{"id":22564,"date":"2019-02-12T13:27:29","date_gmt":"2019-02-12T20:27:29","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=22564"},"modified":"2021-09-07T17:39:00","modified_gmt":"2021-09-07T23:39:00","slug":"saving-animals-while-advancing-human-medicine","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/saving-animals-while-advancing-human-medicine\/","title":{"rendered":"Saving dogs with mitral valve disease while advancing human medicine"},"content":{"rendered":"
<\/div>
\"dog
Mango, who had mitral valve disease, sleeping on his owner\u2019s bed. Photo courtesy of Grace Carroll.<\/figcaption><\/figure>\n

Four years ago, Dr. John Carroll was helping his daughter, Grace, get ready to go back to college when the two noticed that Mango, her 5-pound Chihuahua, wasn\u2019t his feisty self. Usually, 9-year-old Mango would be sunbathing or running around the yard. And as Grace packed her bags, she couldn\u2019t help but wonder if something was wrong with her childhood pet.<\/p>\n

On this day \u2014 and for the past few days \u2014 Mango had been coughing and making a \u201chonking\u201d noise, Grace explained. Mango also seemed breathless and exhausted.<\/p>\n

They decided to visit their vet, who heard a heart murmur. An X-ray also showed Mango had an enlarged heart. The veterinarian referred them to a canine cardiologist.<\/p>\n

Heart murmur? Breathlessness? Fatigue? Coughing? Carroll, an interventional cardiologist with UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus, couldn\u2019t believe what he was hearing. Was it possible that little Mango had some form of heart valve disease?<\/p>\n

Carroll<\/a>, who also is an interventionalist and professor for CU School of Medicine<\/a>, specializes in cardiac catheterization and catheter-based therapies for diseased heart valves, holes in the heart, coronary artery disease and a variety of other novel therapies.<\/p>\n

\u201cThis was an eye-opener for me,\u201d Carroll said. \u201cHere I was watching our own dog go through a disease process that I\u2019d been diagnosing and treating for the past 35 years in the human world.\u201d<\/p>\n

Mango was diagnosed with mitral valve regurgitation. Each chamber of the heart has a one-way valve to keep blood from flowing backward. The mitral valve is between the left atrium and left ventricle. This valve can wear out over time and leak \u2014 called mitral regurgitation.<\/p>\n

Treating mitral valve disease in dogs<\/strong><\/h3>\n

About one in 10 dogs develops some form of heart disease during their lifetime. \u00a0Approximately 80 percent of these dogs end up with mitral valve insufficiency or regurgitation, according to vcahospital.com<\/a>. The disease is more common in small dogs than large breeds.<\/p>\n

In humans, mitral regurgitation is the most common type of moderate to severe heart valve disease among adults older than 55 in the United States, Carroll said. The disease\u2019s occurrence increases with age, the same as with dogs, he added.<\/p>\n

Mitral valve disease in dogs or humans doesn\u2019t always present with symptoms but, when it does, patients often have a noticeable heart murmur and breathlessness and fatigue with normal activity.<\/p>\n

\"dog
Mango celebrates his 10th birthday a few weeks after discovering he has valvular heart disease. Photo courtesy of Grace Carroll.<\/figcaption><\/figure>\n

When a human has a leaky valve it can often be fixed by repair or replacement of the mitral valve with open heart surgery or emerging transcatheter treatments. At UCHealth, a variety of transcatheter treatments for various forms of mitral valve disease are performed. UCHealth hospitals are also investigative sites for several up-and-coming transcatheter therapies, Carroll said.<\/p>\n

\u201cUnfortunately, they have not been re-engineered for use in small animals like Mango,\u201d he said.<\/p>\n

When Grace heard that Mango had heart valve disease, she was devastated. Mango lived a year longer but his lively personality and energy never returned. Just before his 11th<\/sup> birthday, he died.<\/p>\n

\u201cI had seen my dad put in a MitraClip<\/a> the previous summer (2015),\u201d Grace said of one of the innovative therapies. \u201cThe solution was right in front of us, but we couldn\u2019t do it.\u201d<\/p>\n

Interventions fall behind for animals<\/strong><\/h3>\n

\u201cIt raised thoughts in my mind, not only of what could be done for dogs, but on a broader scale, there are strong synergies between cardiology care in animals and humans, and let\u2019s start looking into this seriously,\u201d Carroll said.<\/p>\n

Carroll then learned of a collaborative resource request from Dr. Brian Scansen, a veterinarian and associate professor of cardiology at Colorado State University\u2019s College of Veterinary Medicine and Biomedical Sciences<\/a>, in Fort Collins.<\/p>\n

James L. Voss Veterinary Teaching Hospital at Colorado State University<\/strong><\/h3>\n

Scansen was in the process of establishing interventional cardiology as a unique and advanced discipline within the school\u2019s veterinary medicine program.<\/p>\n

\u201cCardiology was here as a program and is a recognized specialty within veterinary medicine,\u201d Scansen said. \u201cBut it was not subspecialized to the same extent that human cardiovascular programs are. Our vision was to build interventional cardiology into a unique subspecialty of cardiovascular care in veterinary medicine.\u201d<\/p>\n

Cardiology has expanded over the decades in the human realm and many doctors focus on subspecialties within cardiology, such as heart failure or transplants. Interventional cardiology focuses on procedures that improve how the heart may be performing, such as placing a stent to open a clogged artery or a device to repair a leaky valve. Traditional cardiac surgical operations involve opening up the chest while more recently, in the past several decades, interventional cardiologists perform catheter-based therapies. These less-invasive treatments use a catheter to thread a device through a vein to and inside the heart, where it is placed to correct the problem.<\/p>\n

As part of advancing the CSU program, Scansen wanted to create a fellowship and open a new hybrid cardiac catheterization lab<\/a> that would match up to any human lab doing these same interventional procedures.<\/p>\n

\u201cTo develop this new and unique training program, it was key to be able to bounce ideas off someone with that level of experience and expertise,\u201d Scansen said.<\/p>\n

\"photo
Dr. John Carroll, an interventional cardiologist with UCHealth University of Colorado Hospital on the Anschutz Medical Campus. Photo: UCHealth.<\/figcaption><\/figure>\n
\"Photo
Brian Scansen, a veterinarian and associate professor of cardiology at James L. Voss Veterinary Teaching Hospital at Colorado State University. Photo courtesy of CSU.<\/figcaption><\/figure>\n

And that\u2019s when Carroll and Scansen got connected, more than three years ago.<\/p>\n

Collaborating across species<\/strong><\/h3>\n

\u201cIt\u2019s been an evolving partnership,\u201d Carroll said. \u201cWe had some major overlaps in our mission, one of which was the similar mission of training people to become interventional cardiologists in our respective domains of humans and animals.\u201d<\/p>\n

CSU\u2019s interventional cardiology fellowship started in 2016 and is the first in the world, Scansen explained. Scansen and his fellows attended some of Carroll\u2019s procedures at UCH. Much of what they needed to learn in animal health care is similar to human health care when it comes to procedures and safety, Carroll explained.<\/p>\n

Carroll also visited CSU.<\/p>\n

The first collaborative patient case<\/strong><\/h3>\n

Scansen had a patient, a dog named Ricky, who had an atrial septal defect \u2014 a hole in the heart.<\/p>\n

\u201cWe don\u2019t see a lot of these in dogs, whereas he (Carroll) has seen thousands in humans,\u201d Scansen said. \u201cWe\u2019d had conversations in the past, so when this dog came up, I reached out to see if he was available.\u201d<\/p>\n

Carroll\u2019s experience was instrumental. Carroll knew the tricks, as Scansen put it, in using the image-guiding technologies to correctly position the device that would plug the hole in Ricky\u2019s heart.<\/p>\n

\u201cAll of this is very standardized in human procedures but in its infancy in animal procedures,\u201d Carroll said. \u201cI have great respect for Brian (Scansen) and his colleagues in being on the forefront of developing these procedures in dogs, but also that they deal with so many different types of animals, each having unique anatomy, size, and pathophysiology of different cardiac abnormalities.\u201d<\/p>\n

\"surgeons
Brian Scansen, a veterinarian and associate professor of cardiology at L. Voss Veterinary Teaching Hospital at Colorado State University, and his colleagues perform a catheter-based heart procedure, for things like mitral valve disease in dogs, in their state-of-art cardiac catheterization lab. Photo by Kellen Bakovich, Colorado State University.<\/figcaption><\/figure>\n

Unmatched veterinary cath lab<\/strong><\/h3>\n

To do these interventional procedures in animals \u2014 as well as to advance the practice as a whole in his industry \u2014 Scansen needed the very best and latest equipment.<\/p>\n

Carroll again provided insight.<\/p>\n

UCHealth has the longest standing structural heart program in Colorado, performing minimally-invasive procedures like MitraClip, Watchman and TAVR in its cardiac cath labs.<\/p>\n

\u201cWe visited UCH to see what they had, what we might need and what we wouldn\u2019t need, as well as how some equipment may be adapted for animals,\u201d Scansen said.<\/p>\n

Some of the more routine interventional heart procedures were already being done in animals before the creation of the new program, but Scansen wanted to move his subspecialty within veterinarian medicine to the next level.<\/p>\n

\u201cThat required higher-level equipment in imaging, which means a better facility,\u201d he said. \u201cNow, thanks to the generosity of clients whose pets we have treated in the past, we have a cath lab that is as state-of-art as anything available to humans.\u201d<\/p>\n

With the lab and training in place, it is time to move to the next step, he explained.<\/p>\n

Novel interventions<\/strong><\/h3>\n
\"selfie
Grace Carroll with her childhood pet, Mango. Photo courtesy of Grace Carroll.<\/figcaption><\/figure>\n

Carroll said he believes such collaborative partnerships, which aren\u2019t standard, bring a broader \u201clessons learned\u201d understanding into medicine that can sometimes move the field forward. With some animals having the same valve diseases found in humans, these collaborative relationships can spark new research into the genetic paths of those diseases, as well as technology and devices that could reach across species.<\/p>\n

\u201cWe are hoping that we can develop and interface with the medical-device industry, where there is an unmet clinical need in these dogs,\u201d Carroll said.<\/p>\n

Currently, Scansen does about 120 catheter-based procedures per year in animals, mostly dogs. But these are the cases where interventions are available, he said, such as with Ricky, who got a device to close the hole in his heart and is doing well. With nearly 10 percent of all dogs developing valve disease, many more \u2014 like Mango \u2014 would benefit from new interventions not currently available to animals.<\/p>\n

\u201cThere is technology commercially available for humans that requires minimal or no alteration for use in animals, but we need to grow our expertise and learn how best to adapt such technologies for animal anatomy because they are made for humans,\u201d Scansen explained. \u201cWe are making those adjustments and have some things in development, but the next level is to push the boundaries as to what can be done to help animals with heart disease.\u201d<\/p>\n

Carroll said he sees these advancements also benefiting interventional cardiology for humans.<\/p>\n

\u201cThese collaborations bring in fresh insight into doing things that didn\u2019t previously exist,\u201d he said. \u201cI believe people in my profession will likewise see it\u2019s not only relevant to their own pets, but to their clinical investigations. There is this lighting of the fire of collaboration by exposing people to things they\u2019ve never even thought of. I want to expose the adult human cardiology community to heart disease in animals and its parallels.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Four years ago, Dr. John Carroll was helping his daughter, Grace, get ready to go back to college when the two noticed that Mango, her 5-pound Chihuahua, wasn\u2019t his feisty self. Usually, 9-year-old Mango would be sunbathing or running around the yard. And as Grace packed her bags, she couldn\u2019t help but wonder if something […]<\/p>\n","protected":false},"author":2164,"featured_media":22553,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[122,3512,82,811,3300,4781,4151,263],"class_list":["post-22564","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-colorado-state-university","tag-heart-and-vascular-care-cardiovascular","tag-heart-and-vascular-care-cardiology","tag-heart-disease","tag-heart-surgery-treatments","tag-research-in-health-care","tag-the-watchman-device","tag-university-of-colorado-hospital"],"acf":[],"yoast_head":"\nMitral valve disease in dogs paralles man's disease - 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