Optimal timing for mitral valve repair surgery for asymptomatic patients with mitral valve prolapse and severe mitral valve regurgitation has become a topic of study in both humans and dogs. The results of these investigations have led to improvements in perioperative management, including anesthesia and cardiopulmonary bypass, and the skill of surgeons. Mitral valve repair has been established as one of gold standard surgical method for mitral valve disease. Surgical procedures have advanced and surgical indications have expanded with the development of the artificial mitral annulus ring and replacement of the chordae tendineae using artificial materials.High survival rates can be expected in dogs if the appropriate surgery is performed. As the number of mitral valve repair procedures increases, it will be necessary to evaluate the progression of degenerative lesions and the longterm durability of the procedures. Furthermore, as mitral valve repair becomes more common and accessible in more facilities, high levels of expertise and proficiency among veterinary care practitioners will be required.

A 14-year-old castrated male Shih Tzu weighing 5.4 kg presented for refractory pulmonary edema evaluation. The dog was diagnosed with myxomatous mitral valve disease, ACVIM guidelines stage D with an intermediate probability of pulmonary hypertension. Four months after the initial visit, the dog underwent surgical mitral valve repair. The dog recovered well from surgery and was discharged 4 days after the procedure without complications. One month after surgery, the dog presented for ascites and multiple episodes of syncope. The dog was diagnosed with right sided congestive heart failure due to pulmonary hypertension and died 69 days after mitral valve repair from apparent respiratory distress despite aggressive medical treatment, including sildenafil, furosemide, and pimobendan. While the cause of this patientʼs pulmonary hypertension remains unknown, pulmonary thromboembolism was suspected based on blood coagulation tests and clinical course. This case suggests that increased age and preoperative tricuspid regurgitation severity might be associated with postoperative pulmonary hypertension.

Brachycephalic airway syndrome often occurs in Bulldogs, Pekingeses, Pugs, Boxers and Japanese Chins. Brachycephalic airway syndrome is a syndrome causing upper airway obstruction due to stenotic nares, elongated soft palate, tracheal hypoplasia, everted laryngeal saccule and morphological abnormalities of the nasal tract. Common symptoms of brachycephalic airway syndrome are snoring, dyspnea, coughing, and syncope. Negative pressure pulmonary edema and sinus arrhythmia are also observed. We report a dog with suspected cardiogenic pulmonary edema which turned out to have negative pressure pulmonary edema caused by brachycephalic airway syndrome.