Case 31 — Third Visit

Three months after first visit

Pertinent history

  • Boris is presenting for not doing right over the last week, according to the owner.

Physical examination

  • BARH. BCS 3/9. HR=180 RR=40 MM=pale pink. Grade V/VI right sided systolic murmur. Friction rub-like sound on auscultation, that is associated with heartworm entanglement in the tricuspid valve. No jugular distension but jugular pulses can be seen 2–3 cm dorsal to the thoracic inlet. Strong femoral pulses with pulse deficits. Increased bronchovesicular sounds that are generalized. No masses palpated in the abdomen. Remainder of the exam was unremarkable.

Problems

  • Heartworm disease
  • Hemoglobinuria (caval syndrome)
  • Thrombocytopenia

Comments

  • CBC: HCT=29% PP=9.9 Platelets=230,000 WBC=9000
  • Echocardiography: RA and RV dilation. Heartworms were visualized in right atrium, right ventricle, and pulmonary artery. Since there are some present in the right atrium it may be possible to remove them via a jugular venotomy using forceps and ultrasound guidance. It is best to try to remove them immediately before they are pushed back out of the atrium.
  • Boris was anesthetized. A surgical cutdown on the right jugular vein was performed. Three heartworms were removed from the right atrium by jugular transvenous extraction with a three-pronged bronchoscopy retrieval device using ultrasound guidance. Two females and one male D. immitis worms were recovered. No worms could be identified on echocardiography following the procedure.

Heartworm extraction

Boris after being anesthetized

Boris the cat anesthetized for heartworm extraction surgery.

Bronchoscopy retrieval device used for heartworm extraction

Bronchoscopy retrieval device used to extract heartworms.

Removal of the first heartworm

First heartworm being removed from Boris via jugular venotomy.

Removal of the other two heartworms

Two additional heartworms removed from Boris.

P: Discharge tomorrow if Boris is stable throughout the night. Continue prednisone 10 mg PO BID and antibiotic therapy overnight.

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