Stephen J. Birchard DVM, MS, Diplomate ACVS

Friday, January 31, 2014

The Amazing Story of "Josie": A yellow Lab who was shot through the heart but lived to tell about it.

October 16, 2007; a day I will never forget. I was in between surgeries and taking a break in the hallway just outside of the operating rooms at the veterinary hospital at Ohio State. I heard someone from the other end of the hall call my name, and looked up to see Dr. Bob Sherding motioning me to come look at something. He said excitedly: “You’re not going to believe this; come look at these radiographs.” Thoracic radiographs of a dog were on the view box in the treatment area. He was right, I couldn’t believe my eyes. An arrow had pierced a dog’s chest and was completely through the heart. (Figs. 1-2) 
Fig. 1: Lateral thoracic radiograph of Josie
Fig. 2: Ventrodorsal thoracic radiograph of Josie
Even more unbelievable was, the dog was alive and had just arrived at our hospital. (Fig. 3)
Fig. 3: Josie with arrow protruding from her thoracic inlet.
The dog was being treated by the emergency service. She had just been admitted and, remarkably, appeared to be in stable condition. A typical Labrador, she wagged her tail as I approached her. No arrow through the heart was going to affect the disposition of this friendly retriever. The arrow was protruding out of her thoracic inlet and was bouncing up and down in the same rhythm as her heart beat. Her vital signs were all normal, and she was alert and responsive.

We did not know her name at this point. A friend of the hunter who shot the arrow took her to Drs. Steven Sawchek and Rhonda Masterson. They immediately referred the dog to Ohio State and one of their technicians drove her there. She was a 1 year old in tact female yellow Labrador. The Ohio State students decided she should be called “Cupid” until her real name was later discovered, which was “Josie”.

Supportive care was begun on Josie and some diagnostic tests immediately performed. An echocardiogram (Fig. 4) confirmed that the arrow was indeed completely through her heart and had penetrated the right and left ventricles.
Fig. 4: Echocardiogram showing the arrow (indicated by arrows)
inside the heart.

Routine blood tests did not reveal any significant abnormalities. Josie was taken to the anesthesia prep area, placed under general anesthesia and prepped for surgery. (Fig. 5)
Fig. 5: Josie under anesthesia during the aseptic preparation of her chest cavity
We performed a median sternotomy to allow exposure of the entire heart. (Fig. 6)
Fig. 6: Performing the sternotomy with an oscillating bone saw.
 The arrow could be clearly seen entering the right ventricle and exiting the left ventricle. (Fig. 7)
Fig. 7: Intraoperative photographic of Josie's heart. Cranial is to the left.
The arrow is seen protruding from the left ventricle (arrow)
No lung lobes had been punctured, and the tip of the arrow stopped just short of the diaphragm. There was no blood in the pleural cavity and the heart was not bleeding from the arrow punctures. The arrow was acting like a cork, sealing the heart muscle and preventing hemorrhage.

A pericardial sling was performed by opening the sac, placing stay sutures and anchoring them to the Finochietto retractor. This elevated the heart toward the sternum improving exposure. Now for the difficult part. How do we extract the arrow from the heart without causing catastrophic hemorrhage? After some quick discussion with my resident and the other doctors in the room, I decided to place a purse string suture of 3-0 PDS around the exit site of the arrow in the muscle of the left ventricle. The arrow was then backed out of the left ventricle by pulling from the cranial aspect, and the purse string was tightened as the tip of the arrow went inside the heart. A small jet of hemorrhage occurred even after tightening the suture, so an additional simple interrupted suture was placed to control the bleeding. Very little blood was lost and Josie continued to do well under anesthesia. The same suture type was placed in the right ventricle and the arrow then completely removed.

A thoracic drain tube was placed, the sternotomy closed routinely and Josie moved to ICU for recovery and further care. She was kept on a continuous ECG, her PCV monitored, and she was treated with analgesics, antibiotics, and antiarrhythmics.  She had a systolic murmur since there was a defect in the ventricular septum created by the arrow, but her cardiovascular parameters were otherwise normal.

Josie did very well and was discharged 3 days postoperatively. Two weeks after surgery she came in for suture removal. She was doing well and thoracic radiographs showed no abnormalities. (Figs. 8-9)
Fig. 8: Lateral thoracic radiograph of Josie 2 weeks postoperatively (The sternotomy was closed
with wire).
Fig. 9: Ventrodorsal view of the thorax on Josie 2 weeks postoperatively
The systolic murmur was still present however.

About 3 months after surgery Josie came back to Ohio State for ovariohysterectomy. On physical examination no abnormalities were found and no cardiac murmur was present on auscultation. A repeat echocardiogram confirmed that the ventricular septal defect had healed. I asked my student if it was ok for me to scrub in with her on this spay since this was kind of a special case. The surgery went well and Josie was discharged the following day.
Josie just before release from the hospital
I can honestly say this was the most incredible case I have ever treated.  How can a dog sustain an arrow completely through the heart and live to tell about it? I am not a hunter but I’m told that the arrow that penetrated her was a “field tip” rather than a “broad head” arrow and that’s why she survived. The tip of the arrow is the same diameter as the shaft. Thus, the shaft was able to seal the holes in the cardiac muscle and prevent hemorrhage.

I could not have successfully operated Josie without all the excellent faculty, staff, and students at Ohio State’s College of Veterinary Medicine. Drs. Shane Bateman, Rich Bednarski, and John Bonagura helped with the various aspects of her care and deserve recognition and thanks along with all the others who participated. I feel very fortunate that I was able to play a role in the care of this amazing and sweet dog.  She is the definition of a “survivor”!

Long Term Follow Up

Dr. Sawchuk recently spoke with Josie's owner. She is now 10 years old and still doing well. Here is a recent picture of her. What a beautiful dog she is.