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Rico, a 1 year old Bull Mastiff, received his second chance at the Royal Veterinary College where over 20,000 are treated each year. As a pup his vets noticed something abnormal about his heart. As it didn't cause any obvious problem for Rico at that time the condition was not investigated.
As Rico grew he became less energetic and then suddenly became very breathless. Referred to the QMHA as an emergency case, he was stabilised and investigated by the cardiology team. Rico was diagnosed with severe pulmonic stenosis in which the valve allowing blood from the right side of the heart is abnormally narrow, and severely restricts blood flow. The heart problem also caused an accumulation of fluid in Rico's chest, compressing his lungs and causing breathlessness. Excess fluid was drained from Rico's chest and he started medication to help reduce the rate of fluid build-up.
The treatment options were explained to Rico's owners. Two main techniques are used to treat dogs with this condition. Either the heart is opened and the narrow valve surgically widened, or a balloon is passed into the heart via a neck or leg vein and inflated at the valve's narrow part to tear a larger hole for blood to pass through.
The balloon procedure is less expensive and although it carries risks they are less than that of an open heart procedure. Rico's owners decided to try the balloon technique.
Unfortunately the balloon technique failed to create a significant increase in valve diameter and blood flow from Rico's heart was still severely restricted. Surgeon Dan Brockman discussed with Rico's owners the possibility of open heart surgery, which would involve stopping his heart for around one hour and a by-pass machine taking over the work of his heart and lungs.
With few options remaining, they decided to go ahead.
Rico had fluid drained from his chest twice before surgery. With Rico lying on his right hand side, surgeons opened his chest on the left side, cutting between two of his ribs. Rico was then connected to the bypass machine where his blood was oxygenated and returned through the carotid artery under sufficient pressure to force it around his body.
Clamps were placed to prevent blood entering the heart which was then stopped by injection of a special cold solution that also prevented damage to the heart cells while it was not beating. The by-pass kept Rico alive during the 55 minutes in which his heart was stopped. During this period Dan opened the heart and cut out the deformed valve. A large patch graft was placed over the incision in the heart increasing the space for blood to move past the narrow section, as well as sealing the incision. The graft is made of a very strong and flexible synthetic material ( Gortex™ ), and is normally well tolerated by the body even though it is not a natural part of the heart. Rico received blood transfusions during the surgery both to fill the by-pass machine's connecting tubes and pumps with blood and to replace blood lost during surgery. In addition a Dideco ‘ Cell saver ' was used to collect blood lost during surgery and clean it of any contamination (tiny pieces of fat or tissue from the surgical site) so it can be returned to the patient. As there is no National Blood Service for animals, transfusion supplies are always extremely limited despite the RVC's ongoing blood donor programme . We are always looking for new donors. Click here to see how our pet could make a big difference.
Rico recovered well in the ICU and a small amount of bleeding into his chest was managed with additional transfusions and the Cell Saver to ‘recycle' some of this haemorrhage. His heart improved dramatically after surgery and within a week no more fluid was accumulating and a cardiology re-check found the heart functioning well. Rico did suffer from a sciatic nerve problem which made him temporarily lame but he is slowly recovering from this.
The Monty Stone-Brown By-pass Surgery Programme which saved Rico's life is the culmination of a long-term strategic plan to bring together a skilled team of staff to perform open heart surgery. This effort received a huge boost in the form of the very generous donation of the by-pass machine (see below) and other key equipment by Mrs Stone-Brown, whose pet Monty had a valve replacement procedure. This type of surgery programme is only possible through the generosity of people who donate money and equipment, and the owners who bring their pets to our regular blood donation sessions.
