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Degenerative mitral valve remains the commonest heart disease seen in dogs. Recently, several studies have improved our knowledge to guide our treatment decisions. When asymptomatic dogs develop cardiomegaly secondary to their mitral regurgitation, pimobendan has been shown to delay the onset of congestive heart failure by 15 months. The evidence for using ACE inhibitors remains ambiguous and most cardiologists do not start them in asymptomatic dogs. There is more consensus when heart failure develops, with loop diuretics such as furosemide, calcium inodilators (pimobendan), ACE inhibitors and aldosterone antagonists (spironolactone) indicated to control clinical signs and address the neurohormonal activation that occurs during heart failure.
As dogs become refractory to conventional treatment, the frequency of furosemide administration can be increased from twice daily to very 6 – 8 hours. The addition of another diuretic acting on a different part of the nephron can provide sequential nephron blockade working synergistically with furosemide. Alternatively, furosemide could be switched to the more potent loop diuretic torsemide.
Now surgical repair of the mitral valve under cardiopulmonary bypass is becoming available. Centers in Japan and London have successful programs allowing dogs to be referred for valve repair. The technique involves replacement of the damaged or stretched chordae tendineae with PTFE sutures and annuloplasty with a sutures around the mitral annulus reducing the diameter of the orifice. Florida will be starting a program in 2019 with help from the Japanese team.
