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Your Singapore, the Tropical Garden City
WSV18-0296
SVA SOFT TISSUE SURGERY
SURGICAL MANAGEMENT OF BRACHYCEPHALIC SYNDROME
H.B. Seim1
1Colorado State University
Key Points
• English bulldogs are significantly over-represented.
• Light general anesthesia is required for accurate evaluation of laryngeal function and defects.
• Limited use of crushing clamps and cautery results in less postoperative swelling. • Overall prognosis for dogs with brachycephalic syndrome is favorable.
If you would like a video of these surgical procedures on DVD go to www.videovet.org or contact the author at videovet@me.com. You may click on the ‘Seminar Price’ for any DVD you would like to purchase.
Definition: Brachycephalic syndrome is a combination of upper airway disorders commonly seen in brachycephalic breeds (e.g., English bulldog, Boston terrier, Pugs). Disorders associated with this syndrome include stenotic nares, elongated soft palate, and everted laryngeal saccules. Occasionally patients present with laryngeal collapse. Patients may present with any combination of above listed disorders.
Diagnosis
Clinical presentation:
Signalment: Brachycephalic breeds are most commonly affected (i.e., English bulldog, French bulldog, Boston terrier, Pug, Pekingese, Boxer, and Bull Mastiff). The age at presentation ranges from less than one year to 11 years. The majority of patients present between 1 and
4 years with English bulldogs presenting at a younger age than other breeds. There is no apparent sex predisposition.
History: Historical findings are generally related to upper airway obstruction and include noisy respiration, heat intolerance, exercise intolerance, cyanosis, and occasionally syncopal attacks. Gagging, retching, and vomiting may also be reported. Historical findings may vary depending upon the number of abnormalities present (i.e., stenotic nares, elongated soft palate, and/ or everted laryngeal saccules). Generally, the more abnormalities present the more severe the historical and clinical findings.
Clinical signs: The most frequently reported clinical signs in patients with brachycephalic syndrome include noisy respirations and exercise and/or heat intolerance.
 Hyperthyroidism
   cTnI increased in the hyperthyroid state, to the same levels as cats with heart disease. Normalises once euthyroid state achieved by radioactive iodine therapy.
   NTproBNP increased in the hyperthyroid state, to the same levels as cats with heart disease. Normalises once euthyroid state achieved by radioactive iodine therapy.
   High for both
    Chronic kidney disease
   cTnI higher in cats with azotaemic CKD than healthy age- matched controls. No correlation between creatinine and cTnI.
   Higher NTproBNP in cats with IRIS stage IV renal disease,
but no correlation with creatinine concentration overall.
   High
   Systemic hypertension
 Increased cTnI in cats with hypertension secondary to CKD
– higher still in
cats with evidence of hypertensive retinopathy. However, no significant reduction with successful antihypertensive treatment and few cats underwent echocardiography.
 NTproBNP
increased in cats with hypertensive retinopathy than healthy controls. Few echocardiographic results available,
so incidental cardiomyopathy cannot be excluded.
 Medium
 Anaemia
   Increased cTnI
in a group of anaemic cats than a control group
of non-anaemic
but systemically unwell cats. No echocardiography performed. Different exclusion criteria
for test vs. control groups.
   No published studies
   Low cTnI
No published studies for NTproBNP
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