Ah B, 12 years old, was a challenging case, battling refractory or stage D myxomatous mitral valve disease (MMVD), atrial fibrillation, heartworm disease, and pulmonary hypertension. Despite maximal medical management, he required 4 emergency admissions over the past six months. We knew that his life is nearing its end.
In an effort to slow disease progression, the owner agreed for us to perform left atrial decompression (LAD) — the first reported case in a dog in Malaysia.
What is LAD?
Some dogs with advanced myxomatous mitral valve disease (MMVD) reach a stage where medications are no longer enough to control their heart failure. They may continue to develop fluid buildup, breathing difficulty, and require repeated emergency visits.
In selected cases, we may consider a procedure called LAD.
LAD is a minimally invasive, catheter-based procedure. Using a catheter and a transseptal needle, a small opening is carefully created between the upper chambers of the heart. This opening is then gently enlarged with a balloon catheter through several rounds of controlled dilation.
This procedure allows blood to flow from the high-pressure left side to the lower-pressure right side. This helps reduce pressure in the left atrium and can relieve congestion in the lungs, making breathing easier.
Important to know
LAD is palliative, not a cure. It’s considered when surgery or transcatheter edge-to-edge repair is not possible.
Anesthetic Risk in Ah B’s Case
The anesthetic risk for this case was classified as ASA IV (high risk), but our anesthesia team performed exceptionally well. In addition, our sonographer provided clear and stable intraoperative imaging guidance, which was critical to the success of the procedure.
Many dog owners may not be willing to take on such risks, which is one of the reasons why this type of advanced procedure has been slower to develop in Malaysia. We are truly grateful to the owner for the trust and confidence placed in our team.
What happens after LAD?
In some cases, once the heart size and pressure improve, mitral valve repair by TEER may become an option later on. In some dogs, a reduced dosage of diuretic may be possible. However, this depends on each individual dog.
A reduction in Ah B’s left atrial size was observed post-procedure, and he was discharged just two hours later.
Our goal
To give dogs with advanced heart disease a better quality of life, even when options are limited. If your dog has been diagnosed with advanced MMVD, speak to your veterinarian to understand all available options.
We hope this procedure will help improve Ah B’s clinical condition and enhance his quality of life.
