Pulmonary Artery Banding in a Cat with Atrioventricular Canal Defect Type A with Concurrent Muscular Septal Defect

Abstract

Background: This case report describes the surgical management of pulmonary artery banding (PAB) in a cat diagnosed with an incomplete atrioventricular canal (AVC) defect and a concurrent muscular septal defect. It highlights the use of PAB as a palliative treatment to manage this rare congenital heart condition in companion animals.

Case presentation: A 9-month-old European long-haired male cat presented with clinical signs of heart failure. Pharmacological treatment with sildenafil and furosemide failed to stabilize the patient's condition. Echocardiographic assessment revealed an incomplete AVC type A and a muscular septal defect. Pulmonary artery banding was performed to reduce pulmonary blood flow and alleviate heart failure symptoms. Pre- and postoperative echocardiographic evaluations were conducted to monitor structural and functional changes in the heart. Post-surgical outcomes included a marked reduction in the size of the right atrium and ventricle and a stable pulmonary artery flow velocity of 3.8 m/s. The cat has remained in very good condition without the need for pharmacotherapy for 13 months post-surgery and is still alive at the time of reporting.

Conclusions: PAB proved effective as a palliative intervention for managing an incomplete AVC in this feline patient. The successful outcome suggests that PAB may offer significant long-term benefits and improved survival in selected cases of incomplete AVCs in cats.

Keywords: AVSD; PAB; atrioventricular septal defect; cat; pulmonary artery banding.

Figure 1

Right-sided long-axis view, diastolic phase. RA—right atrium, LA—left atrium, RV—right ventricle, and LV—left ventricle. The closed atrioventricular valve is visible, along with part of the interatrial septum showing ASD I—atrial septal defect I—and ASD II—atrial septal defect II. RV and RA enlargement is visible.

Figure 2

Right-sided long-axis view, diastolic phase. LA—left atrium, LV—left ventricle, RV—right ventricle, PT—pulmonary trunk, and ASD I—atrial septal defect I. The open left atrioventricular valve is visible.

Figure 3

Right-sided long-axis view. RA—right atrium, LA—left atrium, RV—right ventricle, and LV—left ventricle, systolic phase. Left-to-right blood flow is visible in color Doppler through ASD I.

Figure 4

Left-sided four-chamber view. LA—left atrium, RA—right atrium, RV—right ventricle, LV—left ventricle, and ASD I—atrial septal defect I.

Figure 5

Right-sided short-axis view. The open common atrioventricular valve is visible, with RIL—right inferior leaflet, LIL—left inferior leaflet, LLL—left lateral leaflet, LSL—left superior leaflet, RSL—right superior leaflet, RLL—right lateral leaflet (commissures), and an asterisk marking the interatrial septal defect.

Figure 6

Right-sided long-axis view. LA—left atrium, RV—right ventricle, and LV—left ventricle, systolic phase. A regurgitant jet into the left atrium is visible despite the closed left atrioventricular valve (arrow). No clear VSD shunt is visible at the junction of the bridging leaflets with the IVS crest.

Figure 7

Intraoperative photograph: PT—pulmonary trunk; arrow indicates the Gore-Tex band placed to reduce the lumen of the pulmonary trunk.

Figure 8

Right-sided short-axis view at the level of the pulmonary trunk. RVOT—right ventricular outflow tract, PPT—proximal pulmonary trunk, DPT—distal pulmonary trunk, AAo—ascending aorta, and RPA—right pulmonary artery. The arrow points to the site of surgical pulmonary trunk banding.

Figure 9

Right-sided short-axis view at the level of the pulmonary trunk with color Doppler. RVOT—right ventricular outflow tract, PPT—proximal pulmonary trunk, DPT—distal pulmonary trunk, AAo—ascending aorta, and RPA—right pulmonary artery. The arrow points to the site of surgical pulmonary trunk banding.

Figure 10

Continuous Doppler imaging showing flow through the banding. Flow velocity of 3.8 m/s.

Figure 11

Right-sided short-axis view at the level of the papillary muscles. A right-to-left shunt is visible in color Doppler (arrow). RV—right ventricle; LV—left ventricle.

Figure 12

Right-sided short-axis view at the level of the papillary muscles. A left-to-right shunt with low velocity through a large, muscular VSD is visible in color Doppler (arrow). RV—right ventricle; LV—left ventricle.