Intra-operative use of transesophageal echocardiography in dogs undergoing interventional procedures for pulmonic stenosis: a case series

Abstract

Six dogs were presented for interventional treatment of pulmonic stenosis (balloon valvuloplasty or pulmonary stent implantation). Intra-operative transesophageal echocardiography was performed for subjective pulmonary valve assessment and to measure the transpulmonary pressure gradient. Balloon valvuloplasty was performed in two dogs; the remaining four dogs underwent pulmonary stent implantation. The reduction in pressure was assessed after balloon inflation/stent deployment by right heart catheterization and transesophageal echocardiography. In two patients, complete catheterization was not performed, and success was based solely on a reduction in the pressure gradient measured by transesophageal echocardiography. The procedure was completed successfully in all six dogs, with reduction in pressure measured by catheterization ranging from 47.0% to 96.8% (median: 78.6%) in four dogs and 47.3%–85.2% (median: 80.9%) measured by transesophageal echocardiography in all six dogs. No complications associated with transesophageal echocardiography were observed. In this case series, transesophageal echocardiography allowed subjective assessment of the pulmonic valve leaflets and measurement of annular diameter and transpulmonary pressure gradient. The reduction in transpulmonary pressure gradient seen with transesophageal echocardiography was comparable to the reduction documented on catheterization. Further studies are indicated to objectively assess the agreement between transesophageal echocardiography and catheterization measurements, but in these patients, transesophageal echocardiography allowed increased confidence in procedural success.