{"id":1211,"date":"2020-05-05T03:02:41","date_gmt":"2020-05-05T03:02:41","guid":{"rendered":"http:\/\/caninemegaesophagusinfo.com\/staging\/?page_id=1211"},"modified":"2022-02-28T22:59:10","modified_gmt":"2022-02-28T22:59:10","slug":"praa","status":"publish","type":"page","link":"https:\/\/caninemegaesophagusinfo.com\/index.php\/praa\/","title":{"rendered":"PRAA"},"content":{"rendered":"

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\u2026 At this point my mind was only picking up on certain words, like Starvation and Strangling. I asked him, “what do I do? Do I have to put her to sleep?” \u00a0Luckily, he said “NO”\u2026<\/p><\/blockquote>[vc_row_inner][vc_column_inner][vc_column_text]<\/p>\n

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What is Persistent Right Aortic Arch?<\/h3>\n

PRAA, or vascular ring anomaly, is a congenital anomaly of the blood vessels of the heart that result in constriction of the esophagus.<\/p>\n<\/div>\n

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In the fetus<\/strong>, there are blood vessels<\/strong> that at first may serve a function, but then naturally deteriorate<\/strong> as the embryo grows.\u00a0 Occasionally, vessels in the chest cavity, called the aortic arches, will fail to disappear.<\/em> The right aortic arch passes near the esophagus. \u00a0If this blood vessel persists in the newborn, the esophagus is trapped between it and the heart.<\/strong><\/p>\n

This inhibits the growth and function of the esophagus, thus restricting food passage to the stomach.<\/p>\n

In 95% of the cases of a vascular ring anomaly, a constricting band prevents solid foods from passing to the stomach<\/strong> which prevents the puppy from thriving well.\u00a0 In the remaining 5% of cases, a bizarre anomaly of the vessels is present (double aortic arch and aberrant subclavian artery), which may be difficult to correct and may not have a good prognosis.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Signs & Symptoms<\/h3>\n

Signs of this condition usually become apparent shortly after weaning, when a puppy begins eating semi-solid or solid food.\u00a0 While milk will slide down nicely, bulky foods will \u201cjam up\u201d in the esophagus, leading to a stretched structure and the inability to get food down, hence the symptom known as regurgitation<\/strong>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

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taking a thorough medical history to determine if the pup is regurgitating or vomiting is very important.\u00a0<\/strong>– Dr. Michael Huddleston, DVM, Westheimer Animal Clinic, Bellaire, TX\u00a0<\/strong><\/p><\/blockquote>\n

Regurgitation<\/strong> involves the puppy producing undigested food<\/em> and mucus through the mouth with no effort; the pup tilts its head down and the food and mucus simply roll out.\u00a0 By contrast, vomiting<\/strong> is an active process, meaning there are abdominal contractions (heaving) and a retching noise when food and mucus are expelled out the mouth.<\/p>\n

Regurgitation is\u00a0synonymous with PRAA and megaesophagus<\/em>, whereas dozens of disorders may cause a pup to vomit.<\/strong><\/p>\n

Stunted growth (due to an inability to take in nutrients) and breathing problems (often the result of aspiration pneumonia secondary to regurgitation) are other common symptoms.<\/p>\n

It is important to note that the vast majority of dogs with vascular ring anomalies do not have true megaesophagus. The esophagus is merely dilated because of the obstruction caused by the vascular ring.<\/strong>\u00a0-Dr. David Holt, BVSc, Diplomate ACVS, Professor of Surgery, University of Pennsylvania<\/p><\/blockquote>\n

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Treatment<\/h3>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Surgery to correct PRAA<\/h5>\n

Surgical removal of the stricture (narrowing) caused by the persistent right aortic arch is the preferred treatment<\/strong>.\u00a0 It is important to perform surgery early <\/em>in the disease, before permanent growth damage has occurred.\u00a0 Generally, puppies between the ages of 2-6 months, that are not severely emaciated or have severe aspiration pneumonia, are considered good candidates for surgery.<\/strong> Under the age of two months, surgery is considered risky due to anesthesia and surgery complications.<\/p>\n

Although it is recommended the sooner the vascular ring anomaly is corrected the better, there have been cases of adult dogs that have undergone surgery with success.<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Opting out of surgery<\/h5>\n

In some cases, surgery is not possible<\/em>.\u00a0 These pups need to follow feeding instructions for Megaesophagus.<\/strong> They need to be fed in an upright position<\/strong> and kept upright for an appropriate amount of time after meals.\u00a0 As long as the stricture or narrowing allows for nutrients to pass into the stomach, these dogs can continue to thrive.\u00a0 Usually consistency of the food is \u201csoupy\u201d<\/strong> or a liquid gruel in order for it to pass by the stricture.<\/p>\n

Restricted diet, consisting of liquefied foods, will need to be followed closely to limit the damage to the esophagus due to constant regurgitation.<\/em><\/p>\n

For those whom surgery is not a candidate, another option is a\u00a0gastric feeding tube.<\/strong> This allows for nutrition to go directly to the stomach, bypassing the esophagus.\u00a0 Although the idea of a feeding tube seems extreme, many dogs live long happy lives with feeding tubes in place.<\/p>\n

For more information please click on the tab marked \u201cFeeding Tubes\u201d.<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

[\/vc_column_text][vc_empty_space][\/vc_column_inner][\/vc_row_inner][vc_empty_space][vc_separator border_width=”3″][vc_empty_space][vc_column_text]There are t<\/strong>wo types<\/strong><\/em> of surgeries you can elect to have for your puppy.<\/p>\n

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  1. Classic Thoracotomy <\/strong>(opening the chest)<\/li>\n
  2. Minimally Invasive Surgery\u00a0 (MIS) \u2013 Thoracoscopy.\u00a0<\/strong> MIS allows diagnostic and\/or therapeutic surgical procedures to be performed using very small incisions<\/em> through which a camera and instruments are placed inside body cavities.<\/li>\n<\/ol>\n

    Advantages<\/strong> of MIS include:<\/p>\n