Anaesthetic management and clinical outcomes of balloon pulmonary valvuloplasty in dogs with severe pulmonic stenosis: a retrospective study (2024-2025).

INTRODUCTION

Balloon pulmonary valvuloplasty (BPV) is the most common interventional procedure for treating severe pulmonic stenosis (PS) in dogs. Due to the cardiovascular compromise associated with PS, anaesthetic management must be carefully planned to ensure patient safety.

OBJECTIVES

To describe the anaesthetic protocols, perioperative complications, and clinical outcomes of dogs with severe PS undergoing BPV.

METHODS

A retrospective review of medical records was performed for 21 dogs with severe pulmonic stenosis (echocardiographic pressure gradient > 80 mmHg) that underwent balloon pulmonary valvuloplasty between 2024 and 2025. Anaesthetic protocols were individualized based on cardiovascular assessment. Data were analyzed descriptively, and statistical analyses were performed using IBM SPSS Statistics for Windows (version 25). A significance level of p < 0.05 was adopted.

RESULTS

Twenty-one dogs were included, with a median age of 18 months (range: 3-84) and median body weight of 7.75 kg (range: 2.2-26). French Bulldogs were the most common breed (33.3%). Syncope (42.9%) and fatigue (38.1%) were the most frequent clinical signs. Anaesthetic induction was predominantly performed using etomidate-midazolam-based protocols (95%), and anaesthesia was maintained with mainly isoflurane combined with intravenous adjuncts. Hypotension (MAP < 65 mmHg) was the most common intraoperative complication, occurring in 66.7% of dogs, frequently requiring vasoactive support. Cardiac arrhythmias, including ventricular arrhythmias and bradyarrhythmia's, were also observed. Balloon pulmonary valvuloplasty resulted in a significant reduction in right ventricular pressure gradient in 90% of cases.

CONCLUSION

Balloon pulmonary valvuloplasty effectively reduced right ventricular pressure in dogs with severe pulmonic stenosis. Anaesthetic management was heterogeneous, with frequent use of etomidate- and benzodiazepine-based induction and inhalant anaesthesia combined with intravenous adjuncts. Intraoperative hemodynamic instability and arrhythmias were common, reinforcing the need for individualized anaesthetic planning and vigilant perioperative monitoring.