Topher had a lot of heart. The 3-month-old Labrador-pit bull puppy had been consigned to oblivion, abandoned in a dumpster in southwest Missouri. He managed to stay alive long enough to come under the protection of Rescue One, a state-licensed, foster-based animal rescue in Springfield, Missouri.
But, there was a problem. His belly would rapidly fill with fluid. Rescue One staff took Topher to Seven Hills Veterinary Clinic in nearby Nixa, Missouri.
“The vets at Seven Hills could drain the fluid off and get him feeling more comfortable, but then his belly would refill with fluid pretty quickly,” said Stephanie Shelton, a registered nurse and member of Rescue One’s board of directors. “He had to have his abdomen drained every two or three days.”
Ana Smith, a veterinarian at Seven Hills, examined Topher and although there was no abnormality she could detect with a stethoscope, she recommended that he be taken to the MU Veterinary Health Center (VHC) to see the Cardiology Service for further care.
“Fluid in the belly can be due to a whole host of things, but in this particular case Dr. Smith, the referring veterinarian, was spot-on with her original diagnosis,” said Kelly Wiggen, DVM, a cardiology resident at the VHC. “She referred him up here to us because she was worried about a specific congenital heart defect. She deserves a lot of credit for that.”
Indeed, Topher had too much heart. He had a congenital heart defect called cor triatriatum dexter. The normal heart has four chambers: two top chambers, known as the atria, and two bottom chambers, the ventricles. Topher had a triatrial heart.
“Cor triatriatum dexter is basically a fancy term for the fact that Topher had three top chambers to his heart,” Wiggen says. “The upper chamber on the right side was split in two, with a front half and a back half divided by a membrane.
“What happens in this disease is blood from the top half of the body can drain normally into the front chamber of the right side, which allows it to go out to the lungs, and then get pumped out to the rest of the body to deliver oxygen,” Wiggen says. “But, all the blood from the back half of the body is getting dumped into the back chamber, and the problem with that is that sometimes there’s either no opening in that back chamber or there’s only a tiny opening.
“Topher had only a very tiny opening that allowed a very small amount of blood to go from the back chamber into the front chamber and allow it to go out to the lungs, but most of it was stuck,” Wiggen says. “That’s what was causing all of this fluid to build up in the back half of his body. Because blood can’t get out of that back chamber, the pressure in the blood vessels becomes so high, fluid starts to leak out of the vessels. That fluid is part of the blood that is just liquid. He was essentially in right-side congestive heart failure.”
“When he came in to see us, we got excited because this is a really uncommon congenital heart defect and it’s potentially fixable,” Wiggen recalled. “When we first saw him he was so sad looking. He was really skinny, but had this big belly. You could tell he wanted to be a happy puppy, but he just didn’t feel good. He was trying really hard, but he just couldn’t quite do it. It was a shame.”
The VHC cardiology team consisting of Wiggen, resident Lyndsay Kong, DVM, and head of cardiology Stacey Leach, DVM, were able to get a successful diagnosis using an echocardiogram.
“We talked to them about fixing this surgically, using minimally invasive techniques,” Wiggen said. “Essentially, we went in through a blood vessel in his back leg and up into that back chamber of his heart. We used two different types of balloons to blow open that tiny hole between the back chamber and the front chamber. First, we used a cutting balloon, which has four little razor blades on it. When you inflate it, the razor blades pop out and they cut into that tissue. Then, we removed the cutting balloon and inserted a high-pressure balloon, which is much bigger.
“When we inflated that second balloon, all of the little tears we made with the cutting balloon turned into much bigger tears, creating a larger hole between the chambers,” Wiggen explained. “That allowed all of the blood from the back half of the body to get into that front chamber, get out to the lungs, get oxygen, and circulate appropriately. The procedure went really well; Topher did well during surgery. After surgery, we were able to document much better flow through that hole between the two chambers.”
Topher returned to the VHC in April for his one-month, post-operative checkup.
“When he came back for his recheck, he was doing fantastic and didn’t have any more fluid buildup in his belly,” Wiggen says. “He was gaining weight and looked like a normal puppy. He was so excited to be here, he was bouncing all over the place, jumping on people, wanting to lick everyone’s face, saying, ‘hi’ to everybody. It was so exciting to see him, he was just adorable,” Wiggen said.
“There aren’t many of these cases,” Wiggen said. “Sometimes it’s hard to predict how the heart is going to change, now that we’ve established a normal flow of blood. In Topher’s case, his left heart looked a little bit bigger at his one-month recheck. We were essentially allowing so much more blood into the right side of the heart and out to the lungs, significantly more blood was now coming back to the left side, so it expanded. We don’t know if this will be a problem for him, but it’s something we’ll keep an eye on. His next recheck is scheduled for October.”
When Topher first came to the VHC, he belonged to Rescue One. The organization does not have a dedicated facility, but relies on a network of 140 dedicated foster care providers. Topher’s original foster, Dezirae Holmes of Ozark, Missouri, cared for the pup through his surgery. He gained a second foster family in late March. Rachel and Jamie Hankins of Republic, Missouri, finalized the adoption and became Topher’s forever family on April 20. The Hankins brought Topher to his April checkup, but it was not their first trip to the VHC.
“About six years ago, our Jack Russell terrier, Henry, had a cancerous growth on his thyroid,” Rachel Hankins said. “We brought him up to Mizzou and Dr. Brian Flesner oversaw his treatment and Henry had a successful surgery to remove the tumor. Henry was 9 at the time, and he made it till he was 13. He passed away a couple years ago, but those four more years with him were precious to us. So, we’ve had fantastic experiences with both dogs at the VHC. We can’t thank them enough.
“Topher is really doing great,” Hankins continued. “He’s really affectionate; he’s completely changed our lives. He’s getting so much bigger and healthier. He loves going for walks and playing with other dogs. We wanted to focus on getting him healthy. Now we’re talking about getting him a brother or sister.”