9/16/20: Please welcome Athena! She was turned over to us by her breeder because she has a heart murmur. She is currently four weeks old. We are not certain at this time how extensive her heart issue is. She will see the cardiologist once she is eight weeks old. We will be able to determine at that time with an echocardiogram what the issue is and how we need to move forward to help her.
10/20/20: Based on today’s echocardiogram, Athena has been diagnosed with ventricular septal defect (VSD). This is a small hole between the right and left ventricles (lower heart chambers). This results in flow from the left ventricle entering the right ventricular outflow tract and extra blood volume reaching the lungs – which can result in pulmonary overcirculation and left-sided congestive heart failure (CHF) if severe.
At this time, she has evidence of left-sided heart enlargement indicating an increased risk for complications such as congestive heart failure. Her breathing does not suggest that congestive heart failure is currently present. We will move forward with chest x-rays to rule out the presence of heart failure. Many dogs with small VSDs live a completely normal life span. However, if progressive heart enlargement is noted and congestive heart failure develops, the long-term prognosis is poor.
VSD’s are typically not closed surgically in dogs, but they can occasionally be closed based on the location. Other interventional procedures can sometimes be used to help dogs with severe complications from their VSD (pulmonary artery banding, for example). We will consult with a cardiologist at UGA vet school to see if she is a candidate for surgery to repair the VSD.
11/1/20: We spoke with the cardiologist at UGA vet school and they want to see Athena when she is six months old. We are hoping we will know at that time if she is a candidate for surgery.
11/11/20: Athena is 12 weeks old and weighs 14.8 pounds!
2/8/21: Athena had her six month old check up with the cardiologist today.
Athena has been diagnosed with a ventricular septal defect (VSD). This means there is a defect or ‘hole’ in the interventricular septum that allows blood to flow from one ventricle (pumping chamber) to the other. This is a congenital abnormality, meaning it has been present since birth. Most commonly (and true for Athena) this shunting of blood is from the higher pressure left ventricle to the lower pressure right ventricle and occurs when the heart contracts. Most patients with small and even moderate sized VSDs tolerate the shunting of blood through the defect and often do not develop clinical signs. Athena’s shunting flow through the VSD was higher at her first evaluation at two months old. Today, Athena’s VSD appears hemodynamically insignificant, meaning not enough blood flow is shunting through the small hole to lead to clinically significant volume overload of the heart. Athena’s heart chambers measure normal in size today, which is great news! There is a high likelihood that this VSD will never cause any clinical consequences for Athena, given how small the defect is. However, it is possible that over time, patients with this condition may eventually develop volume overload and congestive heart failure. In patients with clinically significant shunting flow through a muscular VSD, interventional closure of the defect with a specialized device may be performed. In other cases, pulmonary arterial banding (a surgical procedure) is performed to try to balance the left and right pressure and reduce the shunting flow. These procedures range from $3500-6000 at UGA, and they are not indicated for Athena at this time due to the fact that her VSD is determined to be hemodynamically insignificant today. Alternatively, in some patients with a VSD, the shunting flow can reverse (flow from right to left) if pulmonary vascular disease develops. In rare cases, the VSD may close over time, but we believe that Athena is now at the age where it is highly unlikely for the defect to close. She has, however, appeared to somewhat “grow into” her septal defect.
In addition to her VSD, Athena has a small atrial septal defect (ASD), which is a hole between the two partial chambers at the top of the heart. Thankfully, this hole, and the blood that is communicating between the two atrial chambers is very minimal at this time.
Lastly, Athena has been diagnosed with mild mitral valve dysplasia. This means that the valve on the left side of the heart, the mitral valve, was formed abnormally. The valve leaflet is mildly thickened and elongated, and it allows a small amount of blood to leak backwards (regurgitate) instead of closing tightly.
Athena’s cardiac changes are all mild, and her heart appears to be compensating for these abnormalities very well. We are very optimistic that Athena will have a normal lifespan and never develop clinical signs related to her heart disease. She will, however, require a lifelong relationship with a cardiologist for yearly echocardiograms. We recommend continuing to monitor her cardiac changes serially in order to monitor for future potential consequences of her VSD, ASD, or mitral valve dysplasia. Clinical signs of congestive heart failure include coughing, respiratory difficulty, exercise intolerance, or lethargy. We recommend another echocardiogram in 9 months with her adoptive family.
It is recommended that Athena finish one heat cycle before her spay surgery.
2/15/21: Athena started her heat cycle today. It is recommended that we wait 2-3 weeks once the heat cycle is over before we do her spay surgery. She is correctly scheduled to have that surgery on March 19th. She will be cleared for adoption once she recovers from her spay surgery.
3/19/21: Athena had her spay surgery today and all went well!