Ugo’s second act: How open heart surgery helped a beloved hound

Sue Gelsomino welcomed her dog, Ugo, into her life in October 2017. The Cirneco dell’Etna (a small, hound-type breed often used for rabbit hunting in Sicily, particularly near Mount Etna) came her way from Italy, and, after Gelsomino had his medical records translated into English, she scheduled a checkup with her local veterinarian, who discovered a heart murmur.

Their local cardiologist diagnosed Ugo, who was then six years old, with degenerative mitral valve disease. His condition remained mild until January 2020, at which point the cardiologist prescribed him pimobendan for progressive cardiomegaly.

Between the medication and twice-yearly cardiology visits, Ugo’s heart disease appeared to be under control—that is, until it wasn’t. One night in mid-July 2023, Gelsomino awoke to the sound of Ugo gasping for breath and raced him to the local veterinary ER, where she learned his condition had progressed to congestive heart failure.

After spending 48 hours in an oxygen cage and receiving furosemide, Ugo was released. Gelsomino took him to their cardiologist, where the 12-year-old Cirneco was given a life expectancy of six to 12 months if they chose to continue his current medications without taking further action.

Seeking options

But for Gelsomino, that diagnosis (and that short amount of time) wasn’t enough. She asked about other options, and initially, her cardiologist mentioned the Transcatheter Edge to Edge (Mitral Valve) Repair operation, known as the TEER procedure. The University of Illinois (UI) Veterinary Hospital in Champaign-Urbana—located about 120 miles from Gelsomino’s home just outside Chicago—was capable of performing the procedure, and it didn’t take long for Gelsomino to set up an appointment for them to evaluate Ugo.

Unfortunately, a full day of tests including an EKG, x-rays, lab work, an echocardiogram, and more showed that Ugo was not a candidate for TEER due to the size of his mitral valve annulus.

But hope was not lost. The doctor knew of a young veterinary cardiac surgeon—Katsuhiro Matsuura, DVM, PhD—who was known for performing highly successful (above 90%) surgical mitral valve repair in Tokyo, where he performed more than 100 successful mitral valve surgical repairs and managed a surgical team specializing in the procedure. And fortunately, Matsuura had just recently joined the University of Florida (UF) College of Veterinary Medicine and was beginning to perform the procedure there.

Gelsomino understood that this open-heart surgery was more invasive and required a cardiopulmonary bypass. Still, she didn’t hesitate to say yes when UI offered to send Ugo’s test results and a letter of inquiry to UF. She saw it as Ugo’s only chance at a longer life, and she was determined to make it happen.

She heard back from UF the following week and learned that Ugo was a likely candidate for the procedure, but more testing and documentation was needed in order to be sure. UF provided a list of required diagnostics, and Ugo’s cardiologist performed the tests. This time, the news was positive—Ugo was not only a candidate but was scheduled for surgery just a few months later on October 24.

And so, on October 20, Gelsomino and Ugo began the three-day drive to Gainesville, and on the 23^rd, Gelsomino and Ugo reported for his pre-operative evaluation at the UF School of Veterinary Medicine Small Animal Hospital. Gelsomino met the full surgical team, received a full rundown of what to expect, completed all the paperwork, and handed over all of Ugo’s food, meds, and other supplies—and then, it was time to leave her “big fella” with the medical professionals who were hoping to save his life.

A new program

The fact that the doctors at UI knew about Matsuura’s work and the UF open heart surgery program was more fortuitous than one might think. The program had only launched in late August 2023, and word had only begun to spread—due in part to Matsuura’s efforts.

“I presented about open-heart surgery at a nationwide conference (ACVIM) in 2023,” Matsuura said. “Also, Dr. Michael Aherne, one of our veterinary cardiologists at UF, and I presented about UF’s open heart surgery program at ACVIM in 2024.” Additionally, their current cardiology fellow is planning to present at a nationwide conference in the future. So, while some cardiologists have heard about the program, it’s far from guaranteed at this time.

Information about the surgery itself, as well as the process of case selection, is available to veterinarians and pet owners on the UF Small Animal Hospital Website. And that seems to have helped in getting the word out, because it’s not only cardiologists who are submitting inquiries; pet parents and general practitioners sometimes reach out directly. Pet parents who contact the program are instructed to have their veterinarian submit the case through the portal on the UF Small Animal Hospital Website, Matsuura said.

However, at times—including at the time of writing this article—the waiting list for surgery becomes so long that the team has to pause inquiries until surgery dates become available.

Matsuura said most cases they receive are determined to be a fit for the procedure. “The most common reason for case exclusion is age. As is the practice with human heart surgery, we will not recommend open heart surgery for elderly patients [14 years old and older],” he said. “We will also not recommend surgery for patients with early-stage mitral valve disease (StageB1) because patients at that stage have a fairly good chance of living a normal life without surgery.”

There are other factors that will affect the success rate of the procedure, as well as the life expectancy post-surgery, Matsuura said: “Cancer, other heart diseases (pulmonary hypertension, arrhythmia) and previous thoracic surgery are potential causes of case exclusion.”

Ugo’s outcome

On October 24, 2023, at 7 a.m., Matsuura and his team began Ugo’s procedure, and by mid-afternoon, Ugo was sleeping off his anesthesia in the ICU following a successful surgery.

A brief episode of atrial fibrillation when the team transitioned him off cardiopulmonary bypass required a single administration of cardioversion—something that’s not unusual, Gelsomino said. Otherwise, Ugo had experienced no issues, and Gelsomino was invited to visit him the following day.

By then, Ugo was already eating and drinking, was off the diuretic, and had started barking at a noisy cat (who was moved to another room). In other words, he was doing well, and he continued improving over the next week. An echocardiogram on October 30—six days post-op—showed improvement in size of Ugo’s left atrium and left ventricle, and his vitals were strong and stable. Gelsomino could already see a boost in his energy.

Finally, after months of seeking answers and appropriate care, it was time to head home.

The recovery

Gelsomino took Ugo to his cardiologist on November 9 for follow-up testing and suture removal. An echocardiogram showed even more improvement in his heart size, and he was taken off the last of his heart medications.

Ugo’s cardiologist rechecked him on November 21, December 19, and January 23, sharing the results from each appointment with his surgical team at UF for review. At every visit, his heart function was normal, and he continued to improve.

One year post-surgery, on October 24, 2024, Ugo—now 13.5 years old—met again with his local cardiologist, who immediately said, “Ugo looks great!”

His lab work, physical exam, and echocardiogram all showed his cardiac measurements to be in the normal range, said Gelsomino. “Everything is as it should be,” she said. “He is no longer on any heart medications, no special diet, and has no restrictions on his activity level.  Next exam is in a year.”

The tests aren’t the only indication of Ugo’s successful surgery. “He has grown back all of his fur [50% of which had been shaved for surgery] now and is close to gaining back all of his weight,” Gelsomino said. “He has gone back to lying in my lap on the couch and flipping over onto his back to have his belly rubbed—both of which he had stopped doing when he was not well.”

Considerations for potential candidates

As thrilled as Gelsomino is with the outcome of Ugo’s surgery, she acknowledges it may not be the right path for everyone, even if their pet meets the medical aspects of qualification.

Aside from age and other health conditions, she notes that the pet’s temperament may be a factor. “In our case, Ugo was 12 ½ at the time of surgery, has always been wonderfully cooperative and compliant, and had only a case of IBS/IBD to deal with in addition to his heart problems,” she said.

And the pet parent needs to be the right fit, too, she said, with the available time, energy level, patience with the situation, and available funds playing a role. Beyond the surgery itself, she said, “Open heart surgery … involves extended recovery time, requires the administration of multiple medications, and adherence to … the schedule of medical appointments—before and after the procedure.”

Gelsomino credits the providers and other medical staff with being true team players, which she found very helpful. “His primary vet and Chicago-area cardiologist were both there for us throughout—starting with the original diagnosis, the determination of what to do, the trip to UF to have the surgery, and all of the follow-up activities afterwards,” she said. “Countless phone calls and e-mails were exchanged, and I always felt that we were being looked after by these caring and diligent professionals.”

Additional resources:

Follow the open heart surgery journey of Lady Renegade, a Cavalier King Charles Spaniel (video)

Webinar: Mitral valve disease in dogs

Photo credits: Courtesy of Sue Gelsomino

Disclaimer: The views expressed, and topics discussed, in any NEWStat column or article are intended to inform, educate, or entertain, and do not represent an official position by the American Animal Hospital Association (AAHA) or its Board of Directors.