results with VetSurgeon.org and VetNurse.co.uk in due course, so please do take part. It'll be fascinating to see whether there's a mismatch between what vets and nurses think are important, and what clients think!

The survey for veterinary professionals is here.

If you know any owners that would be interested in taking part, the survey for clients is here.

The RCVS Disciplinary Committee has reprimanded County Tyrone based Brian Phelim Mallon MRCVS, after it found a number of charges proved in relation to failing to obtain agreed consent for the euthanasia of a dog, for keeping no clinical records for that dog and for failing to reply to written questions from the owner.

The hearing concerned three separate charges against Mr Mallon. The first charge related to his treatment of a Labrador named Bailey on 15 September 2016 in which he was alleged to have euthanased the animal without the owner’s consent, after having been called out to her home following concerns about Bailey’s arthritis. 

The second charge related to failure to keep adequate clinical records for Bailey between 14 March 2015 and 30 September 2016.

The third charge related to failing to respond adequately to communications regarding Bailey’s treatment from his owner between 15 September 2016 and 6 January 2017.

At the outset of the hearing, Mr Mallon admitted the charge relating to keeping inadequate clinical records. However, he disputed the College’s evidence regarding euthanasing Bailey without his owner’s consent. He claimed to have had previous discussions with the owner’s husband about euthanasia six months prior to the event, that he had been informed that the owner had mentioned a possible need for euthanasia in a phone call earlier that day and that, on attending the premises, the owner’s mother had mentioned a need to put Bailey down. During the course of the hearing, Mr Mallon accepted that these incidents could not have reasonably amounted to consent. 

The Committee also heard and accepted evidence that the owner’s mother, who was present when Mr Mallon visited, had wished to contact her daughter to inform her about the planned euthanasia but that Mr Mallon proceeded to euthanase the animal regardless. The Committee also noted there was no contemporaneous clinical records nor any signed consent form for the procedure. Furthermore, the Committee found no evidence that there was a need to put Bailey down immediately and no reason why Mr Mallon could not have waited until the owner was present and had given consent.

Regarding the third charge, the Committee heard that the communications between Mr Mallon and the owner amounted to a telephone call on 15 September and a letter from the owner dated 16 September in which she asked a number of questions about Bailey’s treatment. The Committee accepted that, during the phone call, the owner had made a number of threats to Mr Mallon that had caused him to be fearful for himself and his property. Furthermore, the Committee found that there were a number of points in the subsequent letter to which he could have responded and the Committee noted that, when he was giving evidence, Mr Mallon expected the owner to apologise to him and withdraw the threats before he would engage with her complaint. The Committee therefore found the charge proved.

After finding the charges proved the Committee then went on to consider whether, individually and cumulatively, they constituted serious professional misconduct. It found this to be the case in respect of all three charges. Commenting on the first charge Jane Downes, chairing the Committee and speaking on its behalf, said: "He should have allowed the owner to come to an informed decision. He had an opportunity to obtain informed consent and he failed in this regard. By failing to take this opportunity he overrode the possibility of allowing [the owner] the right to choose whether to be present or to discuss Bailey’s prognosis."

The Committee then went on to consider the sanction for Mr Mallon and heard from a number of clients and professional colleagues who spoke to his skill, care, passion for animal welfare and high standing in his community. The Committee also considered 30 written testimonials from clients. In mitigation, the Committee also considered Mr Mallon’s otherwise unblemished 30-year career, the fact it was a single isolated event related to one animal and the fact that there was no evidence of systemic or repeated behaviour.

Jane Downes added: "The Committee concluded that the appropriate and proportionate sanction is a reprimand in this case. The Committee is confident that Mr Mallon will not repeat the conduct identified in this case again. The Committee wishes to advise Mr Mallon of the need to reflect on the outcome of this case, the need to have clear communication systems in place at this practice that are effective so as to avoid any possibility of miscommunication. The Committee further advises Mr Mallon of the need to be familiar and comply with all aspects of the Code [of Professional Conduct for Veterinary Surgeons] and its associated guidance, particularly in respect of keeping clinical records, informed consent and effective complaint management."

International Cat Care has announced that the Classic Animal Hospital in South Korea has become its 1000th 'Cat Friendly Clinic'.

The charity launched the 'Cat Friendly Clinic' accreditation scheme in 2012, in order to raise standards and reduce the stress experienced by cats (and consequently their owners) when visiting clinics.

In order to be accredited as a Cat Friendly Clinic, a clinic must not only meet high standards of cat care in terms of facilities and equipment, but staff must also demonstrate an understanding of the needs and behaviour of cats and put in place measures to ensure that visits to the clinic are more cat-friendly.

In the six years since its inception, the scheme has become a well-recognised standard in feline veterinary care, with accredited clinics all over the world. 

The Classic Animal Hospital in South Korea (wow, see the architects' photos here), was founded in September 2017 and consists of three vets, eight nurses and three receptionists. Open 24 hours a day, 365 days a year, the clinic's goal is to "provide outstanding veterinary care using the most advanced medical techniques and equipment in an environment that is both comfortable and welcoming for owners and their loved companions’. Currently, about 30% of the clinic’s clients are cats, and this percentage is continuing to grow.

Park Sungwon, owner of the clinic and Chief of Surgery, said: "Since more and more Koreans are having cats as their companion animals, there is growing interest in the Cat Friendly Clinic programme. So many veterinarians who have just started or want to start their own clinic share information about becoming a Cat Friendly Clinic. I also found out about the Cat Friendly Clinic scheme on the vet internet community. When I decided to open my clinic, I planned to become a Cat Friendly Clinic. So I took ISFM’s requirements into consideration when I designed my clinic."

When asked what cat owners think of the clinic’s Cat Friendly status, Park said: "They are very satisfied with our separated, quiet, cat-only waiting area and large hospitalisation facilities. They think that their cats definitely feel more comfortable at my clinic than they feel at other clinics in my town."

Sarah Endersby, International Cat Care’s Veterinary Development Manager, said: "We are delighted to have accredited the 1000^th Cat Friendly Clinic. It is fabulous to know that many veterinary clinics around the world are thinking about how they can make feline visits less stressful, benefitting not only the cats themselves, but their owners and the veterinary team. We have many clinics looking to become a Cat Friendly Clinic, so the community is growing quickly - hopefully we will be welcoming the 2000^th clinic in the not too distant future!"

To find out more about the Cat Friendly Clinic scheme, visit catfriendlyclinic.org.

The scheme is supported by six official partners: Boehringer Ingelheim, Ceva, Elanco, Idexx, Merial and Royal Canin.

Legislation to make CCTV cameras mandatory in slaughterhouses in England has been laid before Parliament by Environment Secretary Michael Gove.

The legislation will come into effect from May 2018, at which point businesses will have six months to comply. The penalty for failing to comply will be an enforcement notice to the business or prosecution.

In August 2017, the Secretary of State launched a consultation on the plans to deliver a manifesto commitment for CCTV to be required in every slaughterhouse in England in all areas where live animals are present, with unrestricted access to footage for Official Veterinarians.

A summary of responses published in November showed that of almost 4,000 respondents, more than 99% were supportive of the plans.

Environment Secretary Michael Gove said: "We have some of the highest animal welfare standards in the world and want to cement our status as a global leader by continuing to raise the bar.

"Introducing compulsory CCTV cameras in slaughterhouses is a further demonstration to consumers around the world that as we leave the EU, we continue to produce our food to the very highest standards.

"The previous reaction to the consultation highlighted the strength of feeling among the public that all animals should be treated with the utmost respect at all stages of life and be subject to the highest possible welfare standards."

The proposals will also give the Food Standards Agency’s (FSA) Official Veterinarians (OVs) unfettered access to the last 90 days of footage to help them monitor and enforce animal welfare standards.

BVA President John Fishwick said: "Mandatory CCTV in all areas of slaughterhouses will provide an essential tool in fostering a culture of compassion that could help safeguard animal welfare.

"We commend the Government’s commitment to provide Official Veterinarians with unrestricted access to the footage, which the veterinary profession has long been campaigning for. 

"It is vets’ independence and unique qualifications that help ensure the UK will continue to have the highest standards of animal health, welfare and food safety post-Brexit."

Photo: Lititz, Pennsylvania. Hoisting a slaughtered steer in Benjamin Lutz's slaughterhouse, 1942. Wikipedia.

Cardiologists at Davies Veterinary Specialists in Hertfordshire have implanted a stent across the pulmonic valve of a four-month-old French Bulldog with severe and deteriorating pulmonic stenosis, believed to be a first in the UK.

Davies says pulmonic stenosis is one of the most common congenital heart defects in dogs. In most cases it is caused by a malformation of the pulmonic valve with fusion of the leaflets (type A stenosis) or with the presence of rudimentary valves accompanied by hypoplasia of the annulus (type B stenosis).

Dogs with severe stenosis are at risk of sudden death, heart failure and have a decreased survival time in comparison to normal dogs.

Minimally invasive catheter based procedures (balloon valvuloplasty) have become the treatment of choice for valvular pulmonic stenosis, with good results in most but not all cases. French Bulldogs are predisposed to the condition and tend to not respond to valvuloplasty as well as other dogs.¹

In this case, the dog was first referred to Pedro Oliveira, RCVS and European Veterinary Specialist in Small Animal Cardiology at Davies, for treatment of severe pulmonic stenosis.

An echocardiogram confirmed the presence of a type B stenosis accompanied by marked right ventricular hypertrophy and also an atrial septal defect.

A standard balloon valvuloplasty procedure was performed without complications and the dog initially showed improvement (click image right to enlarge). Soon after, however, she began to suffer episodes of weakness and collapse and was readmitted.

An echocardiogram showed that the right ventricular obstruction had worsened.

Pedro said: "Re-stenosis has been reported in up to 16% of cases following balloon valvuloplasty and in this case it was suspected to be due to the formation of scar tissue in the valve leaflets. The pressures inside the right side of the heart were now higher than left allowing blood to flow through the atrial septal defect from the right to the left atrium directly without receiving oxygen from the lungs.

"Whenever Gracie got excited or tried to exercise she would go 'blue' from lack of oxygen and collapse. In fact her quality of life was so poor that euthanasia was suggested at that point. For this reason we decided we should attempt this novel procedure. The only other option would have been open-chest surgery (patch graft) but this held a higher risk of complications during the anaesthesia and even death. Also, the cost of surgery would have been higher than this new option."

Pedro performed the procedure with fellow Davies cardiologist, Jose Matos, while Antonia Mavropoulou guided them using transoesophageal echocardiography.

Under a general anaesthetic the heart structure was assessed using transoesophageal echocardiography and angiography to choose the correct size of the stent for Gracie.

An 8mm wide and 4cm long stainless steel catheter tightly mounted on a balloon was chosen.

This was then positioned across the pulmonic valve and the balloon was expanded forcing the stent to open up to its full size (figure 2B). There was an immediate and significant improvement of blood flow through the stent (figure 2C), the patient recovered well and she was discharged four days later.

Re-examination after three months showed improved flow across the stent and a reversal of the right to left shunting across the atrial septal defect. Gracie stopped experiencing episodes of collapse or cyanosis and is now able to exercise and lead a more normal life.

Pedro said: "This technique has been used in very few cases in the whole world and to the best of our knowledge this is the first time it has been used in the UK.

"It is more technically challenging and costly than a standard ballooning although it may provide an effective, safe, and cheaper alternative to patch graft surgery. In this particular case we feel it made an important difference in terms of quality of life and prognosis for Gracie.

Reference

1. Retrospective review of congenital heart disease in 976 dogs. Oliveira P, Domenech O, Silva J, Vannini S, Bussadori R, Bussadori C.J Vet Intern Med. 2011 May-Jun;25(3):477-83. doi: 10.1111/j.1939-1676.2011.0711.x. Epub 2011 Mar 21.PMID:21418326 Free Article