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Case Reports
. 2022 May;63(5):497-503.

Adjunct ambrisentan therapy had clinical benefits in 5 dogs with sildenafil-refractory pulmonary hypertension

Seijirow Goya  1 , Tomohiko Yoshida  1 , Shigeharu Sennba  1 , Tsuyoshi Uchide  1 , Ryou Tanaka  1
Affiliations
Case Reports

Adjunct ambrisentan therapy had clinical benefits in 5 dogs with sildenafil-refractory pulmonary hypertension

Seijirow Goya et al. Can Vet J. 2022 May.

Abstract
in English, French

Although sildenafil is used in dogs with severe pulmonary hypertension, they sometimes become resistant and clinical signs deteriorate over time. The objective of this study was to determine the benefits of adjunct ambrisentan therapy in dogs with sildenafil-refractory pulmonary hypertension. In 5 dogs with severe pulmonary hypertension with deteriorating clinical signs despite ongoing sildenafil treatment, adding ambrisentan improved appetite, activity, and respiratory functions. Although peak tricuspid valve regurgitation velocity, as measured by Doppler echocardiography, did not necessarily decrease after ambrisentan administration, there was improved partial pressure of arterial oxygen and the alveolar-arterial oxygen gradient, with no apparent side effects. We concluded that ambrisentan has potential as an adjunct treatment in dogs with pulmonary hypertension that are refractory to sildenafil therapy. Key clinical message: Ambrisentan improved clinical signs in dogs with sildenafil-refractory pulmonary hypertension.

Le traitement d’appoint à l’ambrisentan a eu des avantages cliniques chez cinq chiens atteints d’hypertension pulmonaire réfractaire au sildénafil. Bien que le sildénafil soit utilisé chez les chiens souffrant d’hypertension pulmonaire sévère, ils deviennent parfois résistants et les signes cliniques s’aggravent avec le temps. L’objectif de cette étude était de déterminer les avantages d’un traitement d’appoint à l’ambrisentan chez les chiens souffrant d’hypertension pulmonaire réfractaire au sildénafil. Chez cinq chiens souffrant d’hypertension pulmonaire sévère avec détérioration des signes cliniques malgré un traitement continu au sildénafil, l’ajout d’ambrisentan a amélioré l’appétit, l’activité et les fonctions respiratoires. Bien que la vitesse maximale de régurgitation de la valve tricuspide, mesurée par échocardiographie Doppler, n’ait pas nécessairement diminué après l’administration d’ambrisentan, la pression partielle d’oxygène artériel et le gradient alvéolo-artériel d’oxygène ont été améliorés, sans effets secondaires apparents. Nous avons conclu que l’ambrisentan a un potentiel en tant que traitement d’appoint chez les chiens souffrant d’hypertension pulmonaire qui sont réfractaires au traitement par le sildénafil.Message clinique clé:L’ambrisentan a amélioré les signes cliniques chez les chiens souffrant d’hypertension pulmonaire réfractaire au sildénafil.(Traduit par Dr Serge Messier).

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Figures

Figure 1
Figure 1
Radiographic (Left) and echocardiographic (Right) findings in Case 1. Left — Note the interstitial pattern in the cranial lung lobe. This case was suspected to be idiopathic pulmonary fibrosis and was treated with prednisolone. Right — Right atrium enlargement and tricuspid valve regurgitation without left-sided heart enlargement.
Figure 2
Figure 2
Radiographic (Left) and echocardiographic (Right) findings in Case 2. Left — Right- and left-sided cardiac enlargement without pulmonary edema. Right — Right and left atrium enlargement and tricuspid and mitral valve regurgitation.
Figure 3
Figure 3
Temporal changes in echocardiographic findings in Case 2. A — before ambrisentan administration. B — 8 h after ambrisentan. C — 24 h after ambrisentan administration. TR velocity and right ventricular internal diameter (yellow double-headed arrow) decreased over time. TR — Tricuspid valve regurgitation.
Figure 4
Figure 4
Radiographic (Left) and echocardiographic (Right) findings in Case 3. Left — Right-sided cardiac enlargement without pulmonary edema. Right — Right atrium and ventricular enlargement and tricuspid valve regurgitation without left-sided heart enlargement. Note the dilated persistent left superior vena cava.
Figure 5
Figure 5
Radiographic (Left) and echocardiographic (Right) findings in Case 4. Left — Right- and left-sided cardiac enlargement without pulmonary edema. Right — Right and left atrium enlargement and tricuspid valve regurgitation and mitral valve regurgitation.
Figure 6
Figure 6
Radiographic (Left) and echocardiographic (Right) findings in Case 5. Left — Right-sided cardiac enlargement without pulmonary edema. Right — Right atrium and ventricular enlargement and tricuspid valve regurgitation without left-sided heart enlargement.
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