March 14, 2011

Zolty's Heart Surgery at CUVS

Zolty is an amazingly sweet 9-year-old Golden Retriever who was born on Valentine's Day in 2002. Zolty's owners recently noticed an acute onset of extreme weakness, prompting them to take Zolty to see Dr. Nolan Zeide, their regular vet at Bull's Head Pet Hospital. After a thorough examination, Dr. Zeide found that Zolty suffered from pericardial effusion and a condition called cardiac tamponade. In layman's terms, pericardial effusion is the accumulation of excess fluid around the heart. Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up between the heart and the outer covering of the heart. Dr. Zeide referred Zolty to Cornell University Veterinary Specialists for further evaluation and treatment.

When Zolty arrived at CUVS, he was extremely weak with a fast heart rate and weak pulses. His heart sounds were barely audible with a stethoscope. One of the first diagnostic tests run on Zolty at CUVS was an echocardiogram, which confirmed Dr. Zeide's findings of pericardial effusion and cardiac tamponade. Additionally, a mass was located on the right side of Zolty's heart.

In order to alleviate the stress created by fluid buildup on the outside of Zolty's heart, criticalist Dr. Sergi Serrano, LV, DVM, DECC performed an ultrasound-guided pericardiocentesis. In other words, Dr. Serrano used ultrasound as a means of guidance to insert a needle into the sac surrounding Zolty's heart and remove the excess fluid that was trapped there. After Dr. Serrano removed 100mls of fluid, Zolty's tampanade resolved on its own and his heartrate returned to normal. While this remarkable turnaround sounds exciting, it was simply a temporary fix for the symptoms associated with a larger problem: the mass on Zolty's heart. It should be noted that Zolty still had arrhythmias, or abnormal electrical patterns within his heart, and that the fluid would have continued to fill up within the outer covering surrounding Zolty's heart if no further action was taken.

After a consultation with Dr. Serrano, Zolty's owners decided that they wanted to have the mass removed from Zolty's heart. A second consultation with Dr. Mandi Kleman, DVM, DACVIM (Cardiology) involved more detailed and extensive analysis of Zolty’s heart and the mass. Using echocardiogram, Dr. Kleman found that the pumping function of Zolty's heart was moderately depressed. Additionally, she described the location, size, and appearance of the mass within the edge of the right atrium. Based on these findings, she suspected to be a malignant type of cancer called hemangiosarcoma.

Zolty's large run allowed him to stretch out and relax post-surgery.
After the values of a full blood test were found to be favorable, and no metastatic disease was discovered on abdominal ultrasound, Dr. Alon Kramer, DVM , DACVS scrubbed in to perform Zolty's heart surgery. Zolty’s surgery involved a thoracotomy (open chest surgery) to allow exposure, and careful excision of his heart’s right atrial mass. Dr. Kramer also removed part of Zolty’s pericardial sac (the outer covering of the heart) to prevent any future fluid accumulation. The surgery went very well, despite being a technically difficult procedure. Zolty recovered recovered uneventfully and was comfortable in our ICU shortly afterwards. After the surgery, the mass was sent out to the lab for a histopathology and analysis.

Zolty relaxes in his run in ICU while we monitor his heart functions post-surgery.
Zolty stayed in the ICU for four days after surgery for close monitoring and pain and arrhythmia management, during which time he successfully won over every single employee that participated in his care.
Zolty and critical care technician Stephanie Phillips, BA, AAS, LVT
After his stay in ICU was over, Zolty was discharged to his owners with a Holter Monitor, which is an ambulatory device that measures heart rate and rhythm for 24 hours. The beauty of these devices is that they can be worn by the patient while resting in the comfort of their home. The dog can relax while the Holter monitor acts like a portable ECG, recording information about the heart that can be downloaded later for analysis. Heart rhythm abnormalities can vary from hour to hour, so without a portable device like the Holter monitor, the animal could experience abnormalities while away from the animal clinic that would otherwise be missed by the doctor. Zolty stayed at home resting for 24 hours while wearing the Holter monitor, and then he was brought back to CUVS to have the monitor removed. The data was then downloaded and analyzed. We were all pleased to find that the Holter monitor showed no evidence of concerning arrhythmias post-surgery.

The histopathology report on the heart mass did reveal cells consistent with hemangiosarcoma, confirming Dr. Serrano and Dr. Kleman’s pre-surgical suspicions. Hemangiosarcoma is a form of malignant cancer. Zolty is currently being seen by CUVS oncologist Dr. Edwin Brodsky, DVM, DACVIM (Oncology) who has begun treating him with chemotherapy. Chemotherapy does not usually make animals feel ill like it can do to humans. The use of chemotherapy in animals is not meant to absolutely cure the cancer; rather, it is a way to prolong a good quality of life. As such, we are very happy that we were able to give this wonderful dog more time with his owners. Zolty is an amazing animal who deserves to live a comfortable life, and we all feel blessed to be able to help with that.

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