Leading with heart: Cardiology operating suite a first in veterinary medicine

When Halle and Paul Scagnelli brought home their new dog, Luna, they did not know she had congenital heart defects that would affect her life. The breeder had told them a few things about the Italian Mastiff; she had a faulty gait and underbite, which would prevent her from being a show dog. But there was more to Luna’s story.

“About a month after we got her, she would breathe so heavily upon my arriving home at night from the excitement that she would have to sit down and stretch her neck in an attempt to catch her breath,” Paul recalled. “It was heartbreaking to see this, and to watch her sit and watch her siblings run and play in the yard.”

Dr. Alan Spier, a veterinary cardiologist in Tampa, Florida, told the couple that Luna’s life expectancy was likely under two years, and probably closer to one.

“He said if we wanted to research heart repair surgery for Luna, the only place he would recommend was Colorado State University,” said Paul, who admitted that the news about her heart issues was devastating for him and his wife.

‘Particularly unique’

Enter Drs. Brian Scansen and Chris Orton from the cardiology and cardiac surgery team at the James L. Voss Veterinary Teaching Hospital. For the last few months, the veterinarians have been conducting surgeries in a new, 1,400-square-foot operating room, with high-tech imaging displayed on high-definition monitors.

Known as the Pocket Foundation Hybrid Cardiac Interventional Suite — in recognition of the gift from the foundation that covered a majority of the expenses — the space offers the most modern care possible to animal patients.

Chris Orton Halle Scagnelli and Luna in the new surgical suite
Dr. Chris Orton with Halle Scagnelli and her dog, Luna at the opening of the Pocket Foundation Hybrid Cardiac Interventional Suite.

“The new operating room has capabilities that no other veterinary hospital in the world has,” said Scansen, an associate professor in CSU’s Department of Clinical Sciences. “It’s not the first hybrid operating room that has been built, but it is the first in veterinary medicine that encompasses all of the advanced imaging capabilities that we have.” Similar facilities exist for human patients only at major medical centers, he added.

How does this change what CSU’s veterinarians and clinicians do on a daily basis?

Scansen said he and the team are better equipped to view what’s inside of a patient’s body, and to guide devices to individual structures, like the valves around the heart and arteries. They can now use advanced fluoroscopy, which is similar to a moving or real-time x-ray, ultrasound and endoscopy. This technology is mounted on a C-shaped arm, allowing it to be moved around the operating table so that clinicians can zero in on specific parts of a patient’s body.

Members of the surgical team are required to wear lead aprons, due to the constant but low-dose radiation emanating from the machine, similar to what patients wear in the dentist’s office when getting X-rays taken.

Repairing a hole in the heart

The CSU medical team recently performed surgery on a young puppy to close an abnormal vessel near the heart, which is known as a patent ductus arteriosus. Patti Mueller, a registered veterinary technologist, said the team sees two to three of these cases each month. The animals will often die before they reach the age of 1 without the procedure to close the vessel.

One large screen in the operating room displayed vital signs, including the patient’s heart rate and temperature, in lime green, purple, aqua and yellow. Several students in CSU’s Doctor of Veterinary Medicine Program observed the surgery in a control room. They listened attentively when Mueller and others on the team explained what was taking place. They could see the small animal’s beating heart on a screen, as Scansen inserted a catheter with a dilator, using a wire as a guide. The team placed an occlude, or plug, which would cause a clot to form — similar to scar tissue — closing the vessel near the dog’s heart.

“We have a lot more capability with more complex cases,” said Mueller. “With this technology that’s so new, we can take our care to the next level of complexity, and do things that have not ever been done before in veterinary medicine,” she added.

In another international first for veterinary medical centers, CSU’s new operating suite has rotational angiography — where the x-ray system spins around the patient to create a three-dimensional picture — and three-dimensional ultrasound, both of which can be superimposed onto the moving x-ray, in real time. That means veterinary cardiologists can see where a valve is directly on a beating heart, which helps them to guide the procedure.

“It is not quite virtual reality, but we have an array of different images that can be super-imposed onto one,” said Scansen. “Having this ability is particularly unique in veterinary medicine.”

For CSU veterinarians that specialize in cardiology, the goal has always been to conduct less-invasive procedures to cure heart disease. The new imaging equipment and other devices make that even easier.

“Our goal is to be less invasive, with shorter recovery times for patients, while providing optimal care” said Scansen.

Orthopedic and general surgeons at CSU have also started to use the new facility, opening up new capabilities to treat diseases and conditions in other parts of the body.

Misty, patient No. 1

Misty, a Great Pyrenees-Australian Cattle Dog mix, was the first patient to have surgery in the new space.

When Amy and Mark Hefestay adopted Misty from the Dumb Friends League in Denver in April 2016, they knew that she had a congenital heart defect. They were told she would have a shortened life expectancy. “We decided to adopt her anyway,” said Mark. The Hefestays have six rescue dogs.

Misty Hefestay
Misty, a Great Pyrenees-Australian Cattle Dog mix, was born with a congenital heart defect. Photo: Amy and Mark Hefestay

Since that time, she’s done well. “She regulates her own activity,” said Amy. “She would stop and catch her breath if she needed to. She’s always done well with that.”

But on April 8, Misty got overexcited and collapsed due to heart failure. The Hefestays rushed her to a local emergency veterinary clinic, and returned for a heart scan the next morning. Based on what they saw, veterinarians at the emergency hospital suggested bringing Misty to CSU for an evaluation.

They met on April 16 with Scansen, who said that he could help open up the valve in a procedure known as a balloon valvuloplasty.

The Hefestays described the trip that day to Fort Collins for Misty’s surgery as harrowing.

“The drive up there was pretty intense,” said Mark. Misty was breathing heavily during the drive and when they arrived at CSU, she wasn’t even strong enough to walk down the hall.

“We got there on the right day, I think,” he said.

CSU clinicians said they were aiming for a 50 percent improvement of blood flow through the faulty valve, using minimally invasive surgery. In the end, they saw a 70 percent improvement.

“We were thrilled with the procedure and how well she did,” said Mark, who described Misty as a “brand new” dog just two days after the surgery.

“She’s like a puppy, exploring everything,” Amy added.

“Before, Misty would run over to our fence to bark at a squirrel or the dog next door,” Mark explained. “She’d have to stop and catch her breath. Now, her response is: what else can I do? She’s playing with our other dogs. She was jumping over one of them repeatedly recently. It was so funny. The other dogs were like: who are you?”

Luna, patient No. 2

Luna was the second patient to undergo surgery at the new facility.

She had three procedures at CSU during two medical trips over the course of more than nine weeks, including open heart surgery. The Scagnellis knew the surgery was potentially high risk, with a long recovery for Luna, but it could also provide long-term relief and increase her life expectancy.

“From day one, we felt as if we had the strongest, most dedicated advocates working for Luna’s success,” said Paul.

The surgery went well, but the young pup developed several complications that kept Scansen, Orton and the rest of the medical team on their toes. She developed several blood clots that had to be dissolved. Luna also developed chylothorax, a condition that causes fluid to accumulate around the lungs and heart.

Throughout all of the procedures, and the ups and downs, Paul said the CSU team provided loving, personalized care for Luna.

“I cannot tell you how many times during our two or three daily visits that we came in and saw staff sitting with Luna, petting her and talking to her,” he said. “The staff cared for our baby like she was truly their own pet. Amazing is not a word that covers the care they gave to Luna.”

CSU’s veterinarians even made a few house calls. After Luna was discharged but still being monitored, Orton came to the hotel where the Scagnellis were staying to drain fluid from Luna’s chest.

“Yes, we got a house call from arguably the country’s premier cardio surgeon,” said Paul. “If that’s not dedication, dedication does not exist.”

A month out from the heart surgery, Paul said Luna is doing well.

“She is finally able to be a puppy, running and chasing her siblings in our back yard,” said Scagnelli.