Ariel’dale’s Story


1.25.2021 Update

Ariel’dale has blossomed in her foster home. She is playing, teething, and being a joyful handful.

With less than a week until she may have surgery, we hope to see her continue to love life. With the unknowns coming up, Arial’s foster family lives in the moment and focus on making her feel special.


An exceptional vet rescued Ariel’dale from a puppy mill. Her journey started on 1/12/21. The first few days of Ariel’s new life were scary. There were times that the vet and assistant thought Ariel was going to perish.

Through love and dedication, Ariel was able to come to our rescue on 1/14/21. Her condition was still urgent, and no one knew day by day how much longer she would survive.

Time was in essence for Ariel. Upon rescue, Bath Veterinary Clinic first was the first to examine her the day she was rescued. That started a busy life for Ariel!

Within 24 hours, including 7 hours of driving and 6 hours of meeting with vets, things started to fall into place. Metropolitan Vet Clinic reviewed her paperwork Monday morning and asked her foster to rush her in. Puzzled, they sent the paperwork to Ohio State, who then also asked her foster to rush her in the next day.

She puzzled all the vets. Through teamwork at all the clinics, they came to the following conclusion.

Ariel is starting to develop a “reversed” PDA. Currently, her shunting is called “bidirectional” This is a rare condition in which shunting is both in the usual “left-to-right” direction but also in the reverse direction- “right-to-left.” Right-to-left is very uncommon, affecting 2% of PDA cases. In addition to that statistic, there has only been 3 reported cases of surgery on a dog in this condition. As pressure increases in the pulmonary circulation due to the PDA, pulmonary hypertension develops as blood is shunted across the PDA back into the pulmonary circulation.

Surgery is a higher risk because of the bidirectional shunting, but without it, Ariel will have a shortened life span (less than a year) and poor quality of life.

Ariel’s PDA has reversed, which significantly increases the risks and complications associated with PDA closure. With a reverse PDA, life-threatening pulmonary hypertension can develop when the PDA is occluded. In general, if the shunt has reversed, closure of the PDA is usually contraindicated as it often results in fatal complications at the time of surgery.

To prepare her for surgery, Ariel is on an assortment of drugs, including Furosemide (Lasix), Clavacillin (Amoxicillin/Clavulanate), Sildenafil, Vetmedin (Pimobendan).

Want the full medical report? Check it out below.


Prognosis:
Ariel Dale has been diagnosed with a congenital (present from birth) heart defect known as patent ductus arteriosus (PDA).
This defect is due to the persistence of the ductus arteriosus, a normal vascular structure important during development in
utero. The ductus arteriosus is a small channel that connects the pulmonary artery (which will carry blood to the lungs after
birth) and the aorta (which carries blood to the rest of the body). In the womb, it is responsible for conveying blood past the
non-functional lungs (since puppies don’t need to breathe air before birth), and into the systemic circulation.


At birth, when an animal takes its first breath, the lungs become filled with air. This triggers spontaneous closure of the
arterial duct. In the normal animal, the ductus arteriosus closes fully within the first 7 to 10 days of life.


In some animals, the ductus arteriosus does not close, remaining patent (open). When this happens, blood from the aorta
(high pressure) is allowed to flow into the pulmonary artery (low pressure); this is called a “left-to-right shunt.” This abnormal shunting of blood overloads the pulmonary circulation and left side of the heart. Most animals with PDA develop signs of heart failure or die within 1 year of life, and dogs with PDA rarely have a normal life span. For this reason, we
recommend an interventional or surgical correction of most PDAs.
Ariel is starting to develop a “reversed” PDA and currently her shunting is called “bidirectional” (shunting both in the normal
“left-to-right” direction, but also in the reverse direction- “right-to-left”). As pressure increases in the pulmonary circulation
due to the PDA, pulmonary hypertension develops as blood is shunted across the PDA back into pulmonary circulation.
Eventually, the pressure in the pulmonary artery increases to the point that the flow of blood reverses across the shunt,
causing blood to flow from right to left.


Closure of the arterial duct is designed to stop blood flow through the PDA. This may be achieved by a minimally invasive
interventional procedure, using a special catheter to place a small device inside the ductus to occlude blood flow. There are
several different device options, chosen based on the size and shape of each individual ductus, but we most commonly use
one called the Amplatz Canine Ductal Occluder (ACDO). This device is positioned by feeding a long catheter through a vessel
in the leg (the femoral artery) and into the aorta. The advantage of this procedure is a high rate of success with very low risk
of complications, all done through a small skin incision in the inner thigh. Alternatively, this may be achieved by a
thoracotomy (open-chest surgery) and manually tying off the ductus. Based on the severe dilation of the PDA as well as
surrounding structures, interventional closure is recommended over surgical closure. Also, because we are unsure how
Ariel’s heart will tolerate closure due to her pulmonary hypertension, we can monitor her intracardiac pressures and remove
the device if needed. There is a chance that once we start surgery and catheterize her femoral artery and do intracardiac
contrast studies, we find her PDA is not a good shape to handle a closure device like an ACDO and then she would need to
go to surgery to have her defect surgically ligated.

Ariel’s PDA has reversed which significantly increases the risks and complications associated with PDA closure. With a
reverse PDA, life threatening pulmonary hypertension can develop when the PDA is occluded. In general, if the shunt has
reversed, closure of the PDA is usually contraindicated as it often results in fatal complications at the time of surgery. With
Ariel’s medication protocol, we hope to reduce her pulmonary hypertension over the next 2 weeks to try to prevent further
reversal of blood flow across the PDA before her PDA occlusion procedure to hopefully make her a better and safer candidate
for closure. We will re-assess her in 2 weeks (with chest x-rays and a recheck echocardiogram) and determine if closure
should be attempted.

Medications:
Furosemide (Lasix) 12.5 mg tablets: Give 1/2 (one half) tablet by mouth every 12 hours (twice daily). This is a diuretic
medication used to decrease fluid accumulation in the lungs. It will cause increased urination and thirst. Possible side effects
include dehydration, electrolyte abnormalities, and kidney dysfunction. Kidney bloodwork will need to be periodically
monitored while your dog is receiving this medication. Your pet must have water available at all times while receiving this
medication.


Clavacillin (Amoxicillin/Clavulanate) 62.5 mg tablets: Give 1 tablet by mouth every 12 hours (twice daily) until the
next recheck (2 more weeks). Give with food. This medication is an antibiotic that is being used to treat for possible
pneumonia. Side effects include gastrointestinal upset (vomiting, diarrhea, anorexia/decreased appetite).


Sildenafil 20 mg tablets: Give 1/2 (one half) tablet by mouth every 8 hours. This medication dilates the blood vessels of
the lungs to reduce pulmonary hypertension. Side effects can include low blood pressure.


Vetmedin (Pimobendan) 1.25 mg tablets: Please give 1 tablet by mouth in the morning and then give 1/2 (one-half)
tablet by mouth about 12 hours later. This medication dilates blood vessels (decreasing the workload on the heart) and
increases the heart’s pumping ability. Possible side effects are rare but include gastrointestinal upset such as inappetence,
diarrhea, or nausea

Monitoring:
Please continue to monitor Ariel for clinical signs of congestive heart failure or worsening pulmonary hypertension.
Symptoms include exercise intolerance, difficulty breathing, inability to sleep or rest comfortably, collapse/fainting, hind limb
weakness, and/or recurrent coughing. Call your veterinarian or OSU Cardiology if these are observed.

Activity:
Continue exercise restriction until her recheck. Going for walks and mild play are fine, but avoid intense
exercise/running/playing.