December 28, 2011
When six-year-old, 180-pound St. Bernard “Noah” came to Angell Animal Medical Center, he was lethargic and short of breath. Initially diagnosed with a dangerous accumulation of fluid around his pericardial sac—the sac that surrounds the heart—by the Bolton Veterinary Hospital in Connecticut, he was later referred to Angell’s Nancy Laste, DVM, DACVIM (Cardiology) in a bid to ease his symptoms and find a more definitive solution to his problem.
|Noah is prepped for surgery at Angell Animal Medical Center|
Dr. Laste, a board-certified Cardiologist with over 20 years’ experience treating cardiac disease in animals, realized the least invasive way to treat Noah was to conduct a Thoracoscopy, an advanced surgical procedure that would enable her to examine the inside of Noah’s thoracic cavity and pericardial cavities to more accurately diagnose his disease. This helped assure his owners that despite what could be a dangerous diagnosis followed by a long road of treatment Noah would at least recover swiftly from the procedure.
Said Noah’s owner David Patenaude, “It’s a very scary situation to be in—both for Noah and for us—and knowing that Dr. Laste has a long and successful Thoracoscopy history helped put our minds at ease in the lead-up to the surgery. Noah is treasured member of our family and we want to ensure he has the best care possible.”
Giant Breed’s Size Presents Enormous Surgical Challenge
Despite performing over one hundred Thoracoscopy procedures—which are minimally invasive because they do not involve open chest surgery and, thus, enable faster recovery periods—Dr. Laste faced a unique challenge due to Noah’s enormous size.
The dog was so large he barely fit on the operating table, requiring Dr. Laste and her team to extend the surgical table and position him in alternative ways to allow easy entrance into his chest. Failure to find an entrance into the chest would have necessitated a Thoracotomy, the open chest version of the surgery, which would have resulted in much more pain and recovery time for Noah.
Despite these challenges, Dr. Laste executed a successful procedure which allowed her to open and drain the pericardial sac. This not only alleviated Noah’s symptoms but will prevent continued compression of the heart by accumulation of fluid around his heart. Moreover, it provided new insights into his condition.
Noah’s Diagnosis and the Path Forward
Although Noah’s thoracic cavity and the external surface of his pericardium appeared visually normal, upon opening the pericardial sac and removing several two cm diameter pieces, the surface of the heart appeared irregular and nodular, leading Dr. Laste to suspect he may be suffering from malignant mesothelioma. Mesothelioma, the tumor type linked to asbestos exposure in humans, is an aggressive cancer that can start in the pericardial sac and later extend to the pleural cavity. Noah’s biopsy results, however, did not reveal evidence of cancerous cells.
Dr. Laste advised Noah’s owners to treat the results with “cautious optimism” as cancers such as mesothelioma are very difficult to diagnose. “We can never rule this type of tumor out completely, and should mesothelioma present itself in the weeks and months ahead we will collaborate with Angell oncologists to assess chemotherapy and other options to ensure the best course of treatment for Noah,” said Laste. “For now, he is recovered from his surgery and back to his happy, bouncy self. And everyone is grateful for that.”
Setting the Highest Standard for Cardiac Surgery
|Dr. Nancy Laste of Angell Animal Medical Center performs a Thoracoscopy on Noah|
The unique challenges associated with Noah’s size and diagnosis underscore just how sophisticated modern veterinary cardiology has become, and the leading role Angell Animal Medical Center plays in advancing innovation in the field. Dr. Laste pioneered the thorascopic surgery program at Angell Animal Medical Center in 1998 and since that time has successfully treated more than 120 patients with minimally invasive techniques. She is part of a four doctor cardiology team, which provides comprehensive medical and surgical Cardiology care, as well as directing the minimally invasive thoracic surgical program. The Angell Cardiology team is well known for its residency program which has successfully trained many of the nation’s top Cardiologists.