Garfiliano came to see Dr. Steven Cole for his cardiology appointment and our team fell in love with him!
Cranberry was diagnosed with severe pulmonary stenosis when she was just a few months old, meaning flow of blood from the right ventricle of the heart to the pulmonary artery was obstructed, causing pressure and stress on the heart.
Depending on the severity of the obstruction, it can cause issues like a murmur, an arrhythmia, or even congestive heart failure. Upon diagnosis, Cranberry’s regular veterinarian referred her over to Dr. Steve Cole, the head of Cardiology at ACCESS San Fernando Valley.
Cranberry was part of the rescue group Angel City Pits, who after meeting with Dr. Cole, decided they wanted to pursue a procedure that would correct the issue. Dr. Cole teamed up with Dr. Yonathan Buks, one of the surgeons at ACCESS, to perform a balloon valvuloplasty in our interventional radiology suite. Using fluoroscopy, they were able to see a live x-ray of Cranberry’s heart. They made a small incision to insert a catheter that was used to guide the balloon (see below) the exact point needed to repair Cranberry’s heart. The balloon was successfully inflated at the point of the obstruction to open the path and allow blood to flow properly.
Cranberry made a full recovery and will now live a full, healthy life. She’s now considered a “foster fail” as her original foster mom decided to adopt her and officially make her a part of the family! We are so happy we were able to help Cranberry and thrilled that she has found a loving forever home.
If you would like to support Angel City Pits, please visit www.angelcitypits.org
By Rhianna Depew, RVT…
Dr. Steven Cole, our board-certified cardiologist, approached me and asked a very delicate question. “How do you feel about doing anesthesia on a two-week-old, tiny puppy?”
“Puppy” as she was aptly called, since she hadn’t acquired a name yet, was a cute and cuddly, and very fragile Burmese Mountain Dog neonate that was already having cardiac issues at her young age. She had patent ductus arteriosus, or PDA, which is a congenital vascular communication between the aorta and pulmonary artery. This is normal for humans and animals in the womb, however in some cases, this vessel fails to close normally at the time of birth.
If left untreated, a PDA can cause severe cardiac enlargement, and eventual congestive heart failure (fluid in the lungs), or pulmonary hypertension (high blood pressure in the lungs).In fact, most dogs with an untreated PDA do not survive the first few years of life. Because of how tiny she was, she wasn’t a good candidate for the typical, minimally invasive technique with catheters. Instead, Puppy needed open chest surgery in order to accomplish the PDA ligation; but that also meant a lot of risk, and a whole host of potential complications.
Dr. Cole knew I loved challenges, and was always up for our most difficult cases, but this one was different—a suckling neonate under general anesthesia is extremely high risk. But we were determined to do everything we could to help this puppy, so I started planning ahead. I thought about this small, delicate puppy every day leading up to the procedure, as well as the night before. She kept me awake, going over every detail and making mental checklists of everything I needed to get her safely through her risky life-saving surgery.
That morning I woke up early and wanted to make sure I arrived at the hospital ahead of schedule to start planning and preparing. This was the smallest heart surgery I had ever assisted with. She would need the tiniest versions of all the equipment we normally used. Tiny catheters, tiny endotracheal tube, tiny, tiny doses of medication and anesthetic drugs. I calculated all the “what if” emergency medications ahead of time and went over and over again everything we needed. I went over to Puppy’s cage and scooped her up. She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.
She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.I gave her a kiss and held her up to my cheek and told her that she was going to do great, and that there would be plenty of days of running through grassy parks, toys, and treats in her future. Then I placed her back in her bed of cozy blankets so she could get some rest before her big procedure, and so that I could go triple check that everything was in place.
When it came time for surgery, we prepped the puppy before we put her under anesthesia and had every warming device at our disposal to keep her temperature up. I gave her micro doses of anesthetic to get her sleepy, placed ET tube in her trachea to control her breathing, hooked her up to the anesthesia machine and patient monitor, listened to her little heart beating on the monitor, and gave her some tiny breaths.
Then, I remembered to breathe, as I was holding my breath with each step taken to prepare Puppy for her big procedure. We were on our way.
Our board-certified surgeon Dr. Jana Norris, along with Dr. Cole, arrived into the OR, and we wasted no time getting right to it. The room was silent. We were all hyper focused in our tasks at hand: to accomplish this procedure and get this puppy out quickly and safely. Dr. Norris’ skilled hands were each the size of the entire patient, and they worked precisely and efficiently around the puppy’s tiny heart and lungs. I continuously watched between my monitor, the patient and the doctors, monitor, patient, doctors, monitor, patient, doctors—trying to stay a step ahead at all times. You could cut the tension with a knife, and I don’t think any of us had taken a full breath, then….
Dr. Norris assured everyone in the room with a confident “I got it.”
Puppy was doing great under anesthesia, and knowing the mission was accomplished, I could feel some nervous tears welling up. We finished the surgery and gave each other well deserved verbal high fives. I brought our tiny patient into recovery and stayed by her side until she fully woke up. Within a couple of hours she was back to being her cute and wiggly self, and wanting to be bottle fed.
Puppy was able to go home a few days later and recently came in for a recheck with her beloved cardiologist. She’s doing very well and is expected to grow fully to her Burmese Mountain Dog size and live a long, happy life. Puppy will be a constant reminder that preparation, precision, dedication, and team work, are all crucial to saving an animal’s life. For now, Puppy will continue to steal our hearts and bring joy to the hospital with each and every visit.
From Left to right: Dr. Jana Norris, Dr. Steve Cole, and Registered Veterinary Technician, Rhianna Depew.
Roscoe is a three year old male terrier mix who was found as a stray. He was hiding in a bush behind a Good Samaritan’s house, where he sought shelter from the cold spring rain. He was scared, hungry, and guarded. After quite some time, though, the homeowner was able to lure Roscoe out from behind the bush and began looking for his original owner.
This proved unsuccessful, and she took Roscoe to the shelter in the hopes that his owners would look there for him. When his time was up at the shelter, it became apparent that no one was coming for Roscoe. The Good Samaritan—Clarice— adopted Roscoe and took him to the neighborhood veterinarian, who detected a very large heart murmur. Clarice and Roscoe were then referred to ACCESS Specialty Animal Hospital in the San Fernando Valley to see Dr. Steve Cole in the cardiology department.
Roscoe was diagnosed with patent ductus ateriosus (PDA), which is a congenital vascular communication between the aorta and pulmonary artery. If left untreated, a PDA can cause severe cardiac enlargement, fluid in the lungs, or high blood pressure. In fact, most dogs with a PDA do not survive the first few years of life.
After presenting Roscoe’s owner with all of the information, she opted for a minimally invasive surgery to correct the PDA. Dr. Cole performed the procedure with Dr. Jason Arndt from ACCESS Specialty Animal Hospital – Los Angeles cardiology department in our interventional radiology suite in Los Angeles, which happens to be the first purpose-built interventional radiology suite for animals on the West Coast! Here, the doctors were able to utilize fluoroscopy and angiography to perform the procedure with minimally invasive tools. This allowed them to see in real time exactly where the necessary catheters were to be placed. A small incision was made on Roscoe’s leg, and from there Dr. Cole and Dr. Arndt were able to close the opening with a small device through the femoral artery. Roscoe recovered well and was discharged from the hospital the next day.
His prognosis is excellent since the device successfully closed the abnormal blood vessel. Roscoe’s family was able to proceed with the surgery with funding from The Big Hearts Fund, a wonderful 501(c)(3) non-profit organization that raises funds and awareness for pets diagnosed with heart disease.
(Top left photo Credit for Roscoe goes to the The Big Hearts Fund.)
Brody is a young French Bulldog that was born with a heart murmur.
Using an ultrasound of the heart called an echocardiogram, Dr. Jason Arndt from ACCESS Specialty Animal Hospital’s Veterinary Cardiology Department, was able to indentify ‘severe pulmonic stenosis’, a narrowing of the pulmonic outflow from the right ventricle of the heart in little Brody .
The narrowing was putting a large amount of stress on the right side of Brody’s heart, so an interventional procedure called a ‘balloon valvuloplasty’ was performed which significantly improved the stenosis.
Even better news is that the little guy was able to return home the following day!
Below is a picture of Brody’s ‘angiogram’ showing the pulmonic stenosis. (An angiogram is an imaging technique that uses fluoroscopy to visualize blood flow to the arteries and veins.)
The Cardiology Services at ACCESS Specialty Animal Hospitals specializes in minimally invasive correction of many congenital cardiac diseases in animals.