1. Thoracotomy

2. Approaches depends
upon following factors

3. Factors
 Lesion type: DH, lobectomy,
pericardiotomy, thoracocentesis
 Condition of the animal- whether an
early
diagnosed
- withstand extensive
sternotomy(splitting of sternum)/
Intercostal incision should be taken
up

4. factors
 Shape and size of thorax
Less capacious- more manipulation-
sternotomy
More capacious – more manipulation-
intercostal is sufficient/ rib split/ rib
resection

5. Techniques of thoracotomy
 Intercostal
incision:
• Cranial to the rib –
intercostal vessels are
located caudally
• Extend the incision to
desired length
• A self retaining rib
retractor is used for
adequate exposure of
the intrathoracic
organs.

6. Techniques
• Serratus ventralis
dorsally and external
abdominal obliqus
ventrally – after
incising the facia.
Separate the fibres to
expose external
intercostal muscle.

7. Thoracotomy
• During expiratory
pause the
intercostal m and
pleura – incised-
midway between
the ribs

8. Closure
 Chromic
catgut/nylon –
cranial and caudal to
incision- ribs
opposed with towel
clamps
 Adv: simple&quick
Dis: insufficient- heart
& great vessels
- Rib fracture when
held with rib
retractor

10. Technique
 St. incision- over
rib- reflect
periosteum- lat.
and medial

11. Rib resection
 Periosteal
elevator- used
to separate the
periosteum
medially and
laterally

13. Closure
 Adv: -good
 Series of healing
interrupted
 No gap
sutures placed
about 1 cm
apart- lateral  Disadv: lot of
and medial skill
periosteal  Time consuming
surfaces- cranial  Weak point-
and caudal edge absence of rib
of incision

14. Split rib technique
 Expose the rib
 St. longitudinal
incision- center-
oscillating bone
saw.
 Rib is sectioned-
transversely at
either ends- of
primary incision

15. Split rib technique
 Adv: maximum
exposure-
without
involvement of
rib retractor
 Closure is simple
and quick-
interrupted
stainless steel
wire

16. Disadv:
Dent formation along margins
 Sternum splitting incision (Median
sternotomy)
 Required for extensive manipulation-
cardiac defects and associated structures
 Animal on dorsal recumbency
 Skin incision- manubrium to xiphoid
 Sternum split- chisel/splitter/ electrical
saw
 Don’t sever vessels – either side of
midline

17. Closure
 Drill hole in sternabrae- suture with
monofilament nylon
 Disadv:
-Postoperative pain- discomfort- depth
of respiration is affected
-Inaccurate apposition
-cardiac output is reduced due to
increased CVP

18. Transabdominal
 Other approaches like transabdominal to
repair DH- paracostal incision
 Heart worm disease:
-dirofilaria immitis
-Mosquitoes- vectors
-Dog- Primary reservoir

20. Heart worm disease:
-3rdstage larva-
infective- 2-3
weeks- mosquito
mouth parts
-Penetrate skin-
susceptible animal-
3m- immature
worms – reach
right side of heart-
obtain full size-
15-35 cm –
5-6months- live for
>5years- non-
infective
microfilariae

21. Heart worm disease:
-adult worm – pulmonary trunk-less no. in
rt. Ventricle- but found in rt. Atrium and
caudal vena cava in heavily infested
animal
• -severity based on
3. No. of worms and location
4. Host immune response
5. Duration of infection

22. Heart worm disease
 Pathogenesis:
 Adult worm causes mechanical irritation of
intima and pulmonary arterial walls- CHF
 Glomerulonephritis- immune complexes
 Pulmonary inflammation and edema
 Symptoms: coughing, exercise intolerance,
dyspnoea, cyanosis,wt.loss despite good
appetite hemoptysis, syncope, epistaxis and
ascites

23.  Diagnosis:
 Antigen detection test
 Right ventricular hypertrophy patterns are
seen
 Detection of microfilariae in routine blood
examination- failure to detect- doesnot
rule out- presence of microfilariae in
heart- go for concentration technique-
count / ml of blood – 1000 MF=1 adult
worm
 5-10% dogs – adult worm- no detectable
circulating MF- eosinophillia is suggestive

24.  Mild cases- RG appearance- normal
 Angiocardiograms- linear filling defects –
branches of pulmonary artery
 Moderate and severe infections- RG-
dilatation of rt. Heart enlargement and
dilatation of pulmonary trunk and its
arteries

25.  Splitting
of second heart sound-
suggestive of pulmonary hypertension-
confirmed by direct cardiac catheterization
–measurement of rt.ventricular/
pulmonary artery pressure
 Treatment :
1.Melarsomine dihydrochloride @ 2.5 mg/kg
deep i.m.
2.Ivermectin

26. 3. Diethyl carbamazine @ 2.5 mg/ lb
b.w.daily -10 days-1month
4. 6 weeks after-disappearance of
clinical signs- dithiazanine iodide
(dizan)2-3mg/lb orally- kill the
microfilariae-7 days
5. Digoxin and diuretics are given in
CHF

27. 3. Restrict exercise- to reduce thrombosis and
endothelial damage
4. Class IV dirofilariasis – Caval syndrome- vena
cavae syndrome -extreme infestation- sudden
onset- collapse with haemoglobinaria and
respiratory distress
5. Surgical removal –questionable- suggested
that – dogs- with less than 50 worms- can
tolerate chemotherapy

28. Puncture ventriculotomy:

29. Puncture ventriculotomy:
 Apply a purse string
suture- pass an
alligator foreceps – in
rt. Ventricle-
repeatedly introduced
and taken out while
hemorrhage is
controlled by purse-
string suture

30. Through median sternotomy-from right
atrium and orifice of tricuspid valve
and caudal vena cava to save the life
of the dog.

31.  Rigid / flexible alligator forceps/
intravascular retrieval snare- via
rt. Jugular vein with fluoroscopic
guidance- pass the instrument
untill worms are no longer
retrieved
 Fluid therapy