A Tiny Patient and a Comprehensive Care Team: Alfred’s PDA Journey

At Mission Veterinary Emergency & Specialty, advanced technology gives our specialists more options, but comprehensive care means knowing when a different approach is right.

When Alfred, a 10-week-old Corgi mix, was referred to our Cardiology team for evaluation of a significant heart murmur, board-certified veterinary cardiologist Dr. Shane Murphy discovered that this tiny patient was facing a serious congenital heart defect: patent ductus arteriosus (PDA).

What Is Patent Ductus Arteriosus?

Patent ductus arteriosus is a congenital heart defect caused when a blood vessel known as the ductus arteriosus fails to close normally after birth. Before birth, this vessel serves an important purpose by allowing blood to bypass the lungs. Once a puppy begins breathing on its own, however, the vessel is no longer needed and should close within the first few days of life.

When it remains open, or “patent,” blood can continue flowing abnormally from the aorta into the pulmonary artery. This creates excess blood flow through the lungs and places additional strain on the left side of the heart. Without correction, PDA can eventually lead to congestive heart failure and significantly shorten a dog’s life.

For many patients, Dr. Murphy and the MVES Cardiology team can now treat PDA through a minimally invasive occlusion procedure, using fluoroscopy to guide a catheter and place a small device within the PDA to stop the abnormal blood flow. Compared with traditional open-chest surgery, this approach can reduce pain and discomfort while providing an effective way to correct the defect.

But Alfred’s case was different.

A Tiny Patient Facing a Big Problem

At his initial cardiology evaluation, Alfred weighed just 2.13 kilograms, less than five pounds. His echocardiogram confirmed a PDA with significant abnormal blood flow as well as severe enlargement of the left side of his heart. Even more concerning, Alfred had already developed congestive heart failure and pulmonary edema, or fluid accumulation within the lungs, at an unusually young age.

Because Alfred was so small, the minimally invasive transarterial PDA occlusion procedure available through MVES Cardiology was not an appropriate option. And because his heart was already beginning to decompensate, treatment could not simply wait until he grew larger.

Dr. Murphy recommended beginning medications to stabilize Alfred’s congestive heart failure while pursuing PDA closure as soon as safely possible. He then collaborated directly with the MVES Surgery team to determine another path forward: open-chest surgical ligation of Alfred’s PDA.

When One Specialty Hands the Case to Another

This is where having multiple specialties working together under one roof can make an important difference.

After discussing Alfred’s case with Surgery, Dr. Murphy coordinated an expedited consultation with board-certified veterinary surgeon Dr. Stacy Friesen, with surgery planned shortly afterward once Alfred had time to stabilize on his cardiac medications.

On July 28, Dr. Friesen and the surgical team performed a thoracotomy, entering Alfred’s chest and carefully identifying and isolating the abnormal vessel. Two ligatures were placed around the PDA and progressively tightened while Alfred’s cardiovascular parameters were closely monitored. Once the vessel was completely ligated, the abnormal vascular flow was no longer detectable. The surgical report documented complete PDA occlusion with no surgical complications. Throughout the procedure, our board-certified veterinary anesthesiologist managed Alfred’s anesthesia and the unique cardiovascular challenges associated with his condition and open-chest surgery. Following the procedure, Alfred transitioned to our ICU team for continued oxygen support, cardiovascular monitoring, and postoperative care.

His recovery wasn’t without challenges. Alfred experienced cardiovascular instability following surgery, requiring close collaboration among Surgery, Anesthesia, Cardiology, and the ICU. A postoperative cardiac assessment with Dr. Murphy, however, showed something remarkable: Alfred’s severe cardiac enlargement had already improved substantially following closure of the PDA, and his pulmonary edema had improved or resolved.

Six Weeks Later: A Remarkable Transformation

Alfred continued to improve after leaving the hospital.

At his six-week Cardiology recheck, his family reported that he was active and doing well at home with no breathing difficulty, exercise intolerance, or collapse. He was no longer receiving cardiac medications. His follow-up echocardiogram told an even bigger story.

There was no residual blood flow through the PDA, his previously severe left atrial enlargement had normalized, and the dramatic changes to the left side of his heart had improved to near-normal. His congestive heart failure had resolved without ongoing medication.

Dr. Murphy ultimately considered Alfred’s surgical PDA ligation curative, with no cardiac medications, exercise restrictions, or scheduled cardiology rechecks required at that time.

Comprehensive Care Means Having More Than One Option

Fluoroscopy and minimally invasive PDA occlusion have expanded the range of options our Cardiology team can offer patients with congenital heart disease. But advanced veterinary medicine isn’t defined by a single procedure or piece of technology.

It’s about having options.

When Alfred was too small for the minimally invasive procedure, his care didn’t stop there. Cardiology recognized the urgency of his condition and stabilized his heart. Surgery provided an alternative method of correcting the defect. Anesthesia developed and managed a plan for a high-risk cardiovascular patient. And our ICU team provided the intensive postoperative support he needed to recover.

The goal wasn’t to make Alfred fit a particular procedure. It was to bring together the right specialists and develop the best treatment plan for Alfred.

His case is an example of what comprehensive specialty care can look like: multiple disciplines working collaboratively, adapting when circumstances change, and using their collective expertise to give each patient the best possible opportunity for a positive outcome.

Today, Alfred’s PDA is closed, his congestive heart failure has resolved, and this once critically affected puppy can get back to something much more appropriate for his age, simply being a puppy.