Pericardial Diaphragmatic Herniorrhaphy in Dogs

 PPHD occurs congenitally in dogs and other animals when the peritoneal cavity (abdominal cavity) and pericardial sac (heart cavity) do not separate during embryonic development. This means that the cavity and sac are continuous later in life, which allows abdominal organs to migrate into the pericardial area, occasionally putting pressure on the heart or affecting gastrointestinal functioning. The organ that most commonly moves into the pericardial sac is the liver but the intestine and other abdominal organs may also impinge in the pericardial area. Some dogs do not exhibit signs of this defect but when symptoms occur, which include signs of cardiac and respiratory distress as abdominal organs put pressure on pericardial organs, and symptoms of gastrointestinal distress such as vomiting, reduced appetite, and diarrhea, pericardial diaphragmatic herniorrhaphy may need to be performed to rectify the condition.

This congenital condition is more common in Weimaraner dogs and is often accompanied by other congenital defects that may need to be addressed.

Pericardial diaphragmatic herniorrhaphy in dogs is performed by a qualified veterinary surgeon under general anesthesia.

If asymptomatic, PPHD may be found incidentally and may not require surgical intervention, but if cardiac or gastrointestinal symptoms are present, radiographic testing may be ordered that reveal this condition, and require pericardial diaphragmatic herniorrhaphy to replace displaced organs and surgically close the opening to prevent further intrusions by abdominal organs into the pericardial sac. Your dog will be physically examined prior to surgery and blood work conducted if deemed necessary to ensure that undue risk from underlying medical conditions that would complicate surgery are not present. You will need to fast your dog prior to surgery. 

Your dog will be sedated and put under general anesthetic for the procedure. Surgical intervention may be performed by making an incision into the abdominal cavity (laparotomy) or into the pleural cavity (thoracotomy), whichever is indicated most appropriate by radiographic evidence. An incision will be made into the appropriate cavity. Abdominal organs will be carefully manipulated back into the appropriate cavity and the opening between the pericardial sac and peritoneal cavity sutured shut. Air can be trapped in the pericardial cavity during this procedure and a pericardiocentesis will need to be performed prior to closure of the incision to remove trapped air. Tubes to provide drainage of fluids may be necessary. After the incision is closed your dog will be hospitalized for and provided supportive care during recovery and while tubes provide drainage. Careful monitoring will be conducted to watch for signs of breathing conditions which will need to be addressed with further evacuation of air from the pleural space. Cage rest and warmth will be provided. Analgesics will be administered cautiously as breathing can be affected.

If other complications and congenital conditions are not present, pericardial diaphragmatic herniorrhaphy is effective at addressing PPHD and prognosis is good. 

Post-surgery, your dog will need rest and monitoring for sign of respiratory distress, infection, and maintaining body temperature. Antibiotics and analgesics may be administered along with other medications deemed necessary by your veterinarian. Follow all instructions carefully and schedule and conduct follow-up as recommended. Prevent your dog from interfering with surgical wounds; an e-collar will be recommended.

This procedure requires intensive postoperative care and the cost of the procedure, including anesthesia and hospitalization, ranges from $2,500 to $5,000 depending on your location and the degree of care required.

Complications from anesthesia, hemorrhaging, air trapped in pericardium, and infection are risks with herniorrhaphy to repair PPHD. Surgery should be performed by an experienced veterinary surgeon and hospitalization post-surgery is required, followed by careful monitoring by pet owners and follow up with a veterinarian to ensure complications are addressed immediately, as they can be life-threatening.

Animals that exhibit this congenital defect should be spayed or neutered and should not be part of a breeding program. This will reduce the incidence of PPHD in future generations of dogs.