Diuretics are dehydration drugs, which prevent possible stagnant effects. They result in an increased urine production and therefore multiplied excretion of sodium and water. With regular use of diuretics, the kidney values as well as electrolyts should be controlled with regard to the possible side-effect Addison's disease.
ACE inhibitors expand the blood vessels, increase the cardiac output per minute and reduce the vascular resistance, so that the blood flow is easened and the heart relieved. Thereby they raise the life expactancy of the animals and lead with the improvement of physicial resiliance and general condition to a higher life quality.
Pimobendan combines the heart strengthening effects of digitalis preparations with the vasodilative effects of ACE inhibitors and only shows a few side-effects.
As it was already shortly announced under 'news' on the 12th of January 2015, there is an alternative to immediate euthanasia in such cases where the blood backflow is already noticeable in form of intense water retention. This palliative (relieve in symptoms, not a full cure) operation is called the 'Rashkind maneuver'.
We will briefly explain what this method is about.
The 'Rashkind maneuver' is originally from the human medicine for pediatric cardiology but it can also be used within animal cardiology. A hole will be torn into the atrial septum (partition between right and left vestibule) by using a catheter and under heart-friendly anesthesia. This hole will then be supported by a stent, so that the blood can flow directly from the right to the left vestibule.
The goal of the operation is to relieve the pressure of the right vestibule and to work against the blood stasis as well as the connected water retention (which is a sign for the upcoming cardiac insufficiency) more effectively then it is possible with medicine.
The blood which directly flows from the right to the left vestibule is now avoiding the lung and thus cannot be enriched with oxygen. Hence, there will be inevitably a part of blood in the systemic circulation which is poor on oxygen.
To compensate this circumstance the body will soon produce more red blood cells, which are used for the transportation of oxygen. To make sure that the suffering dog will overcome this period of adjustment there will be an intensive care and oxygen will be provided via a breathing mask. It generally takes around 2 weeks until the body adjusted accordingly; in exceptional cases it can take up to 6 weeks.
As far as we know, such operations for heart sick dogs in Germany are exclusively performed in the Klinik für Kleintiere der Justus-Liebig-Universität in Gießen.
Of course, such an operation also entails its risks: it is definitely not an minor intervention and the time point of the operation must be perfectly adjusted to the current constitution of the dog. Since it is the last possible palliative approach of therapy, it should definitely be considered as an alternative to an instant mercy death.
A curative cardiac valve surgery – according to current status – carries a high risk. It is said, that in Japan the surgery has already been performed successfully several times, but here in Germany the research is still at the very beginning.
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The prognosis of a tricuspid valve dysplasia is strongly affected by individual characteristics of the respective animal and its age, as well as the degree of severity of the disease at the time of the diagnosis. The earlier a tricuspid valve dysplasia is recognised and treated (with medications), the higher the chances are to get affecting symptoms later and to increase both life span and life quality. Precise statements about the life span cannot be taken, but Dr. Kresken (chairman of the Collegium Cardiologicum e.V.) tells the critical age of 5 years. Especially dogs with strong pronounced disease showing clear symptoms by the fifth birthday at the latest.