Transvenous heartworm extraction in a mixed breed dog with caval syndrome
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May, Lauren G.
Case Description—A 3-year-old 26.3 kg (58 lb) castrated male Labrador mixed breed dog was admitted to the Cornell University Hospital for Animal’s Emergency Service for an acute (1-day) history of lethargy, inappetance, and a shallow-irregular breathing pattern. Prior to presenting to Cornell, the dog presented to a referring veterinarian who ausculted an arrhythmia and confirmed it on ECG. Clinical Findings— On presentation, the patient had pale mucous membranes and a capillary refill time of 2 seconds. On auscultation, a coarse grade IV/VI right-sided heart murmur was heard along with an arrhythmia. The patient was tachycardic and his femoral pulses were weak to fair. He was tachypneic on room air. Pigmenturia was noted on presentation. The arterial blood gas on presentation showed hypoxemia. Thoracic radiographs showed enlarged pulmonary arteries and mild right heart enlargement suggestive of heartworm disease. A 4Dx SNAP test was positive for heartworm antigen. Furthermore, an echocardiogram revealed a large mass of numerous hyperechoic linear structures within the right atrium supportive of heartworm infection. Diagnostic evidence and clinical signs were compatible with a diagnosis of heartworm disease induced caval syndrome. Treatment and Outcome— Transvenous heartworm retrieval was performed under general anesthesia via jugular venotomy. Post-operative care included supplemental oxygen therapy, intravenous fluids, antibiotics, anticoagulants, adulticide therapy, and heartworm preventative. The patient was discharged after 3 days in the hospital with marked respiratory improvement. On one-month follow up recheck with the cardiology service, the patient received his final doses of adulticide therapy. The owner’s report the patient has done well at home with no episodes of dyspnea, but has occasional episodes of dry coughing. Clinical Relevance— This paper includes a discussion of important diagnostics, heartworm disease induced caval syndrome, transvenous worm retrieval followed by adulticide therapy, procedural risks and outcomes, and follow-up.
Senior seminar paperSeminar SF610.1 2010
Dogs -- Parasites -- Treatment -- Case studies