{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T14:59:58Z","timestamp":1763564398535,"version":"3.41.2"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Vet. Sci."],"abstract":"<jats:p>A 9-month-old female Jack Russell Terrier was referred because of two episodes of suspected syncope. Echocardiography revealed a large, isolated mid-muscular ventricular septal defect (7 mm) with bidirectional shunting. A diagnosis of Eisenmenger syndrome and erythrocytosis (68.5% of hematocrit) was made and sildenafil therapy (0.5 mg\/Kg twice daily) was initiated. Regular follow-up examinations were performed and Sildenafil therapy was gradually increased based on changes in clinical signs, packed cell volume and heart rate. The dog's clinical conditions have been stable without the need of phlebotomy for 4 years and 6 months, until April 2021 (month 74) (about 7 years of survival) when the dog had 80% of hematocrit and signs of hyperviscosity syndrome. The dosage of administered sildenafil reached gradually 6 mg\/Kg DIE (2 mg\/Kg three times a daily) in June 2022. Lastly, in November 2023 a closed pyometra was diagnosed and the dog was hospitalized and operated. The major concerns in the peri-operative period were hypotension and the profound hypoxemia, but the dog was discharged and recovered normal activity in approximately 11 days. This report describes the long-term management with sildenafil citrate of Eisenmenger syndrome secondary to a muscular ventricular septal defect with right-to-left shunting in a dog. Sildenafil therapy was always well tolerated with no side effects reported, even at higher dosage and drastically reduced the need for phlebotomy.<\/jats:p>","DOI":"10.3389\/fvets.2024.1393919","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T13:51:07Z","timestamp":1730469067000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case report: Eisenmenger syndrome in a dog with ventricular septal defect: long term management and complications"],"prefix":"10.3389","volume":"11","author":[{"given":"Barbara","family":"Bruno","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Savarino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Bussadori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Degiovanni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Lardone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Bertero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Tarducci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"key":"B1","first-page":"2952","article-title":"Congenital heart disease","author":"Beijerink","year":"2016"},{"key":"B2","first-page":"218","article-title":"Congenital heart disease","author":"Strickland","year":"2016"},{"key":"B3","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1136\/bmj.2.5099.755","article-title":"The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt","volume":"2","author":"Wood","year":"1958","journal-title":"Br Med J."},{"key":"B4","first-page":"70","article-title":"A retrospective analysis of congenital cardiac abnormalities (1977\u20131989)","volume":"20","author":"Hunt","year":"1990","journal-title":"Aust Vet Pract."},{"key":"B5","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/tera.1420070111","article-title":"Congenital heart disease in dogs: epidemiologic similarities to man","volume":"7","author":"Mulvihill","year":"1973","journal-title":"Teratology."},{"key":"B6","first-page":"1","article-title":"Congenital defects of the cardiovascular system of dogs. Studies in comparative cardiology","volume":"20","author":"Patterson","year":"1976","journal-title":"Adv Vet Sci Comp Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1111\/j.1748-5827.1997.tb03326.x","article-title":"Retrospective study of congenital heart defects in 151 dogs","volume":"38","author":"Tidholm","year":"1997","journal-title":"J Small Anim Pract."},{"key":"B8","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1111\/j.1939-1676.2011.0711.x","article-title":"Retrospective review of congenital heart disease in 976 dogs","volume":"25","author":"Oliveira","year":"2011","journal-title":"J Vet Intern Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0230160","DOI":"10.1371\/journal.pone.0230160","article-title":"Epidemiological study of congenital heart diseases in dogs: Prevalence, popularity, and volatility throughout twenty years of clinical practice","volume":"15","author":"Brambilla","year":"2020","journal-title":"PLoS ONE."},{"key":"B10","doi-asserted-by":"publisher","first-page":"166","DOI":"10.2460\/javma.247.2.166","article-title":"Signalment, clinical features, echocardiographic findings, and outcome of dogs and cats with ventricular septal defects: 109 cases (1992-2013)","volume":"247","author":"Bomassi","year":"2015","journal-title":"J Am Vet Med Assoc."},{"key":"B11","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.ijcard.2014.11.100","article-title":"Physiological differences between various types of Eisenmenger syndrome and relation to outcome","volume":"179","author":"Moceri","year":"2015","journal-title":"Int J Cardiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1111\/jvim.15725","article-title":"ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs","volume":"34","author":"Reinero","year":"2020","journal-title":"J Vet Intern Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1111\/jvim.16072","article-title":"Clinical features and outcome of dogs and cats with bidirectional and continuous right-to-left shunting patent ductus arteriosus","volume":"35","author":"Greet","year":"2021","journal-title":"J Vet Intern Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1161\/CIRCULATIONAHA.106.630715","article-title":"Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blinded, randomized, placebo-controlled study","volume":"114","author":"Gali\u00e8","year":"2006","journal-title":"Circulation."},{"key":"B15","first-page":"279","article-title":"Polycythemia and erythrocytosis","author":"Giger","year":"2010"},{"key":"B16","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.ijcard.2010.02.020","article-title":"Quality of life and functional capacity can be improved in patients with Eisenmenger syndrome with oral sildenafil therapy","volume":"149","author":"Tay","year":"2011","journal-title":"Int J Cardiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.ijcard.2006.10.018","article-title":"Effects of chronic sildenafil in patients with Eisenmenger syndrome versus idiopathic pulmonary arterial hypertension","volume":"120","author":"Chau","year":"2007","journal-title":"Int J Cardiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1111\/j.1939-1676.2001.tb02295.x","article-title":"Long-term clinical management of right-to-left (\u201creversed\u201d) patent ductus arteriosus in 3 dogs","volume":"15","author":"C\u00f4t\u00e9","year":"2001","journal-title":"J Vet Intern Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1111\/j.1939-1676.2001.tb02340.x","article-title":"Hydroxyurea for treatment of polycythemia secondary to right-to-left shunting patent ductus arteriosus in 4 dogs","volume":"15","author":"Moore","year":"2001","journal-title":"J Vet Intern Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1111\/j.1748-5827.2011.01127.x","article-title":"Effects of sildenafil citrate on five dogs with Eisenmenger's syndrome","volume":"52","author":"Nakamura","year":"2011","journal-title":"J Small Anim Pract."},{"key":"B21","first-page":"2807","article-title":"Pulmonary hypertension and pulmonary thromboembolism","author":"Williams","year":"2016"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"ESC Scientific Document Group","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1007\/978-0-387-71764-7_23","article-title":"Normal cardiac output, oxygen delivery and oxygen extraction","volume":"599","author":"Wolff","year":"2007","journal-title":"Adv Exp Med Biol."},{"article-title":"Normal clinical cardiovascular physiology","year":"1998","author":"Kittleson","key":"B24"},{"key":"B25","doi-asserted-by":"publisher","first-page":"ii42","DOI":"10.1136\/heartjnl-2015-308378","article-title":"Pulmonary hypertension in children with congenital heart disease (PAH-CHD, PPHVD-CHD). Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension","volume":"102","author":"Kozlik-Feldmann","year":"2016","journal-title":"Eur Paediatr Pulmonary Vasc Dis Netw Heart."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1016\/S1885-5857(10)70232-2","article-title":"Pulmonary hypertension in congenital shunts","volume":"63","author":"Beghetti","year":"2010","journal-title":"Rev Esp Cardiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1161\/01.CIR.0000102381.57477.50","article-title":"Endothelial dysfunction in pulmonary hypertension","volume":"109","author":"Budhiraja","year":"2004","journal-title":"Circulation."},{"key":"B28","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1111\/j.1751-0813.1998.tb12325.x","article-title":"Acute onset of pulmonary necrotising arteritis in a dog with a left-to-right patent ductus arteriosus","volume":"76","author":"Gavaghan","year":"1998","journal-title":"Aust Vet J."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.2165\/00003495-200868080-00004","article-title":"Management of pulmonary arterial hypertension associated with congenital systemic-to-pulmonary shunts and Eisenmenger's syndrome","volume":"68","author":"Gali\u00e8","year":"2008","journal-title":"Drugs."},{"key":"B30","doi-asserted-by":"publisher","first-page":"745","DOI":"10.7326\/0003-4819-128-9-199805010-00008","article-title":"The Eisenmenger syndrome in adults","volume":"128","author":"Vongpatanasin","year":"1998","journal-title":"Ann Intern Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1807","DOI":"10.1161\/CIRCULATIONAHA.105.603001","article-title":"Phosphodiesterase-5 inhibitor in Eisenmenger syndrome: a preliminary observational study","volume":"114","author":"Mukhopadhyay","year":"2006","journal-title":"Circulation."},{"key":"B32","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1016\/j.ijcard.2014.04.131","article-title":"Dyspnea in Eisenmenger syndrome and its amelioration by sildenafil: role of J receptors","volume":"174","author":"Anand","year":"2014","journal-title":"Int J Cardiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e197","DOI":"10.1161\/01.CIR.0000127113.72093.45","article-title":"Sildenafil use in patients with the Eisenmenger syndrome","volume":"109","author":"Rosenthal","year":"2004","journal-title":"Circulation."},{"key":"B34","first-page":"500","article-title":"Therapeutic methods used in patients with Eisenmenger syndrome","volume":"16","author":"Trojnarska","year":"2009","journal-title":"Cardiol J."},{"key":"B35","doi-asserted-by":"publisher","first-page":"13729","DOI":"10.1074\/jbc.274.20.13729","article-title":"Cyclic GMP phosphodiesterase-5: target of sildenafil","volume":"274","author":"Corbin","year":"1999","journal-title":"J Biol Chem."},{"key":"B36","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s00395-004-0504-5","article-title":"Antiproliferative effect of sildenafil on human pulmonary artery smooth muscle cells","volume":"100","author":"Tantini","year":"2005","journal-title":"Basic Res Cardiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1111\/jvp.12487","article-title":"Pharmacokinetics of single-dose sildenafil administered orally in clinically healthy dogs: effect of feeding and dose proportionality","volume":"41","author":"Akabane","year":"2018","journal-title":"J Vet Pharmacol Ther."},{"key":"B38","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1186\/s12917-018-1617-7","article-title":"Comparative single-dose pharmacokinetics of sildenafil after oral and rectal administration in healthy beagle dogs","volume":"14","author":"Yang","year":"2018","journal-title":"BMC Vet Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"249","DOI":"10.5152\/akd.2015.5834","article-title":"Six-minute walk test in pulmonary arterial hypertension","volume":"15","author":"Demir","year":"2015","journal-title":"Anatol J Cardiol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1164\/ajrccm.161.2.9906015","article-title":"Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing","volume":"161","author":"Miyamoto","year":"2000","journal-title":"Am J Respir Crit Care Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/1465-9921-6-92","article-title":"Health-related quality of life in patients with pulmonary arterial hypertension","volume":"6","author":"Taichman","year":"2005","journal-title":"Respir Res."}],"container-title":["Frontiers in Veterinary Science"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2024.1393919\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T13:51:11Z","timestamp":1730469071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2024.1393919\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,1]]},"references-count":41,"alternative-id":["10.3389\/fvets.2024.1393919"],"URL":"https:\/\/doi.org\/10.3389\/fvets.2024.1393919","relation":{},"ISSN":["2297-1769"],"issn-type":[{"type":"electronic","value":"2297-1769"}],"subject":[],"published":{"date-parts":[[2024,11,1]]},"article-number":"1393919"}}