Considerations you must carefully think about prior to your dog having PRAA surgery:
BECOME EDUCATED: You are your dog’s advocate for not only its health but its safety.
1.  IF told at ME diagnosis your dog may have PRAA, prior to considering surgery, understand what your dog may have and possible solutions, but also safest surgeon to perform surgery if chosen.

2. There are other types of Vascular Ring Anomaly’s (VRA), but Persistent Right Aortic Arch (PRAA) is the most common and is usually associated with causing ME. Surgical removal of the stricture (narrowing) caused by the persistent right aortic arch is the preferred treatment. It is important to perform surgery early, before permanent growth damage has occurred. 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. Under the age of two months, surgery is considered risky due to anesthesia and surgery complications.

3. For those dogs surgery is not a candidate, another option is a gastric feeding tube. This allows for nutrition to go directly to the stomach, bypassing the esophagus. Although the idea of a feeding tube seems extreme, dogs can live long happy lives with feeding tubes in place.

DIAGNOSIS: Know what tests your veterinarian should perform and how.
1. Thoracic radiograph (X-Ray) made after a barium (a gastrointestinal contrast material) swallow. There is a chance the dog could aspirate the barium, so special precautions should be taken. The barium should be administered in an upright position and minimize the time the dog is laying on his side. Sit the dog back up quickly after each x-ray taken to allow safe passage of the barium.

2. X-ray(s) should also be able to check for aspiration pneumonia, however, there could be start of pneumonia and it not appear on x-ray for first 24-hours. It is critical to know your dog and make the veterinarian aware if you have observed any signs of lethargy, lack of appetite, etc (signs of possible aspiration pneumonia).

3. Blood test including a complete blood count (CBC), chemistry profile and urinalysis are recommended to make sure the dog has healthy internal organs prior to surgery. Can also show signs of low blood sugar or a high white blood cell count if infection is present.

FINANCIAL: Understand the costs associated with whatever you are considering.
1. Starting cost of surgery can be between $2,000 and $4,500, depending on the facility and geographic location.

2. Ask about any extra or additional possibilities so you have full disclosure of what you will need to cover.

3. Cost will be higher when specialty hospitals or University teaching schools are used. Finding safe, highly successful veterinarians is an option and we can try to help depending again on your location.

EXTREMELY CRITICAL AFTER SURGERY CARE: Make sure this is followed as threatens the life of your dog.
1. Whether a feeding tube needed to be placed or not your dog MUST be fed in VERTICAL position and held in same for minimum15 min.

CRITICALIF you can do so…stay there to make sure your dog is fed properly using upright position. Request to watch or offer to take that time constraint off a tech and you do the feeding. We were easily able to help with our dog as she required 5 feedings a day and the DVM appreciated the help and was right there within his eyesight so well monitored as well. THAT is the sign your dog’s safety is of utmost importance to them too.

2. Discuss type of food given and consistency pending what surgeon suggests and number of feedings per day.

3. The surgeon or another very experienced associate with this specific surgery should be there to make sure feedings are done properly and in some cases they may do this themselves.

4. Ask about needing to use a neck hug or some form of elevation when the dog is in its kennel. Make sure they also follow this so pooling saliva and any excess mucous can empty out and not be swallowed leaving ability for the dog to aspirate and get pneumonia.

TIME TO GO HOME: Don’t just pick your dog up or checkout without full discussion with the surgeon who performed this major surgery on your dog.
1. Ask questions if you don’t understand (e.g. check temperature, give meds, keep quiet, etc.)

2. Request they show you (demonstrate it) not just tell you how to feed, what food and consistency is being given, and in what position (how are they keeping your dog upright)

3. Get details of exactly what you need to do, when, how, etc…GET IT IN WRITING because you won’t remember (this is critical for giving any meds)

4. Make sure you have DIRECT CONTACT to someone who knows your dog’s situation personally and can provide help immediately should you need it. This number should provide you access to the named person 24/7 until your dog is stable and/or ylou are comfortable of management.