Human, animal doctors report success in dog's open heart surgery

When veterinarians and cardiologists from the University of Florida said "Yankee, go home" this week, they did so with pride and a sense of heartfelt joint ownership.

Yankee, a tail-wagging, 7-year-old yellow Labrador retriever, went home from UF's Veterinary Medical Center Feb. 3, 2006 with her actual owners, the Stazzone family of Satellite Beach, after successful open heart surgery to remove a bamboo barbecue skewer from her heart.

In a collaborative procedure involving UF veterinarians and physicians from the Congenital Heart Center at UF, Yankee was placed on bypass for 55 minutes Jan. 27 at a surgical research facility located near the MRI unit that was used to pinpoint the skewer's location. The skewer had perforated the dog's stomach and pierced the heart after she ate a steak kabob.

The entire operation lasted about three hours, and pediatric cardiothoracic surgeon Mark Bleiweis, M.D., the center's director, was lead surgeon on the case.

"We had very little time to coordinate this thing, and the team worked out really great," said Gary Ellison, D.V.M., a professor of small animal surgery at UF who assisted in the procedure. "While we provided the critical care before and after Yankee's surgery, we don't have the capability of doing bypass at our veterinary hospital and we needed the human surgeon's expertise."

Only two veterinary institutions in the country perform heart bypass procedures in dogs and those are located in Texas and Colorado, Ellison said, adding that Yankee's condition would have made transport to any other facility extremely risky.

Once the skewer was removed, Bleiweis rebuilt a damaged heart valve.

"I'm really proud of what we did, and that we were able to put this many people from so many specialties together to save this dog's life," Bleiweis said. "I'm an animal owner and this is someone's family member."

Bleiweis added that although Yankee had a severe heart infection, she responded to the procedure "better than most people do."

"We were able to get her off the ventilator and out of the operating room without a problem and she was standing on all fours that same day," he said. "It was amazing."

After the operation was completed and Yankee awakened from the anesthesia, she was transported back to the VMC's small animal intensive care unit, where she continued to recuperate this past week.

"By Sunday night, she was eating and walking outside," said Nikki Hackendahl, D.V.M., the small animal internal medicine resident at UF who had primary responsibility for Yankee and monitored her progress every day.

Yankee's woes actually began on Halloween, when the Stazzones had steak kabobs for dinner and Yankee grabbed one, "practically inhaling the whole thing," Mary Stazzone said. "Immediately she was sick and throwing up, and everything I cleaned up was steak, but no stick."

After her initial surgery, Yankee seemed to have recovered. But two months later her condition rapidly deteriorated and it initially appeared to be unrelated to her previous illness.

When Yankee was admitted to the VMC a few days prior to surgery, her blood was not clotting and she was anemic, Hackendahl said. Then Hackendahl detected a heart murmur and immediately requested a consultation from veterinary cardiologist Amara Estrada, D.V.M.

"We did an echocardiogram and noticed a strange linear structure in the heart," Estrada said. "Then we found out the dog had a history of eating a bamboo skewer back in October and surgery had been performed to remove part of it from the dog's stomach."

The veterinarian who referred Yankee to UF had performed a CT scan and been extremely thorough, but wood is not visible on a CT scan, Hackendahl said.

Thankfully, Dr. Hackendahl discovered the heart murmur," Stazzone said. "We knew there was a slim chance this would all work out, but we did a lot of praying on this one. We obviously love Yankee very much."

Because of the close relationship Estrada and the veterinary cardiology group have with the human pediatric cardiology team - the two groups round together on Wednesdays - Estrada shared images from Yankee's echocardiogram and asked her human counterparts' opinion.

"We were going to do inflow occlusion, a procedure that prohibits blood flow but gives you only two to four minutes to open up the heart and look inside," Estrada said. "They said this wasn't such a great idea due to the short time frame and the limited access. I asked them for help and they readily accepted and offered to assist us with the case."

Also playing a key role from the veterinary college were numerous other clinicians, including Hackendahl, small animal medicine associate professor Julie Levy, D.V.M., Ph.D., anesthesiology resident Andre Shih, D.V.M., and cardiology resident Herb Maisenbacher, D.V.M. Assisting from the College of Medicine were Barry Byrne, M.D., Ph.D., a professor and associate chairman of Pediatricsdirector of the Powell Gene Therapy Center at UF; Harvey Ramirez, D.V.M., from UF's laboratory animal services; and Dale Clark, a blood perfusionist. Behind the scenes, many others, including veterinary college faculty and staff who operate the small animal hospital's blood bank, worked overtime to obtain blood components and coordinate what was necessary to complete the procedure.

Although Yankee developed a systemic infection that will continue to be treated with antibiotics, she's alive and improving every day, clinicians said. Her owners said their three daughters have been making cards for Yankee and can't wait to have her home.

"I bought Yankee for my husband when we were just dating and we've had her for seven years," Mary Stazzone said. "It was just such a shock how this has all happened."