Fresh autologous pericardial patch for surgical repair of mitral valve leaflet degeneration in a dog

An 8-year-old, 2.2-kg, spayed female Toy poodle presented with stage D heart failure that was unresponsive to medical management. Echocardiography revealed severe mitral regurgitation (left atrial-to-aorta ratio, 2.4; normalized left ventricular internal dimension in diastole, 2.2; and ratio of regurgitant jet area signal to the left atrial area [ARJ/LAA], 65%), anterior leaflet prolapses, and valve billowing. Mitral valve surgery was recommended based on clinical signs and echocardiographic findings. Mitral annuloplasty and expanded polytetrafluoroethylene chordal reconstruction were performed using cardiopulmonary bypass. Intra-operative assessment revealed leaflet thinning, stretching, and multiple perforations, with regurgitant flow arising from these defects. A 1.5 × 1.5-cm fresh autologous pericardium patch was placed and continuously sutured to the atrial aspect of the anterior leaflet to restore structural integrity and coaptation. Postoperative echocardiography on day 6 demonstrated improved cardiac variables, with the vertebral heart size decreasing from 13.3v to 11.8v, left atrial-to-aorta ratio to 2.0, normalized left ventricular internal dimension in diastole to 1.7, and ARJ/LAA to 18.8%. A transient increase in the C-reactive protein level was observed, which resolved within one month. The patient remained asymptomatic with further reduction in cardiac dimensions, minimal residual regurgitation (ARJ/LAA, 6.7% at 12 months), and no patch-related complications. This is the first long-term report describing a successful mitral valve repair using a fresh autologous pericardial patch in a dog. The dog's pericardial patch demonstrated sufficient durability to withstand high left heart pressure while maintaining the flexibility required for valvular function; thus, this technique may be a valuable addition to the current surgical repair methods.