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Advances in canine heart surgery

By Margo Ann Sullivan
Gadzoo / April 9, 2012
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When Noah, the St. Bernard, lost his appetite and developed a cough, his owner, Dave Patenaude, suspected kennel cough. Patenaude took the 6-year-old dog to the Bolton Veterinary Hospital near their Connecticut home, and he's glad now that he didn't delay.

"I took him to the vet thinking he was just going to be getting antibiotics," Patenaude said. But Noah's veterinarian recognized signs of a more serious medical problem. The veterinarian recommended x-rays "right away," and the tests revealed Noah had excess fluid around the pericardial sac.

According to Dr. Nancy Laste, chief cardiologist at Boston's Angell Animal Medical Center, the pericardial sac, which envelops the heart and protects from infections is normally "paper thin." Noah's sac had developed a problem, she said. His was tightening around his heart and squeezing like a girdle.

'We were pretty upset," Patenaude said when the veterinarian delivered the news. More bad news followed. Laste was about to see Noah at Bolton Animal Hospital where she consults once a month. But the visit had to be cancelled because the dog took a turn for the worse. To deal with that emergency, his regular veterinarian tapped Noah's heart with a needle and drained out the excess fluid.

"That gave him great relief," Patenaude said. The hospital performed an ultrasound to verify the sac was clear. Then another setback: a few weeks later, he said, the follow-up ultrasound showed Noah's pericardial sac was filling up again.

"You can't tap the heart repeatedly," Laste said. It was time to look for other options. Noah's veterinarian at Bolton Animal Hospital recommended seeing a specialist.

The specialist can come up with solutions many people don't know about, Laste said, but even when there is no medical miracle, seeing an expert can help people assess the pet's condition. An initial visit costs about the same as a regular vet's exam, she said, although the prices for tests and procedures can add up.

Two days before Thanksgiving, Patenaude drove Noah to Boston's Angell Animal Medical Center to see Laste. The trip took two hours and all the way the Patenaudes worried they might be doing the wrong thing for Noah.

"To be really honest," he said. "We were pretty hesitant to do anything. We didn't want to put him through pain" and a surgery that ultimately "wasn't going to help," he said. They had been down that road before, he said. "We had another dog that had bone cancer. We had her left front leg removed. She recovered." Then the cancer spread.

"We didn't really gain her anything," Patenaude said. They didn't want to make the same mistake with Noah.

But Laste had pioneered a surgical procedure called thoracoscopy. The technique, according to Rob Halpin, spokesman for Angell Animal Medical Center, is less invasive than open chest surgery, so dogs usually can go home the next day.

It's not the right procedure for every dog, Laste said. Noah was a candidate because he had recurrent fluid accumulations around his heart. If a dog has had only one episode with fluid around the heart, Laste prefers not to do thoracoscopy, she said.

"If it's a first episode, there might not be another," she said. And also, if the dog has cancer, thoracoscopy can hasten the spread of the disease. The procedure can release cancer cells into the chest thoracoscopy she said. She went over all those risks with the Patenaudes, they said.

Noah's size -- at 180 pounds--added to the risk of going through surgery.

But then again, the surgery might restore his health.

Saint Bernards and some other breeds are prone to scarring problems with the pericardial sac, Laste said, and added the sac is an "anatomical paradox." As she went on to explain, dogs will become "really, really sick" if the pericardial sac dysfunctions, she said, and yet they don't need the sac to live. Removing the sac in surgery is an option, she said, to prevent fluid from ever building up around the heart again. And if a tumor or aggressive cancer isn't the hidden problem, the longterm outcome should be excellent.

As for Noah, Laste didn't know what she would find until she operated.

"In this case," Patenaude said, they decided to take a chance on the specialist. Laste became Noah's savior, he said.

When Noah arrived at Angell, Halpin said, he was "lethargic" and suffering from shortness of breath.

"He was under so much stress, I would have taken him to California," Patenaude said.

Laste opened Noah's pericardial sac, drained it and removed some pieces of the sac to prevent any future compressions on Noah's heart. She examined the pericardium, the heart and the thoracic (chest) cavities.

The heart was not what she wanted to find, she said. She wanted to see a "nice, pristine normal heart--pink and with fat around it," she said, but when she cut the hole in the pericardial sac and released the fluids, she saw Noah's heart "appeared irregular and nodular," Halpin added.

Laste didn't find any tumors and the biopsy did not identify any cancer cells, she said, but she is concerned Noah may ultimately develop malignant mesothelioma, an aggressive cancer. The longer he goes without symptoms, the better, she said. After six symptom free months, she'll be 90 percent sure he's OK. After a year, she said, she'll be 100 percent sure. Meanwhile, she's told the Patenaudes to stay cautiously optimistic, she said.

"We're not out of the danger zone yet," Patenaude said. "Noah has a very guarded outlook; it very well may be cancer." But the family is focused on the first six month milestone, Patenaude said. "We're spoiling him rotten and watching him closely," he said.

Noah's treatment was expensive, he said. "Between Angell and our primary vet, it was probably close to $5,000.00," he estimated. "We would do it again. Noah's one of those dogs you become very attached to. He doesn't really do tricks. He'll sit, and he'll give you his paw and get food and lots of hugs. He loves to be with his people."

To find out more about Angell Animal Medical Center's Cardiology Service, call 617-541-5038 or e-mail cardiology@angell.org.

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Noah, a 6-year-old St. Bernard, needed heart surgery. (Brenda Cataldo) Noah, a 6-year-old St. Bernard, needed heart surgery.