Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1365 Gortner Ave, St Paul, MN 55108, USA.
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1365 Gortner Ave, St Paul, MN 55108, USA.
J Vet Cardiol. 2024 Oct;55:19-25. doi: 10.1016/j.jvc.2024.07.001. Epub 2024 Jul 14.
A one-year-old male intact American bulldog was presented for evaluation of previously diagnosed pulmonary stenosis. Echocardiography identified ultra-severe stenosis with an instantaneous trans-pulmonary pressure gradient of 240 mmHg. Angiography confirmed the presence of an anomalous coronary artery with a prepulmonic course of the left coronary artery arising from a single right coronary ostium consistent with a type R2A coronary anomaly. A trans-pulmonary stent was successfully placed transvenously with diameter sizing based on coronary compression testing. No coronary compression was present on postimplantation angiography. A marked reduction in the pressure gradient was obtained on postoperative echocardiography (reduction to 68 mmHg), despite selecting a stent diameter less than the pulmonary annulus diameter. This is the first report of the use of coronary compression testing in transvenous trans-pulmonic stent implantation in a dog with a type R2A coronary artery anomaly. Selection of a stent diameter less than the pulmonary annulus diameter conveyed a clinically relevant reduction in the trans-pulmonic pressure gradient while avoiding coronary compression in this case.
一只一岁大的雄性未绝育的美国斗牛犬因先前诊断的肺动脉瓣狭窄而就诊。超声心动图检查发现严重的狭窄，瞬时跨肺压力梯度为 240mmHg。血管造影证实存在异常冠状动脉，左冠状动脉起自单一右冠状动脉开口，呈前肺段走行，符合 R2A 型冠状动脉异常。经静脉成功放置了跨肺支架，支架直径根据冠状动脉压迫测试进行了选择。支架植入后血管造影未见冠状动脉受压。尽管选择的支架直径小于肺动脉瓣环直径，但术后超声心动图显示压力梯度明显降低（降至 68mmHg）。这是首例在 R2A 型冠状动脉异常的犬中使用冠状动脉压迫测试进行经静脉跨肺支架植入的报告。在这种情况下，选择小于肺动脉瓣环直径的支架直径可显著降低跨肺压力梯度，同时避免冠状动脉受压。
