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Re:Heart transplant (or LVAD?), what does it require

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  • nala nala
    Dear Sam s People: First, welcome to you! I am sorry to read about Sam, as you probably already know, HCM is relatively common in the Maine Coon and the first
    Message 1 of 6 , Dec 2, 2007
      Dear Sam's People:

      First, welcome to you!
      I am sorry to read about Sam, as you
      probably already know, HCM is relatively
      common in the Maine Coon and the first
      feline HCM genetic mutation was identified
      in this breed.

      Second, most of us here at the feline heart group
      have had a cat with a heart disease resulting in
      congestive heart failure. It seems from reading
      the old posts, that most of the cats manage to
      recover from CHF (more than the 65% number
      you quoted), but it is sometimes tricky to get
      the proper lasix dosage worked out for any
      one cat. I would also not rely on the 1 year
      estimate. Some cats manage to live for several
      years after having gone into CHF, but of course
      some don't.

      Third, I think it is very exciting that you are
      considering this as an option. I looked into
      the possibility of a alcohol septal ablation or
      surgical myectomy for my cat's obstructive
      HCM, but I didn't find anyone willing to try
      in a cat (contacted a 5-6 veterinary schools).

      As far as keeping Sam stable until a surgery
      might become possible, you did not mention what meds
      Sam is taking currently. Most HCM/CHF cats take a
      combination
      of lasix and an ACE inhibitor (e.g. benazepril,
      enalapril).
      Many cats also take the beta-blocker atenolol or
      a calcium channel blocker such as diltiazem. Also,
      if his HCM has already caused left atrial enlargement,
      one would usually consider an anticlotting medication
      (e.g. aspirin, plavix, low molecular weight heparin,
      or
      the over-the-counter and not yet studied in cats -
      nattokinase). Many members here believe that
      certain supplements might be useful as well as
      a high protein low-grain canned food. My cat
      received fish oil (omega-3 fatty acids)
      and CoEnzyme Q 10. Some members here
      also supplement their cats with Taurine and
      Carnitine.

      As you mentioned, heart transplantation in
      felines is virtually unknown which makes it
      difficult to advise on what might or might
      not work. There is more extensive information
      on canine heart transplants. I would suspect
      that the transplant specialists you have talked
      to would tell you what kind of requirements Sam
      would have to meet as far as his own disease being
      stable
      enough to be a sugery candidate. There was
      a case of a heart being placed into the abdominal
      cavity of a cat in the early 1970s. I don't
      remember the details of that - other than that
      the purpose was to study some other process
      and that the heart started to beat very rapidly
      after several days.

      I know very little about LVADs other than what
      I saw on the recent PBS series "The Mysterious
      Human Heart." One question I would consider
      is whether or not I would want my cat to
      undergo two surgeries, one to place an LVAD
      and the second to replace the heart. I have
      read a bit about pacemaker placement in
      cats with AV-block (not HCM or another
      cardiomyopathy) and even that technology
      doesn't seem terribly advanced. There was
      one case at feline-heart that you can read
      about in the archives. There
      was a case in the UK as well and I think
      I saw another case in the US.
      My recollection is that for the UK case, the
      implant caused irritation resulting in
      fluid build-up (chylothorax) - so I would wonder
      whether
      an LVAD device placed in the chest
      could do the same?

      Another question I would ask the transplant
      specialist about is recovery time. I think
      that if they needed to open the chest cavity,
      that could pose some difficulty for a cat
      who bears the weight of his chest on his
      front legs. I also wonder about pain
      management. It seems like because of
      their anatomy (we don't walk on
      our arms - can you imagine doing that with
      your sternum healing?) and that unlike dogs,
      cats do not tolerate NSAIDs well, how
      pain would be controlled post-surgery.

      Finally, I wonder whether a heart transplant
      is a long-term cure. A new heart would
      relieve all the symptoms for now, but as the disease
      is a genetic disease, I do wonder whether the donor
      heart, as the myocytes are replenished, is remodeled
      from healthy donor tissue or from the HCM cat tissue.
      I don't know the answer to this question. If the
      normal
      turnover of heart muscle is from the HCM kitty,
      I would wonder how long it would take before the
      heart would be remodeled back toward an HCM
      heart (2 yrs? 15 yrs?). These
      are questions to discuss with your veterinary
      cardiologist and surgeon. I imagine they
      won't be able to easily answer these questions.

      In the meantime, give Sam and your other
      two kitties as much love and attention
      as you can muster. You have some big
      decisions coming up.

      Best to your, your wife, Sam, your
      Somali and your Siamese mix.

      Nala with Camille and Cozette in spirit.


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    • elanonuevo@aol.com
      In a message dated 12/2/2007 5:34:46 P.M. Eastern Standard Time, nala_zq@yahoo.com writes: Some cats manage to live for several years after having gone into
      Message 2 of 6 , Dec 2, 2007
        In a message dated 12/2/2007 5:34:46 P.M. Eastern Standard Time,
        nala_zq@... writes:

        Some cats manage to live for several
        years after having gone into CHF, but of course
        some don't.



        definitely, Oz is over five years since the first HF and CRF and the HCM
        diagnosis. He had another CHF about 3 years ago too but fortunately I knew
        enough to see the oncoming signs.

        Tia



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      • nala nala
        FYI for those interested: Link to The Mysterious Human Heart http://www.pbs.org/wnet/heart/
        Message 3 of 6 , Dec 2, 2007
          FYI for those interested:

          Link to "The Mysterious Human Heart"

          http://www.pbs.org/wnet/heart/




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