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What is Excision of Right Atrial Appendage?

The excision of the right atrial appendage – a muscular pouch located within the right atrium of the heart – is used to treat cardiac tumors in cats. This involves removing the right atrial appendage and surrounding tumors. Open heart surgery is a serious surgical procedure that is associated with some complications. Conservative methods may be employed first to treat the condition, particularly if the cat is not a good candidate for anesthesia. 

Excision of Right Atrial Appendage Procedure in Cats

The excision of the right atrial appendage in a cat is generally only part of a surgical procedure used to excise tumors from the heart. The surgical approach may vary depending on the severity and locations of all cardiac tumors. The general procedure steps for excision of the right atrial appendage are outlined below.

  1. Before surgery, blood work will be done to ensure it is safe for the cat to undergo anesthesia.
  2. Anesthesia and analgesics are administered intravenously.
  3. The surgical site will be shaved, clipped, and draped.
  4. The surgeon may perform median sternotomy, with the cat on its back, or right intercostal thoracotomy, with the cat on its side, to access the heart.
  5. The pericardium will be opened.
  6. The surgeon will perform an atriotomy to gain access to the atria.
  7. Vascular forceps will be used to ligate the blood supply to the right atrial appendage.
  8. The surgeon will carefully remove the right atrial appendage. This may be achieved using a thoracoscope as a guide.
  9. The atrial tissue will then be sutured prior to clamp removal. Additional sutures will be placed to prevent hemorrhage.
  10. Additional procedures, such as the excision of tumors in other locations of the heart and removal of a portion of the pericardial sac, may be performed during this time.
  11. If the intercostal thoracostomy approach was used, a thoracostomy tube will be put into place to reduce the risk of postoperative complications.
  12. The surgeon will ensure all tumors have been removed prior to suturing the incision site.
  13. The cat will be hospitalized until it is considered stable.
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Efficacy of Excision of Right Atrial Appendage in Cats

The efficacy of this procedure will depend on the severity and type of cancer. A cat’s overall prognosis will vary depending on the efficacy of all administered treatments. Excising the diseased right atrial appendage will typically improve a cat’s survival time. Provided that the condition was diagnosed and treated as soon as possible, the prognosis will likely be better compared to cats that have untreated cardiac tumors. However, the prognosis for any malignant heart tumor may range from poor to grave, since cardiac tumors are life-threatening. Ensuring the cat is as comfortable as possible is the main goal of treatment, rather than curing the condition.

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Excision of Right Atrial Appendage Recovery in Cats

Following surgery, the cat will be hospitalized until it is stable. The veterinarian will monitor its condition closely, administering pain medications and nutritional therapies and changing chest bandages as needed.

On the return home, cats should rest extensively according to the surgeon’s recommendations. Analgesics and antibiotics will be prescribed to manage pain and prevent infection. Cats should not engage in any activity during the recovery period. Bandages on the surgery site should be changed regularly, and should remain clean and dry. Owners should check the surgery site daily to ensure no swelling, drainage, or bleeding has occurred. Non-absorbable sutures will be removed within ten to fourteen days following surgery. Additional follow-up appointments will be scheduled as needed to monitor heart function.

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Cost of Excision of Right Atrial Appendage in Cats

The cost of excision of the right atrial appendage will vary based on standards of living and additional costs incurred, including additional treatments such as radiation and chemotherapy. The cost of this procedure ranges from $3,000 to $8,000, with an average cost of $6,000.

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Cat Excision of Right Atrial Appendage Considerations

Excision of the right atrial appendage is typically only part of the treatment regimen for cardiac tumors. Radiation and/or chemotherapy are almost always required to secure the best prognosis for the cat.

Open heart surgery can present serious postoperative complications. These may include, but are not limited to:

  • Right atrial arrhythmia
  • Ventricular arrhythmia
  • Anemia
  • Disseminated intravascular coagulation (DIC): A condition in which blood clots form in the small vessels of the bloodstream.
  • Pneumonia
  • Recurrence of the condition (may or may not be attributed to the efficacy of the procedure)

Complications are uncommon with the intercostal thoracotomy approach. The median sternotomy approach may result in less postoperative pain for the cat. However, the type of approach used will depend on the degree of access needed. Neither approach is considered superior.

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Excision of Right Atrial Appendage Prevention in Cats

HSA and similar cancers are nearly impossible to prevent. Owners should make sure cats get adequate exercise and eat a complete commercial diet to keep the heart as healthy as possible.

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