Requirements to become a surgical candidate for Japan

We all have been there… you bring your dog to the vet for a routine checkup or for what you suspected was a minor issue, only to be sent to the cardiologist and given the dreaded diagnosis of Mitral Valve Disease (MVD), possibly even Congestive Heart Failure (CHF), which lead you to research the disease and ultimately brought you to this site… If you have decided to have your dog evaluated for surgery with Dr. Masami Uechi at the Jasmine Clinic in Japan, please read on.

The first thing to understand is that over the past year, there has been a spike in demand for the Mitral Valve Repair surgery from overseas clients, mostly from the US. There is currently only one fluent English-speaking vet at the Jasmine Clinic (Sayaka Takeuchi).   Sayaka is responsible for coordinating surgeries for all foreign potential candidates. She corresponds with all foreign clients via email and by phone, compiles all the medical records, and evaluates each patient for surgery (new cases can take hours to review). In her final steps, Sayaka presents each case to Dr. Uechi for his final approval before recommending the surgical intervention.

Sayaka schedules surgeries for all foreign dogs, assigns each foreign dog to a primary recovery vet, and participates and translates in all foreign dogs’ surgeries and pre-op/post-op appointments. This is a tremendous amount of work for one person, particularly now with the dramatic increase in overseas interest. Therefore, email correspondence takes more time, as you can imagine.

In order to expedite the evaluation process to get your dog closer to securing a surgery date, the following is a list of all testing needed:

Appointment #1 (with Cardiologist)

  • Chest x-ray
  • Cardiac ultrasound – (this can be performed every 2-4 months at your Cardiologist’s discretion, but a final echocardiogram is requested by Jasmine Clinic one month prior to travel to Japan)

Each echocardiogram should include an echo report, images, and videos (AVI format). The following views are the most important to the Jasmine team when assessing for surgical appropriateness. While these views are standard to anyone trained in echocardiograms, occasionally some are missing from echo reports.   

  • Right parasternal long-axis 4 chamber view
  • Right parasternal long-axis 4 chamber view - color Doppler
  • Right parasternal short-axis view papillary muscle level (M mode)
  • Right parasternal short-axis view mitral level
  • Apical 4 and 5 chamber view (with and without color Doppler)

Appointment #1 or #2

To be performed early, once it has been determined that your dog is a surgical candidate

  • Full abdominal ultrasound: used to rule out potential surgical risks
  • Blood type (DEA 1.1 antigen): Needed in order to prepare donor blood for surgical patients 1 to 2 months prior. The common blood typing test for dogs is DEA 1.1 antigen (+) or (-). Negative type blood donors are not common in Japan, would require advanced planning to coordinate.

Appointment #3

To be performed 2-3 months before surgery

  •  Inulin clearance test or SDMA
  •  Blood test: CBC Chemistry Electrolytes, CRP
  •  Urine test: UPC, UAC, in-house urinalysis including USG

Appointment #4

To be performed 2-4 weeks prior to surgery

  • Coagulation profile: ACT, Fibrinogen, AP, APTT, Antithrombin III (ATIII is mandatory)
  • C-Reactive Protein test is done to measure any possible inflammation in the body prior to traveling (this is a mandatory test)

"Only if indicated" (At your veterinarian’s discretion, the following remaining test below can take place as needed at any or additional appointments, based on any possible abnormal findings)

  • Blood test: Canine SpecPL, T4, TSH, 4DX, ACTH stimulation test, Low dose dexamethasone test
  • Urine culture (sample obtained by cystocentesis)
  • Fecal (culture, occult blood, parasites)

NOTE: The above appointment schedules, have been categorized by the recommended timing of each test.  Some tests can be combined for consolidation purposes and for convenience, at your Veterinarian's discretion. 

Tips to Expedite Surgery

  • Include your dog’s name in the title of your first email message
  • Always reply to the same email thread rather than starting a new message. Whether you decide to send these test results yourself or have your veterinarian send them, it is important that you and your vet continue to reply to the same email thread (have your vet cc you in his/her email so you’ll have access and will be able to reply). This keeps all medical records together so Sayaka will have quicker access to your dog’s medical records when performing her evaluation, or when answering questions, you or your vet may have.
  • Some families have started the quarantine process for Japan before confirming their dog was a surgical candidate.  Doing this allowed them to enter Japan much sooner rather than later, as time for some patients is very critical.  This is a separate process which can be managed by a general vet, though the blood drawn for the rabies titer should be performed by a vet accredited by the USDA.  After completion, the quarantine paperwork is valid for two years. 
  • At this point please be patient.  Once you’ve started the quarantine process, you will have at least six months to get all the testing completed and make your travel arrangements.

This article was intended to be a guide to navigating the extensive list of medical tests needed to determine if your dog is a candidate for Mitral Valve Repair surgery at the Jasmine clinic in Japan.  It is subject to change and will be updated as needed.

By: Carol Young

Mitral Valve Disease in Dogs | Mighty Hearts Project