I am happy to report that Luna Belle made it to NC State and did well when she was there. Unfortunately, after observing and evaluating her, they decided she was not strong or stable enough to proceed with the surgeries we had anticipated them doing. Luna Belle has such a rare condition the entire Cardiology Team was involved in her case.
I asked Luna Belle's Cardiologist at NC State, Dr. Mclaughlin, to outline concerns that best describes her condition and problems, which I have enclosed below.
"We spent the day discussing her case, looking at her echo images, consulting with surgery, and doing a literature search for Fallot's Tetralogy (TOF) interventions. There is not a ton of information about interventional procedures for TOF, as it is generally considered not the safest of procedures. The limited amount available (and from our limited experience) a balloon valvuloplasty carries higher risks of either doing too much or doing too little. The dogs in the case reports did not live very long after the palliative procedure and often had to have an additional procedure (placement of a shunt) to survive long term."
"The dogs that got the placement of shunts did relatively better in the long term. Still, this procedure does NOT address the high pressure in the right heart, and there is a chance that patients could go on to develop right-sided heart failure in the future, although we feel this is uncommon. There is also a reasonable chance that if her shunt is well balanced right now and has no clinical signs, that might be the best we can expect from her. This is a bit of a different situation because she is with rescue and needs to be adoptable, so we may decide to do a procedure even though she might be doing well with medical management. All of that being said, this is the overall consensus from NCSU Cardiology."
"We want to continue medical management for weeks to a few months to allower her time to gain weight, so she has less trouble with anesthesia during a complicated procedure. Since she is asymptomatic now, we feel that if we give it some time, we could probably get her in a better body condition score, and she would tolerate the procedure better if we decide to intervene."
"If the decision is made to intervene, we are leaning towards recommending a surgical shunt (Modified Blalock-Taussig Shunt). It seems that patients have better outcomes with the shunt placement. This is an aggressive and invasive procedure, but we have one surgeon here who has placed a fair number with good results, and we have the utmost faith in him."
"Suppose the outcomes are still not acceptable after that. In that case, a gentle balloon valvuloplasty could be considered. Still, there would be a real risk of pulmonary edema from flooding the lungs through a combination of the shunt and the balloon valvuloplasty."
"It is important to note that she will probably have some problems and need intensive follow-ups, probably no matter what we do. Dogs with BT shunts can still need periodic phlebotomy, even if the shunt remains functional (they can close over time), so it is not always a permanent fix. If we induce a left-sided congestive heart through either of these procedures, she will need medication and follow-up as well. I wish there were a more straightforward answer!"
As you can see from the note, we still have many balls in the air, and where they land cannot be determined at this time. Luna Belle is back with us at our Rehab facility and is under strict medical care. We are doing everything possible to give her the best Quality of Life and keep her from having a massive heart attack. To say we are stressed over this adorable pup is an understatement.
We allow her to interact with other dogs at this time as long as she does not get too excited. The minute she gets excited, we scoop her into our arms and take her to a calm place where she can calm down. Once she is calm, she is out of danger.
I had so hoped Luna Belle would have already had her procedures, and we would be on the other side of this. We can't rush something so delicate no matter how much we want it. In the meantime, we are doing everything her Specialists wanted us to do and are keeping her Cardiologist on speed-dial. Please, keep this very special pup in your prayers.