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Kiba: Double-Chambered Right Ventricle

Education > Patient Stories 10th May 2019
 


At just 8 months young, Kiba the Shiba Inu was diagnosed with a rare congenital heart defect known as Double-Chambered Right Ventricle. He was experiencing fainting spells almost every day and might not live to celebrate his 2nd birthday. But Juliana and Jonathan would not let that happen. They flew to Japan for open-heart surgery - giving their best friend his best chance at life.

WHAT IS DOUBLE-CHAMBERED RIGHT VENTRICLE?

Double-chambered right ventricle (DCRV) is a rare congenital heart defect characterised by abnormal fibromuscular bands or membranes within the right ventricle resulting in an obstruction to blood flow out of the right side of the heart. This obstruction creates increased outflow pressure and workload for the right side of the heart, leading to thickening of the muscle as well as tricuspid regurgitation (back flow of blood through the tricuspid valves).



DCRV DIAGNOSIS AND CLINICAL SIGNS

Kiba was 8 months young when he was first referred to veterinary specialist Dr Nathalee Prakash at Mount Pleasant Vet Centre (Gelenggang). According to Juliana, “Kiba was fainting nearly every day (syncope) from anything that excites him, like daily occurrences of us reaching home. We had to quickly hold him firmly before he got too excited. Usually he would collapse on the floor for a few seconds. When it was a bad episode, he would scream and urinate uncontrollably.”



MEDICAL MANAGEMENT ASSOCIATED TO POORER PROGNOSIS

Kiba was initially managed with medication to improve relaxation of the heart muscle and relieve the outflow obstruction which minimised the fainting episodes. However, medical management was associated to a poorer prognosis and meant he was medication dependent. There are also potential side effects such as slowing of heart rate and lowering of blood pressure. If the condition progresses, patients may develop signs of right-sided heart failure (which include fluid in the abdomen, enlarged liver, poor circulation) with increased risk of sudden cardiac arrest.

“Past publications show that in the small number of patients this condition has been documented in, surgery is the preferred option due to an improved lifespan. Furthermore, in the time leading up to Kiba’s surgery, there was some progression on repeated echocardiography, which gave further support that surgery was the right decision despite the risks involved,” says veterinary specialist Dr Prakash.

RIGOROUS SCREENING AND QUARANTINE

There is no veterinary surgeon in Singapore qualified to perform the open-heart surgery on Kiba. His family thus made the huge decision to travel to Japan where Kiba will be operated on by Dr Masami Uechi of JASMINE Veterinary Cardiovascular Medical Center.

In the months leading up to surgery, Kiba had to fulfill export requirements and also go through rigorous screening to ensure he was a suitable candidate for surgery. Juliana explains, “There is a strict requirement for rabies vaccination and a 6-month quarantine before Kiba could travel to Japan. It was stressful to wait and not be able to do anything to improve his condition.”

OFF TO JAPAN FOR A FIGHTING CHANCE

Juliana and Jonathan had visited JASMINE Center in February to meet the team and view the facilities. “We are very relieved that Kiba is finally on his way for surgery after such a long wait. We have total confidence in Dr Uechi and the JASMINE team.”





DCRV OPEN-HEART SURGERY

The aim of cardiac repair is to surgically remove the abnormal muscle bundles dividing the right ventricle into two cavities. An incision is made in the right ventricle spanning the region of the defect and the location of the obstruction determined by visual inspection and palpation of the right ventricular wall. The fibromuscular membranes are then excised, taking care to avoid injury to the papillary apparatus of the tricuspid valve.





Kiba is very fortunate to be in a family who is able to go against all odds to save his life. “Not every family can afford to give their pet the opportunity to correct a heart condition. Take your time to do your research if you are purchasing a pet from breeders – ask around, speak with current owners, get to know the parents of the puppies – such congenital health issues should not be taken lightly.”



After 25 days in Japan pre-and-post-surgery, the family was ready to fly back to Singapore and continue Kiba’s journey to recovery.



POST-SURGERY REVIEW

“DCRV surgery in humans is well-researched and published with a high success rate but there is very little data in the veterinary world. The vets at JASMINE Center will continue to monitor Kiba from a distance together with the ever-so-patient Dr Prakash at Mount Pleasant (Gelenggang). Without Dr Prakash’s help over the past months, Kiba might not have made it to Japan for his surgery.”