Jw. Buchanan et Cd. Sammarco, CIRCUMFERENTIAL SUTURE OF THE MITRAL ANNULUS FOR CORRECTION OF MITRALREGURGITATION IN DOGS, Veterinary surgery, 27(3), 1998, pp. 182-193
Objective-To develop a method for reducing mitral regurgitation in dog
s by positioning and tightening a circumferential suture around the mi
tral valve annulus. Study Design-Description of clinical cases. Animal
s-15 dogs with spontaneous mitral valve disease, annular dilation, and
refractory congestive heart failure treated between 1962 and 1994. Me
thods-A composite suture material was constructed using braided Teflon
-impregnated polyester sternotomy suture, barium sulfate thread, and S
ilastic tubing. Through a left lateral thoracotomy, the suture was pos
itioned around the mitral annulus by passing it through the coronary s
inus, right atrium, and underneath the left coronary arteries before t
ightening it. Results-Six dogs died during surgery because of hemorrha
ge from the left atrium, coronary sinus, or left coronary artery. Thre
e dogs died postoperatively because of coronary artery compression by
the suture. Satisfactory suture placement was achieved in six dogs, th
ree of which were long-term survivors (6 to 26 months) before they wer
e euthanatized for noncardiac reasons. Conclusions-Reduction of mitral
annulus diameter with a circumferential purse-string suture does not
require cardiopulmonary bypass. The surgery is technically difficult,
and detailed knowledge of coronary artery anatomy is required. The cur
rent suture design is inexpensive, radiopaque, and biocompatible; no s
pecial instruments are required for placement. Clinical Relevance-Mitr
al regurgitation is the most common cardiovascular disorder in dogs an
d the most common cause of congestive heart failure. Annular dilation
occurs as a consequence of mitral regurgitation. Placement and tighten
ing of a circumferential suture around the mitral annulus reduces the
degree of mitral regurgitation. (C) Copyright 1998 by The American Col
lege of Veterinary Surgeons.