From vomiting/bloody diarrhea, Ava now has PDA -- now what?

[AJT]

Originally Posted by msvette2u

After having our foster pup die on the table (2nd surgery and thousands of dollars spent to that point) my feeling was...
I wish I'd just put her on meds and kept her with us until she passed naturally or had to be put to sleep at the vet.

She could have lived every day spoiled and maybe even made it to 1-2yrs.

The doctor said no meds would help mitigate the issue. From what I understand the duct from her heart to her lungs did not fully close while she was in utero so there is leakage from her heart to her lungs. Unless there is meds available? I don't see how meds will help prevent the duct from opening.

On the other hand, I'm pretty active with Ava and she loves running around and hiking with me. I would feel terrible if we were running around and she dropped dead...

[msvette2u]

I know what a PDA is...we did surgery twice, the coil was attempted then open heart surgery during which she passed away. It happens in humans, too, btw. PDAs.

Medication can help take the stress off the heart and keep it from enlarging more.

In my experience with foster dogs, when there's one such defect, often there are others, in that girls case, her heart tissue was just extremely fragile and she died on the table as her heart literally disintegrated in the veterinarian's hands.

[kiya]

I'm so sorry to hear of this, I will keep Ava and you in my thoughts & prayers.

[JeanKBBMMMAAN]

I will post later tonight (trying to remember I said this!) about that article.

I like to look at the numbers of things/what are the chances of this and that, and then figure out what is good/bad best/worst (plus/minus cost) and decide what I can reconcile in my own mind so it is a very personal decision to do or not do these things, which is why you will receive different thoughts and ideas (all okay) and why you will make the decision that you feel is best for your situation.

I just tend to try to make that emotional decision in the most logical way I can (sometimes, like when my 15 yo dog bloated and torsed - it is only - well, they will die if I don't do it, so I am going to give him a shot [yay! it worked]). I was helped in this "method" by some friends and have always kind of gone back to it. This has not a lot to do w/the link, but just so you feel okay with whatever you decide to do. This is not a situation of my dog is sick should I go to the vet where there is a definite YES you should.

I have an Ava too.

[Anubis_Star]

Originally Posted by AJT

So for all those who lend their thoughts, suggestions, prayers, and positive energy to me last week during Ava's vomiting and bloody diarrhea episode, many thanks again for being there.

As you know during the vet visits last week, they discovered that she has an abnormally large heart (say 25% larger than expected for a 10 month old). Today was the cardiologist appointment and they discovered during the ECHO that she has PDA -- Patent Ductus Arteriosus. There was a strong recommendation for surgery. Of course I read up on it and would like to hear other people's thoughts.

Prior before the cardiologist appointment, my dad had suggested that no matter what we don't do any surgery. The way the vet explained it was that it was just removing a part of the shunt that was suppose to disappear during her development in the womb. In my head it's very simple -- remove.

I'm kind of emotionally crushed that we have to go the surgery route since the vet since no medication will help. Rationally and logically I'm all for it especially given the high mortality rate if I don't do the surgery. Again, emotionally I'm upset that she would have to go through that kind of surgery and the possibility of losing her so early.

I signed a contract that the puppy has a one year health guarantee (will have to double check -- I'm at work now). I'll be notifying my breeder but what kind of support should I expect or ask of her?

It is a defect she was born with - I would expect the breeder to cover costs of surgery.

PDA surgery can be a very "simple", easy surgery. If it takes the dog can live a perfectly normal life.

In fact, two nights ago we were watching a 3 month old German Shepherd mix puppy that had PDA surgery at a local humane society (we were simply monitoring her overnight). She did GREAT, went to her foster family the next day, and was the sweetest little thing.

[JeanKBBMMMAAN]

Occlusion devices and approaches in canine patent ductus arteriosus: comparison of outcomes. | ResearchGate

Compares the different kind of devices they use in fixing PDAs.

I don't know if there are other studies out there that counter this, so would be looking for those. But there is that one occluder that seems to show above average results.

But what I would do is ask the cardiologists/surgeon what tool they use. Category - Faqs - Animal Medical Center - Los Angeles, California has some more really good information. The more you know ahead of time, the easier it will be to understand what they are talking about (my Anna's cardiologist was a fast talker!) and ask good questions.

With Anna, the plan had been to coil (this was 8 years ago) and then when they saw what it really was (they could not properly image it until day of surgery because her "breastplate" covered it) it was too big to coil and they had to open her up and do an extensive repair. Like I said, hers was an AV fistula and not a PDA, so different, but good to know that they would have a plan B if needed.

I would be looking for board certified surgeons. Anesthesiologists on staff, etc.

[blackshep]

I'm sorry to hear about Ava.

I can't offer advice, because I have no knowledge or experience on this subject, but I would say, if it were me and the prognosis was good, I would certainly consider the surgery. I would much prefer a one time surgery to a lifetime of meds.

Best of luck with your decision and I wish you and your dog the best outcome possible!

[AJT]

Sorry to bring back an old thread but I'm doing it for owners who may be searching on this site or on google for dogs with PDA information. I remember I was a little frustrated over the lack of owner testimonials and such when I was looking things up. I never found what the conclusion was and what the owner ultimately did. I'm hoping this serves as a personal source.

So Ava had surgery to close up the PDA at the end of December. It was considered surgical ligation with a surgeon that specialize in thoracotomy. I really liked the surgeon and read up on him having done the surgeries before based on testimonials from previous owners/dog patients. So shout out to Dr. Davis from Red Bank Vet Hospital in NJ! You rock!

If I went with the coils I would have had to go with a cardiologist to get the procedure done. It is less invasive but the price was the same.

I had asked the surgeon, which one he preferred or would recommend. He said since he is a surgeon, he prefers the surgery and if I asked the cardiologist, the cardiologist would prefer the coils procedure. He was honest and ultimately it was my call.

Pre-operative work up was done -- blood work, xray, ECHO.

Surgery was done the morning of Dec 20. She came home with me on the evening of Dec 21. She was prescribed Rimadyl, Tramadozol, and Metronidazole (had a little bloody diarrhea from eating god knows what). She also came home with a Fentanyl patch on her. Groggy and in pain for the first two days home. Incrementally better as days pass. Weaned her off of the doses of Tramadozol after a week and a half. Gave as needed. Went back for check up two weeks later. No heart murmur.

A month later, we worked back up to running and frolicking around. Since it is winter, our activity has been reduced a bit.

Overall costs is under $4500.00 which includes surgery, initial surgery consultation, pre-operative workup, meds, and the ECHO.

Below is a number of links to PDF's that helped provide me with more information as well as a comparison of risks and costs of each procedure. I really like the first one but the rest help when you are hunting for any and all info. There are also many links that members shared on this thread in earlier posts that had been very helpful.

Patent Ductus Arteriosus in Dogs by Compendium (in-depth description of PDA and chart of estimated costs and risks)

PDA Info from Texas A&M

Minimally Invasive Interventional Cardiology: Diagnosis and Transcatheter Correction of Patent Ductus Arteriosus in Dogs (Ontario Vet College)

Congenital Heart Disease from Michigan Vet Specialists

Not as complicated or scary reads (easy delivery of info)

Specialist Veterinary Cardiology Consultancy

PDA from Univ. of Minnesota

[GigiH]

I'm very glad you gave an update and Ava is doing so well. I thought I'd add in my two cents since I also had a dog with PDA but ours was a different case since he was not diagnosed until he was 6, which is amazing in itself because most dogs do not live that long with it undiagnosed.

He was a black lab rescue we got when he was 4. At his first check-up the vet noticed a heart murmur but didn't think it was a big deal. Now looking back, I realize ANYTIME your vet notices a murmur get it checked out. We could have tried to save a him a lot sooner if I had got a second opinion.

For the next two years he never had any of the other symptoms: coughing, blue gums, shortness of breath, or exercise intolerance. Just one day on the way home from a camping trip, he seemed really on edge..panting, wouldn't lay down in the backseat and I could see his heart literally beating thorough his chest. (He was an American Lab - the thin, tall, lanky type) I took him to another vet this time and he did an X-Ray. I hadn't even got home from dropping him off when the vet called and said I needed to turn around immediately and drive him straight to the University of Minnesota vet hospital. His heart was completely enlarged.

Once there, I met with a team of cardiologists that suggested doing the coil procedure(the surgery wasn't even offered as an option?) The price quote was 6k. So AJT, you got off cheap! They seemed to think that having the surgery would reverse the damage and he would live a normal life. I of course did the surgery and everything went great for about 6 months.

One day, he was playing with our 13yr old Dalmatian in the living room and he completely fainted. I thought he was dead of course and picked him up to rush him into the car. He came around in about a minute while he was in my arms. I still brought him right back to the U of M that afternoon and they weren't too concerned, but hooked up a 24hr Holter monitor to him thinking he might be having arrhythmia. The 24 hours passed, and I dropped off the monitor back at the U. On the way home we stopped by a friends house where he slept by my feet all afternoon.(not unusual) On the way home, in the backseat I heard three long howls(something I had NEVER heard him do) and by the time I could pull over, he was gone. I called the U of M hysterical and even the cardiologist was in shock. They really didn't think he would die.

Looking back now though I realize, and after reading extensively on PDA, that of course he was going to die young. His heart had way too much stress on it and the surgery was too little too late. I guess the moral to my long story is, ALWAYS get a heart murmur checked out extensively and even a second opinion if you need to. I don't regret doing the surgery, it gave us 6 more months with him and I would have never been able to forgive myself if I hadn't tried every option available. To the person who said to just use meds, there aren't any, surgery is the only option, and I can't imagine letting a young dog die of basically congestive heart failure. It's a horrible way to go.

Edited to add: I'm pregnant now, and if we have a son, I'll be naming him after my special boy, Duke.

[msvette2u]

They seemed to think that having the surgery would reverse the damage and he would live a normal life.

Anyone with an enlarged heart, human or animal, their heart does not go back to normal size. I'm surprised they'd have told you that.

I still brought him right back to the U of M that afternoon and they weren't too concerned, but hooked up a 24hr Holter monitor to him thinking he might be having arrhythmia.

Fainting doesn't indicate "just" arrhythmias, but any heart condition that's gotten to the point where blood flow isn't getting to the head/brain.

I think your dog was a lot worse than you realized, and they didn't indicate to you that his heart enlargement was not reversible.
As you mentioned, he would have passed away young, unless it had been caught early (like this kiddos was) and the surgery done before the enlargement.

We've had a number of cardiac cases here in rescue so unfortunately I've learned a lot and had to learn a lot to keep them alive...plus one of my own dogs has developed a murmur (not pda, valve insufficiency) and has enlargement of his heart and CHF as a result.

To the person who said to just use meds, there aren't any, surgery is the only option, and I can't imagine letting a young dog die of basically congestive heart failure. It's a horrible way to go.

Yes, enalapril and vetmedin can ease the load off the heart in the case where surgery can't be done, or isn't going to be an option. It won't fix it, no, but those two drugs can prolong the life of the dog if surgery isn't being performed.
I never said it would "fix" the heart, but it can ease the burden on the heart. Sometimes a dog headed towards failure will be on those meds pre-surgically.

Your dog, in fact, once his heart was enlarged, should have been started on those same drugs. If he wasn't, that's probably why the heart continued to worsen even after the surgery, he was basically in heart failure at the time of the surgery and that doesn't go away after the surgery, unfortunately.

Patent Ductus Arteriosus in Dogs - Page 3

Medical treatment (furosemide, +/- digoxin) may be necessary before surgery if symptoms such as coughing or difficult breathing are present. These symptoms are typically caused by left-sided heart failure - the accumulation of fluid, or pulmonary edema, in the lungs.

When surgery is not an option, and heart failure has occurred, drug therapy with furosemide, enalapril or benazepril and digoxin is often prescribed. A salt-restricted diet is enforced.

My comment about not doing surgery was that surgery basically killed the puppy we had (her heart, we are told, fell apart during the surgery and she died on the table) and if we'd known that was going to happen, we'd have just kept her on the medication and she'd have lived longer (obviously) with just the meds. Yes, she'd have had the murmur but she'd have made it past 1yr. of age, anyway