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Tratamento cirúrgico de shunts portossistémicos congénitos em cães : estudo retrospetivo de 13 casos clínicos
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Resumo(s)
Os shunts portossistémicos congénitos (SPS) correspondem a malformações vasculares que
estabelecem uma comunicação entre a circulação venosa portal e a circulação sistémica, e
afetam mais frequentemente os cães de raça pura.
Apesar de o tratamento médico ser a primeira abordagem em cães com SPS congénito, a
completa resolução clínica está dependente da correção cirúrgica. Este estudo pretendeu
caracterizar uma amostra de 13 cães com diagnóstico de SPS que foram submetidos a
correção cirúrgica, procurando correlacionar os parâmetros clínicos e laboratoriais com a
ocorrência de complicações pós-cirúrgicas a curto e a longo prazo. A amostra em estudo
incluiu 8 fêmeas e 5 machos, com idades compreendidas entre os 2 meses e os 4 anos,
pertencentes às raças Yorkshire terrier (n=5), Caniche anão (n=2), Chihuahua (n=1), Retriever
do Labrador (n=1), Schnauzer miniatura (n=1) e Shih Tzu (n=1), incluindo também cães sem
raça definida (n=2). Todos os indivíduos foram submetidos a correção cirúrgica de shunt
portossistémico através de técnicas extravasculares de oclusão parcial, que tiveram lugar no
Centro Hospitalar Veterinário e no Hospital Referência Veterinária Montenegro. A grande
maioria dos cães apresentava SPS de localização extra-hepática (n=12) e apenas um cão
apresentava um SPS intra-hepático. As complicações pós-cirúrgicas afetaram mais de
metade da amostra (n=7) e incluíram hipertensão portal (n=3), alterações neurológicas (n=1),
hipoglicemia (n=1), recorrência de sinais clínicos (n=2) e morte (n=1). Apesar de não existir
uma correlação estatisticamente significativa entre o BUN e a ocorrência de complicações
pós-cirúrgicas, verificou-se haver uma tendência para os cães com valores inferiores de BUN
apresentarem uma maior incidência de complicações pós-cirúrgicas a curto prazo.
Concluímos que a manifestação clínica desta doença tende a ser precoce (cães com idade
inferior a 1 ano), sendo os sinais gastrointestinais os mais frequentemente descritos e a raça
Yorkshire terrier a mais frequentemente afetada. O tamanho reduzido da amostra, a existência
de historiais médicos incompletos e a discrepância entre protocolos médicos foram as
principais limitações deste estudo, impedindo a obtenção de resultados estatisticamente
significativos. Mais estudos serão necessários para padronizar as inúmeras variações
morfológicas dos shunts e para determinar quais os fatores associados a um melhor
prognóstico.
ABSTRACT - SURGICAL TREATMENT OF CONGENITAL PORTOSYSTEMIC SHUNTS IN DOGS: RETROSPECTIVE STUDY OF 13 CLINICAL CASESCongenital portosystemic shunts are vascular malformations that provides communication between portal and systemic circulation, which typically affects purebred dogs. Although medical treatment is the first-line option for dogs with congenital portosystemic shunt, the complete clinical recovery depends of surgical intervention. This study intended to characterize a sample of 13 dogs with portosystemic shunt diagnosis which were submitted to surgical correction and to correlate the clinical and laboratory parameters with the occurrence of short-term and long-term postoperative complications. The studied sample included 8 females and 5 males, with an age interval between 2 months and 4 years, belonging to the breeds Yorkshire terrier (n=5), Toy Poodle (n=2) , Chihuahua (n=1), Labrador Retriever (n=1), Miniature Schnauzer (n=1) and Shih Tzu (n=1), including mixed-breed dogs (n=2). All dogs were treated using extravascular surgical techniques for gradual occlusion portosystemic shunts, which took place at the Centro Hospitalar Veterinário and Hospital Referência Veterinária Montenegro. The majority of the dogs had an extrahepatic shunt (n=12) and only one dog presented an intrahepatic shunt. Postoperative complications affected more than half of the sample (n=7) and included portal hypertension (n=3), post attenuation neurological signs (n=1), hypoglycemia (n=1), recurrence of clinical signs (n=12) and death (n=1). Although there isn’t a significant correlation between BUN and postoperative complications, it was observed a tendency for dogs with lower BUN to have a higher incidence of short-term postoperative complications. We conclude that the clinical manifestation of this disease tends to be early (dogs under 1- year age), the gastrointestinal symptoms were the most reported and the Yorkshire terrier were the breed most affected. A small sample size, incomplete medical records and discrepancy between the medical protocols were the major limitations in this study, that could explain the upsense of statistically significant results. More studies will be required to describe the numerous variations in the morphology of the shunts and to identify the factors associated with a better prognosis.
ABSTRACT - SURGICAL TREATMENT OF CONGENITAL PORTOSYSTEMIC SHUNTS IN DOGS: RETROSPECTIVE STUDY OF 13 CLINICAL CASESCongenital portosystemic shunts are vascular malformations that provides communication between portal and systemic circulation, which typically affects purebred dogs. Although medical treatment is the first-line option for dogs with congenital portosystemic shunt, the complete clinical recovery depends of surgical intervention. This study intended to characterize a sample of 13 dogs with portosystemic shunt diagnosis which were submitted to surgical correction and to correlate the clinical and laboratory parameters with the occurrence of short-term and long-term postoperative complications. The studied sample included 8 females and 5 males, with an age interval between 2 months and 4 years, belonging to the breeds Yorkshire terrier (n=5), Toy Poodle (n=2) , Chihuahua (n=1), Labrador Retriever (n=1), Miniature Schnauzer (n=1) and Shih Tzu (n=1), including mixed-breed dogs (n=2). All dogs were treated using extravascular surgical techniques for gradual occlusion portosystemic shunts, which took place at the Centro Hospitalar Veterinário and Hospital Referência Veterinária Montenegro. The majority of the dogs had an extrahepatic shunt (n=12) and only one dog presented an intrahepatic shunt. Postoperative complications affected more than half of the sample (n=7) and included portal hypertension (n=3), post attenuation neurological signs (n=1), hypoglycemia (n=1), recurrence of clinical signs (n=12) and death (n=1). Although there isn’t a significant correlation between BUN and postoperative complications, it was observed a tendency for dogs with lower BUN to have a higher incidence of short-term postoperative complications. We conclude that the clinical manifestation of this disease tends to be early (dogs under 1- year age), the gastrointestinal symptoms were the most reported and the Yorkshire terrier were the breed most affected. A small sample size, incomplete medical records and discrepancy between the medical protocols were the major limitations in this study, that could explain the upsense of statistically significant results. More studies will be required to describe the numerous variations in the morphology of the shunts and to identify the factors associated with a better prognosis.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Shunt portossistémico congénito cães classificação morfológica cirurgia prognóstico Congenital portosystemic shunt dogs morphological classification surgery prognosis
Contexto Educativo
Citação
Pina MPP 2020. Tratamento cirúrgico de shunts portossistémicos congénitos em cães : estudo retrospetivo de 13 casos clínicos [dissertação de mestrado]. Lisboa: FMV-Universidade de Lisboa
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária