On 8th December 2024, our team performed Malaysia’s first successful V-clamp surgery on a Cavalier King Charles Spaniel. The dog, named Oscar, had been diagnosed with advanced-stage B2 myxomatous mitral valve disease (MMVD) in June 2024. Since his diagnosis, he had been taking pimobendan, benazepril, and spironolactone to manage the disease. Understanding the severity of the disease and the high risk of progression to heart failure, the owners agreed to proceed with V-clamp surgery for Oscar.
What is MMVD?
To read our previous post on MMVD, please click here.
In summary, it is the most common heart disease affecting small- to medium-breed dogs. The mitral valve becomes degenerative and thickened, leading to blood leakage into the left atrium. As more blood leaks back, the left atrium enlarges, eventually resulting in heart failure. In general, 3 in 10 dogs with MMVD progress to succumb to heart failure.
What is V-clamp?
Developed by Hongyu Medical Technology in Shang Hai, the V-clamp is deployed to ‘staple’ the leaking mitral valve. It reduces the severity of the disease, prolongs the dog’s quality of life, and improves cardiac function. It is a less invasive alternative to open-heart surgery.
After the surgery, the dog may require fewer medications or, in some cases, none at all.
Before the surgery
Oscar was anesthetized to undergo transesophageal echocardiography (TEE).
What is TEE?
Please refer to our previous post.
TEE is an important procedure prior to surgery as not every dog is suitable for the operation. The TEE, which took about 30 minutes, showed that Oscar was a suitable candidate for V-clamp surgery.
Can I omit TEE?
While conventional echocardiography provides some information about the mitral valve, TEE is recommended for a more accurate evaluation and measurement. It also serves as a baseline for the anesthesia team to assess the dog’s response to prolonged general anesthesia during the V-clamp surgery. When pre-surgery TEE results are unavailable, the team may occasionally need to cancel the procedure on the surgery day if the intraoperative TEE reveals that the dog is unsuitable for surgery. An inconvenient truth is, owner still has to pay for the surgery fee if the operation is canceled.
Risk versus benefit of the V-clamp
MMVD is a surgical condition. While medications can delay the progression and onset of heart failure, they do not cure the disease. To illustrate: ‘Imagine if your door is loose—you need a carpenter to fix the door.’
Not all dogs with MMVD eventually progress to heart failure. However, if a dog shows signs of disease progression with a high risk of developing heart failure, surgery is generally recommended. The prognosis is more favorable when surgery is performed before the onset of heart failure (pulmonary edema).
Every surgery carries risks, especially in cardiac patients. However, these risks can be effectively managed with proper and careful monitoring by an experienced anesthesia team. Post-operatively, the dog is monitored continuously for 24 hours to minimize complications such as blood clot formation, bleeding, and other potential issues.
