PMID- 22946404
OWN - NLM
STAT- MEDLINE
DCOM- 20120925
LR  - 20120905
IS  - 1042-7260 (Print)
IS  - 1042-7260 (Linking)
VI  - 42
IP  - 2
DP  - 2011 Jun
TI  - Clinical management of a western lowland gorilla (Gorilla gorilla gorilla) with a 
      cardiac resynchronization therapy device.
PG  - 263-76
AB  - A 24-yr-old, male western lowland gorilla (Gorilla gorilla gorilla) was diagnosed 
      with congestive heart failure using transesophageal and transthoracic 
      echocardiology. New York Heart Association (NYHA) Class III was assigned to the 
      severity of the condition. Over 16 mo, this progressed to NYHA Class IV despite 
      increasing medical therapy. Repeated evaluations suggested that implantation of a 
      cardiac resynchronization therapy device with a defibrillator (CRT-D) could 
      benefit this animal based on clinical signs and underlying evidence of 
      dyssynchrony and suspected fibrotic myocardial disease. Surgical implantation of 
      leads into the right atrium, right ventricle, and left ventricle was 
      accomplished. The CRT-D device was placed under the thoracic pectoral muscles 
      during an initial surgical procedure. Improvement in the gorilla's clinical 
      condition after implantation of the CRT-D device was immediate and dramatic. 
      Subsequent scanning of the device was accomplished through operant conditioning. 
      The data from these device interrogations included stored and real-time cardiac 
      data, which were used to minimize recognized environmental stressors and change 
      device settings. Over 4 yr, case management was critical to successful device use 
      in treatment of the clinical disease. This involved medications, training for 
      device interrogation, exercise to increase activity and improve body condition, 
      and phlebotomy attempts. Dietary management was necessary to manipulate caloric 
      and sodium intake and encourage medication compliance. Cardiac resynchronization 
      therapy device implantation, although requiring specialized equipment and 
      surgical skill, appears to be a viable option for treatment of fibrosing 
      cardiomyopathy with systolic dysfunction in gorillas refractory to medical 
      management. In addition to treatment, this device provides cardiovascular data at 
      rest that could allow for early diagnosis and treatment of gorillas with this and 
      other cardiac conditions in the future. This describes the comprehensive medical, 
      husbandry, and training techniques necessary to successfully manage this intense 
      clinical case in conjunction with intracardiac device therapy.
FAU - Rush, Elizabeth Marie
AU  - Rush EM
AD  - Birmingham Zoo, Inc., 2630 Cahaba Road, Birmingham, Alabama 35223, USA. 
      zuvet9@yahoo.com
FAU - Ogburn, Anna L
AU  - Ogburn AL
FAU - Monroe, Denise
AU  - Monroe D
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - J Zoo Wildl Med
JT  - Journal of zoo and wildlife medicine : official publication of the American 
      Association of Zoo Veterinarians
JID - 8915208
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Diuretics)
SB  - IM
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Animals
MH  - Ape Diseases/*therapy
MH  - Diuretics/therapeutic use
MH  - *Gorilla gorilla
MH  - Heart Failure/*therapy
MH  - Male
MH  - Pacemaker, Artificial/*veterinary
EDAT- 2011/06/01 00:00
MHDA- 2012/09/26 06:00
CRDT- 2012/09/06 06:00
PHST- 2012/09/06 06:00 [entrez]
PHST- 2011/06/01 00:00 [pubmed]
PHST- 2012/09/26 06:00 [medline]
AID - 10.1638/2009-0080.1 [doi]
PST - ppublish
SO  - J Zoo Wildl Med. 2011 Jun;42(2):263-76. doi: 10.1638/2009-0080.1.