One of the many enjoyable veterinary experiences is the puppy or kitten examination. We are looking at a bundle of life that has the potential to bring so much happiness into a family. Anyone that has experienced the pleasure of a great pet knows what I mean.
On the day that Dr. Wohlfahrt examined this unusually handsome group of four Labrador Retriever puppies all seemed well as she gave the first two pups their physical exams and initial puppy vaccinations. As she examined the third puppy, named Jack, the first abnormality noted was a finger-sized hernia at the umbilicus. This is the point where the puppy is attached to its mother by the umbilical cord. Umbilical hernias are not uncommon and rarely pose serious risk to an individual. Externally all that is seen is a small nodule of tissue or fat that varies in size depending on the size of the defect in the abdominal wall. Most umbilical hernias are repaired without complications. As Dr. Wohlfahrt continued her exam she became more concerned as she listened to Jack's heart and lung sounds. Jacks heart sounds were murmur free but muffled and the heart sounds were heard best much further back in the chest cavity than was normal. Dr. Wohlfahrt discussed these findings with Jack's owner and suggested abdominal and chest x-rays to further investigate the abnormal physical findings.
Jacks x-rays were cause for concern. The chest radiograph revealed that his cardiac silhouette was extremely large and the abdominal radiograph showed that his abdominal organs were more forward than they should be.
The term cardiac silhouette refers to the shape of the heart on a radiograph. What the veterinarian is really looking at is the heart itself within a thin-walled sac, the pericardial sac. When the cardiac silhouette is enlarged the increase in size may be because the heart itself is enlarged or because abnormal fluid or organs are trapped around the heart within the pericardial sac. It is often not possible to distinguish between the two conditions radiographically. Ultrasound, on the other hand, can be very helpful in these cases. It will make it possible to look within the pericardial sac and image the contents.
Dr. Wohlfahrt discussed the options with Jack's owner. The fact that Jack's heart sounds were normal but muffled, coupled with the presence of an umbilical hernia, made it most likely that he had a relatively rare condition known as PPH or Peritoneal Pericardial Hernia.
Jack's owners considered their options. Jack seemed to be doing ok but they had noticed that he wasn't quite as playful as the other pups and he often developed labored breathing. A decision was made to have an ultrasound done and if the diagnosis was confirmed the hernia would be surgically repaired.
Jack's ultrasound confirmed the presence of the peritoneal pericardial hernia. His gallbladder, much of his liver, and some loops of small intestines were imaged within the pericardial sac.
Drs. Lemieux and Wohlfahrt discussed the protocol for Jack's surgery with his owners. The surgery would be performed through the abdominal cavity. Displaced abdominal organs would then be gently returned to their normal position and the defect in the diaphragm would be closed. Jack would be placed on a mechanical ventilator or respirator to maintain his breathing throughout the procedure. At the time of his surgery Jack would be only ten weeks old and his thin pericardial sac would be the only barrier that would prevent a collapsed lung. If it were damaged during the procedure Jack would be unable to inflate his lungs.
Peritoneal Pericardial Hernia is a congenital defect that puppies can be born with. It is caused by a failure in the development of the diaphragm, a thin muscle that separates the chest and abdominal cavities. As the diaphragm develops it fails to close completely leaving a communication between the abdominal cavity and the pericardial sac surrounding the heart.
Jack had a very smooth recovery. The following photo was taken about three hours after his surgery. Jack's attitude was incredible. He continued to have such a positive and outgoing outlook in spite of the dramatic change in the position of his organs and the tension created by closing his defect.
Everyone that worked with Jack fell in love with him and it was clear that one veterinary assistant in particular was forming a real bond with him. Jack left the hospital two days after his surgery. Erin Frissell and her mom and dad soon visited Jack at his home. Erin's parents agreed that Jack was an incredible pup and made arrangements for him to become a part of their family.