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By Kristine McComis
Veterinary medicine often mimics human medicine, with specialists learning surgical techniques from each other. The Ohio State University Veterinary Hospital recently collaborated on two unusual canine cases with pediatric surgeons from Nationwide Children’s Hospital. Tricky Woo is a female three year old Bichon Frise that arrived at The Ohio State University Veterinary Hospital exhibiting vomiting, intermittent abdominal pain, and fever. An ultrasound revealed an enlargement of the renal pelvis of both kidneys. Because of this enlargement, Dr. Dennis Chew, professor in the Department of Veterinary Clinical Sciences suggested there could be a possible problem with the connection between the ureter and renal pelvis. Veterinary interventional medicine specialist Dr. Brian Scansen, also in the Department of Veterinary Clinical Sciences, confirmed a narrowing of the ureter during a fluoroscopically-guided scoping procedure and placed stents across the stenoses to decompress the kidneys until a definitive surgical cure could be performed.
Dr. Chew consulted the chief of pediatric urology at Nationwide Children's Hospital, Dr. Stephen Koff, with whom we have collaborated in the past. His team, including Dr. Seth Alpert, pediatric urologist, and Dr. Dan Hirselj and Dr. Doug Storm, both pediatric urology fellows, also became involved in Tricky's case. The pediatricians recognized the condition as Ureteropelvic Junction (UPJ) stenosis, a congenital disease that presents itself in humans in their early development. The surgeons at Nationwide Children's Hospital in Columbus perform 40 to 60 corrective surgeries a year. However, UPJ, especially bi-laterally, is very rare in dogs, and our veterinary specialists had never seen a case like it. Therefore, the experts from both sides of medicine--the team from Children's and Dr. Christopher Adin, Assistant Professor of Small Animal Surgery -- decided to collaborate on Tricky Woo’s surgery. Surgery took approximately three hours. Stents were put in to connect the kidney to the bladder until the new connection had healed. Dr. Adin commented, "The surgery went very well, and it was a great team effort. The veterinarians performed the surgical approach and the surgical team from Children's stepped in to perform the microsurgery that is required to reattach the ureter to the pelvis."
A few weeks later, Dr. Aimee Kidder and Dr. Brian Scansen removed the stents during a minimally invasive procedure. Tricky is doing quite well and continues to show improvement. The Children's Hospital team expressed nothing but praise for Ohio State's veterinary program. Dr. Alpert said, "All of us truly enjoyed our experience working with the surgeons at the vet school and learning more about surgery and anesthesia on small animals. I was very impressed with the depth and breadth of procedures that are routinely being performed there and how similar they are to some of the things we do at Children's Hospital. They obviously care greatly about the health and welfare of their patients as we do about ours."
While Tricky was in the hospital, Dr. Scansen and Dr. Rick Cober, cardiology resident, were presented with another challenging case – this time in cardiology. Sparky is an 8 month old Cavalier King Charles Spaniel that was born with a ventricular septal defect (VSD) – a large hole between the lower chambers of his heart. The Cardiology Service sees VSDs regularly, but Sparky's VSD was located in the muscular portion of his heart, which is rare in dogs – less than about 10 percent of patients have the defect in that location. Historically, repairing a VSD like Sparky's would require open heart surgery, which is costly, risky, and seldom performed in the dog. Dr. Scansen visits Nationwide Children's Hospital intermittently to observe and learn new interventional techniques used in small children. He immediately thought to call on them to discuss this case. Within the past ten years, devices for children have been developed to close septal defects that can be inserted into the heart through the jugular or femoral veins and avoid the need for open heart surgery. Dr. Scansen therefore consulted with Dr. John Cheatham, head of pediatric interventional cardiology, and Dr. Alistair Phillips, pediatric cardiothoracic surgeon, at The Heart Center at Nationwide Children's Hospital. They advised against inserting the device through the jugular vein for such a small patient with such a large hole. Instead, they recommended a hybrid technique that they have helped to perfect in young children where a small incision is made through the chest, exposing the heart, and the device to close the VSD is inserted directly through the outer wall of the heart while it continues to beat normally. The device, called an Amplatzer Muscular VSD Occluder, looks like a two-sided umbrella and neatly plugged the hole. The surgical approach for Sparky was performed by Drs. Adin and Phillips, while Drs. Cheatham and Scansen delivered the device to close the defect. The device was generously donated by AGA Medical Corporation.
"This hybrid procedure has never been done in a dog," Dr. Scansen commented. "Two weeks post-op, he continues to do great." In addition to the VSD, Sparky has a stenotic pulmonary valve in his heart, so Dr. Scansen will perform another intervention in six to eight weeks to open this valve. As this is a fairly routine procedure at Ohio State, the prognosis is good for Sparky.
The Veterinary Hospital continues to move forward and transform our patient care offerings with a focus on providing leading-edge minimally invasive therapies for animals. Dr. Scansen has accepted a faculty position as a tenure-track Assistant Professor in Cardiology and Interventional Medicine in the Department of Veterinary Clinical Sciences. He will be appointed Director of the Cardiac Catheterization and Interventional Medicine Laboratory. He will continue in his current appointment as a Clinical Assistant Professor until this appointment takes effect in September 2009. Dr. Scansen is participating in the Infiniti MedicalTM Interventional Radiology & Endoscopy Fellowship at the University of Pennsylvania's School of Veterinary Medicine where he spends one week per month through December 2009.