Cardiopulmonary function values before and after heartworm removal in dogs with caval syndrome

Cardiopulmonary function values were determined before and after surgical removal of adult heartworms in 25 dogs with spontaneous and 4 dogs with drug-induced caval syndrome (CS). Fifteen dogs with spontaneous CS (recovery group) and 4 dogs with drug-induced CS (drug-induced CS group) recovered after removal, and 10 dogs with spontaneous cs were euthanatized or died (nonsurviving group). Before heartworm removal, injected radiographic contrast medium was regurgitated from the right ventricle to the right atrium. Mean pulmonary arterial pressure and total pulmonary resistance were not statistically different between the recovery and nonsurviving groups of dogs, but the end-diastolic right ventricular pressure (mean +/- SD, 6.9 +/- 9.1 mm of Hg) and the a (8.7 +/- 9.2 mm of Hg)- and v (6.3 +/- 8.5 mm of Hg)-waves of the right atrial pressure curve in the recovery group were less, respectively, than the end-diastolic right ventricular pressure (17.3 +/- 6.0 mm of Hg) and the a (15.8 +/- 6.1 mm of Hg)- and v (21.4 +/- 6.9 mm of Hg)-waves in dogs of the nonsurviving group. After heartworm removal, contrast medium regurgitation disappeared, and cardiac output of the right ventricle increased in dogs of the recovery (from 2.08 +/- 0.72 to 2.38 +/- 0.68 L/min; P < 0.05) and drug-induced CS (from 1.42 +/- 0.19 to 1.88 +/- 0.26 L/min, P < 0.05) groups. However, regurgitation remained, and cardiac output did not increase in some dogs of the nonsurviving group. Mean pulmonary arterial pressure decreased significantly (from 37.7 +/- 18.3 mm of Hg to 32.0 +/- 16.1 mm of Hg; P < 0.01) at 1 week after heartworm removal in dogs of the recovery group, but not in those of the nonsurviving group. Total pulmonary resistance (from 12,612 +/- 7,670 dynes.sec.cm-5.kg of body weight to 9,776 +/- 6,089 dynes.sec.cm-5.kg; P < 0.01) and right atrial pressure (a-wave: from 8.7 +/- 9.2 mm of Hg to 4.1 +/- 5.6 mm of Hg; v-wave: from 6.3 +/- 8.5 mm of Hg to 2.1 +/- 4.6 mm of Hg) decreased after heartworm removal in dogs of the recovery group. Total pulmonary resistance (from 20,309 +/- 9,682 dynes.sec.cm-5.kg to 15,970 +/- 6,798 dynes.sec.cm.5.kg; P < 0.05) and right atrial pressure (a-wave: from 15.8 +/- 6.1 mm of Hg to 10.1 +/- 6.3 mm of Hg; v-wave: from 21.4 +/- 6.9 mm of Hg to 11.1 +/- 3.7 mm of Hg) also decreased in dogs of the nonsurviving group. However, pressures in the right side of the heart and total pulmonary resistance after heartworm removal were greater in dogs of the nonsurviving group than in dogs of the recovery group. At necropsy pulmonary arterial emboli containing dead heartworms were found in almost all dogs with spontaneous CS, but not in dogs with drug-induced CS. The severity of pulmonary arterial embolism correlated significantly with mean pulmonary arterial pressure before (r = 0.710; P < 0.01) and 1 week after (r = 0.728; P < 0.01) heartworm removal.