Heart surgery saves puppy’s life

Published 10:22 pm Saturday, December 11, 2010

A couple of weeks ago was one of those days. An owner brought in a new puppy. She was cute with a great personality, but on her physical exam, I heard a murmur. My heart skipped a few beats.

I listened carefully to be sure, but it was there. A continuous murmur that sounded like machinery.

Murmurs happen when there is turbulence, but one that happens at all times in the beating cycle almost always means that there is either a ventricular septal defect (hole inside the heart) or a Patent Ductus Arteriosus or PDA. Of the two, a PDA is much more common and easier to fix.

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The Ductus Arteriosus is the vessel that shunts blood from the lungs back to the body while the animal is in the uterus. (There isn’t much point in sending a lot of blood to the lungs.)

When the puppy is born the pressure in the now breathing lungs is supposed to shut off the vessel. But in six to eight cases of 1,000 live births, the vessel does not close and remains “patient.”

This means that the heart has to beat much faster to move the same amount of blood. This can lead to respiratory distress, coughing, exercise intolerance and stunted growth.

In later stages there can be rear leg weaknesses and blood concentration and blood thickening to the point of clotting.

Dogs can die of congestive heart failure, arrhythmias or embolus. In fact, 50-60 percent die from congestive heart failure within a year.

This is what I had to tell Squirt’s owner.

There is a treatment. Surgery is very effective if it is done early. This can be to tie off or ligate the shunt or to put in a Gianturco coil that occludes the ductus.

The surgical technique for an uncomplicated case looks easy in the textbook. Go in find the shunt, tie it off, re-inflate the lung that was in the way and close the chest.

Of course, the simple procedure is followed by 27 pages (okay, maybe not quite 27) of everything that can go wrong, including the small animal completely bleeding out in 10 to 20 seconds if you tear the ductus while trying to dissect it away in order to tie it off.

Oh, and the heart is beating the entire time, so tearing is a real possibility. And the anesthesiologist has to breathe for the pup the entire time because the chest is open. Then there are all the special tools that are only used for this surgery. In short, this is a specialist surgery.

But Squirt’s parents had only had him a day and they did not have money for a specialist. Neither did they want their son to get attached to a pup that would die within a year.

So, my team came together and we did surgery. None of us were in our comfort zones that day. We said a prayer for patience and skill before surgery.

And within a couple of hours after surgery, Squirt was up and standing. I did my part well, but could not have pulled off this complex surgery without my staff.

We all felt like heros that day. Even more so when Squirt went home.

Dr. WIXSOM owns and practices at Guardian Animal Medical Center in Flatwoods, Ky. More info at www.Guardian Animal.com or 606.928.6566