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A transect ligamentum arteriosum is a surgical procedure to correct a certain birth defect in dogs, persistent right aortic arch (PRAA). This deformity affects the function of the esophagus. Aortic arches that exist in embryos are supposed to change in formation to become the major arteries in the neck. In some dogs, this regression does not happen, and the aortic arteries trap the esophagus, preventing food from reaching the stomach.
Dogs with this defect are often smaller in size than their littermates and continue to grow slowly. They will likely regurgitate after every time they eat. Some also develop a chronic cough. Medical treatment may be attempted, but surgery is almost always required for the survival of the dog. A thoracoscope is used to complete this surgery. A specialist with access to this technology is needed for the procedure.
The presence of PRAA can often be confirmed during a physical examination. The vet may note an enlarged esophagus while palpating the throat. When listening to the lungs with a stethoscope, crackling may be heard if pneumonia has developed. X-rays and contrast radiographs will then be taken to see if food, air or water has become trapped in the esophagus. Other issues may be differentiated at this time. Advanced imaging such as an MRI or CT scan may be needed to assess the extent of the defect. An endoscope may be used to examine the issue from inside of the esophagus.
A full panel of blood work will be run to determine if the dog is healthy enough to receive general anesthesia. The dog will be required to fast for no more than 4 hours before the operation begins. This is because the vast majority of dogs who receive this surgery are under 6 months of age. The dog's fluids and electrolytes should be increased prior to surgery via intravenous tubes.
Once the general anesthesia has been administered, small portal incisions will be made on the dog's chest. An endoscopic camera will be inserted along with tools to perform the operation. The ligamentum will then be lifted so that it can be easily clipped and cut across using special surgical scissors. The tissue surrounding the ligamentum will need to be carefully dissected. The tools and camera may then be removed and the small incisions sutured shut.
Puppies who receive this surgery have a much better prognosis than those who do not. Using thoracoscopy shortens the healing process and results in less pain for the dog. Small incisions are also less likely to become infected. The earlier that the dog is diagnosed with this defect and treated, the better the overall outcome tends to be. Up to 80% of dogs that undergo this surgery experience improvement from their condition.
Function of the esophagus may not be perfect after the operation, but in the majority of cases the dog regurgitates less and is able to gain nutrients. Dogs with a severe esophagus dilation have a more guarded prognosis. This surgery may also be performed in a traditional manner using one large incision to the chest, however this is associated with more recovery complications.
The dog will need to be closely monitored as it wakes up from the general anesthesia. Puppies especially must receive extra care during this time, as they may experience a severe drop in blood sugar or struggle to breathe. A half dose of pain medication is often administered for young dogs. The dog may also need oxygen supplementation in the hours following surgery.
The chest tubes will need to be cleared every 15-30 minutes in the first days after the operation. The air and fluid that comes out must be measured to help assess how the animal is doing. Tubes may be removed after a day or so of recovery. Antibiotics will be administered if the dog is suffering from aspiration pneumonia.
Liquid food may be given to the dog 12 hours after surgery. The dog will need to stay in an upright position for up to ten minutes after it eats. In the four weeks post-surgery, the dog may slowly resume eating normal food, with less water needed at each feed. A follow-up appointment will likely be scheduled one or two months after the operation to assess how the dog has healed.
Surgery involving puppies is always more complicated due to their smaller size and heightened fragility. Expensive equipment is needed to carry out a transect ligamentum arteriosum, along with special training. Because of these factors, the surgery often costs anywhere from $2,000 to $6,000. Thoracoscopy tends to cost more than thoracotomy (traditional surgery), but is associated with less costs during the recovery period. The dog is also likely to require less hospitalization with endoscopic procedures.
Complications are common with PRAA correctional surgeries. Puppies are at a heightened risk of developing hypothermia after an operation. This can lead to serious heart problems and central nervous system depression. Some dogs still suffer from severe regurgitation issues after the surgery has been performed. Many dogs with this defect will require dietary management throughout their lives. Dehiscence followed by infection is another potential risk with this operation. Medical treatment may be attempted in lieu of surgery, but this is generally palliative.
The only way to prevent this defect from occurring is to only breed healthy specimens. Breeds that suffer from this defect include German shepherds, Boston terriers and Irish setters. greyhounds may carry a genetic form of this issue that can be passed down bloodlines. Always request your dog's full family health history when obtaining the animal.
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