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[Josh Greenman <joshg1973 AT yahoo.com>]

(press release)
http://tinyurl.com/5ymmq

Birmingham Zoo Gorilla 'Babec' Receives Landmark Device to Treat Cardiac 
Disease

Tue Sep 28,12:11 PM ET  

BIRMINGHAM, Ala., Sept. 28 /U.S. Newswire/ -- The Birmingham Zoo announced 
today that a
team of veterinary and human physicians and surgeons successfully installed 
the first
cardiac resynchronization therapy (CRT) device in a gorilla on Saturday. The 
device, an
advanced pacemaker that improves pumping of the heart, was implanted in 
Babec, the Zoo's
24-year-old western lowland gorilla, to improve quality of life.

Since Saturday's procedure, the Zoo veterinary and animal care staff has been 
monitoring
Babec around the clock. He is resting well and starting to return to some of 
his typical
mannerisms. He could return to exhibit within two to four weeks. 

The goal of the Birmingham Zoo's veterinary medicine program is to provide 
animals with
the best available veterinary care and maintain the best possible quality of 
life for
each animal. This was the driving force for pursuing a more aggressive 
therapeutic
regimen for Babec.

Diagnosis and Initial Treatment

Babec began to show symptoms of cardiac disease in early 2003 including 
cough, lethargy
and loss of appetite. In March of that year, he was evaluated transesophageal
echoocardiogram, a non- surgical procedure to evaluate his heart function. 
The diagnostic
procedure revealed that Babec indeed had cardiac disease. Since that original 
diagnosis,
Babec responded well to progressive medical therapy aimed at increasing his 
overall
cardiac function. Amazingly, he has shown very few outward signs of his heart 
disease
until recently. Scheduled non-surgical, follow-up cardiac evaluations were 
performed in
November 2003 and July 2004 to monitor and evaluate the progression of his 
heart disease.
The results from these evaluations provided invaluable information to the 
team of
specialists working monitoring his condition, and those results were used to 
make the
appropriate adjustments to his medications and diet. 

Prescription for Powerade

Babec's treatment included many of the same medications human patients take 
for cardiac
disease, including diuretics. To replace electrolytes washed away by the 
diuretics, Dr.
E. Marie Rush wrote an additional prescription - she ordered that Babec be 
given a
gorilla-sized (30 ounces, twice daily) portion of Powerade daily. 
Birmingham's Coca-Cola
Bottling Company gladly donated the Powerade for Babec.

Continued Progression of Disease 

Babec's most recent cardiac evaluation in July 2004 showed an increase in the 
severity of
his cardiac disease. Following consultations with multiple human and 
veterinary
cardiologists and specialists, additional adjustments were made to his 
medications in an
effort to improve his heart function. 

Despite these steps, over the past month Babec started to show more outward 
signs of the
progression of his disease, including poor appetite, lethargy, weight loss, 
and
non-compliance with his medications. These are all common clinical 
manifestations of
congestive heart failure. In the eight weeks since Babec's last 
immobilization, he lost
more than 80 pounds, 20 percent of his body weight. At this time it was felt 
that his
cardiac disease had progressed into the category of end stage, class four 
heart failure. 

This is the final stage of congestive heart failure. Multiple human and zoo 
veterinary
medical specialists came together to evaluate Babec's case in order to 
provide him with
the best possible medical care to ensure that he had a good quality of life. 

Groundbreaking Treatment

Babec's medical team decided to immobilize him September 25 for extensive 
diagnostics of
his heart and physical condition to determine if his quality of life could be 
improved
with more aggressive treatment. Experts in the field of human and veterinary 
cardiology
collaborated with Dr. Rush to determine a course of action. The team 
determined that
Babec's quality of life could benefit from a treatment never before attempted 
in a
gorilla. 

Babec's team initiated surgical implantation of a cardiac resynchronization 
therapy (CRT)
device. The procedure was based on the human model, as this is the first time 
this
therapy has been used in a gorilla. A portable fluoroscopy unit, which shows 
real time
radiograph images of the heart and major vessels, was used to image his 
anatomy during
the surgical placement of the device and its components. This equipment, as 
well as the
echocardiograph machine, was graciously donated for use, transported and 
operated by
Philips Medical Systems, their representatives and their technologists. The 
RENEWAL 3 CRT
system was donated by Guidant Corporation, their representatives and 
specialists. A
dedicated and talented team of medical specialists collaborated to perform 
diagnostics,
evaluate and monitor Babec, surgically place and evaluate his CRT device, and 
assist with
his recovery and monitoring over time.

More than a Pacemaker

The decision to implant Babec with a CRT system was based on the criteria 
used in humans
as approved by the Food and Drug Administration (news - web sites). The CRT 
system
implanted in Babec consisted of a CRT device with endocardial leads placed in 
the right
atrium, right ventricle and the left ventricle by access through the coronary
vasculature. 

Unique Post-operative Therapy

Post-operative care has been, and continues to be a great concern. Primates 
are often
very difficult to manage post- operatively, due to their intelligence and 
ability to
manipulate incision sites with their hands and feet. Alterations in his 
enclosure and
habitat during recovery are helpful for preventing any activity that could 
compromise the
placement of the device or the surgical incision, such as reaching above his 
head and
pulling up on doors and platforms with his left arm. 

In addition to enclosure modifications, to help prevent Babec from picking at 
his
incision site, various methods of distraction were employed. Chewing gum that 
had been
softened to stick in his hair and small skin sutures, were placed in various 
locations to
give him an alternative target to manipulate. Several patches of hair were 
shaved to
resemble the incision site and divert his attention. All of his fingernails 
were trimmed
and manicured so that they were smooth, making it difficult to pick at his 
sutures.
Several of his fingernails were painted as a deterrent, giving him something 
unusual to
occupy his attention. 

Procedure Improves Quality of Life but Not a Cure

Although this procedure will hopefully improve both Babec's quality and 
quantity of life,
it does not repair his heart disease. The type of disease he has is 
progressive, and in
his case, not curable. The CRT device can help his heart to work more 
efficiently, which
will hopefully increase his energy, appetite and activity. In patients who 
respond to
CRT, cardiac remodeling may improve cardiac function with time. Disease 
progression is
complicated by other organ involvement and response to the therapy. While it 
can improve
efficiency it may not reverse fibrosis or damage existing to his cardiac 
tissue. The
damage present may continue to progress, and eventually may become terminal. 
Human
patients who respond to cardiac resynchronization therapy often improve one 
heart class
and their ejection fraction, a measure of cardiac output efficiency, may 
improve five to
10 percent Most importantly is the improvement in quality of life seen in 
therapy
responders which was the goal of Babec's implant. 

Babec's medical care team and the Birmingham Zoo staff hope to see an 
improvement in
Babec's attitude and quality of life in the next few weeks and a return to 
his exhibit,
in his favorite cave, drinking his Powerade.

Founded in 1955, the Birmingham Zoo is a not-for-profit organization 
accredited by the
American Zoo and Aquarium Association (AZA). Look for the AZA logo whenever 
you visit a
zoo or aquarium as your assurance that you are supporting a facility 
dedicated to
providing excellent care for animals, a great experience for you, and a 
better future for
all living things. 

http://www.usnewswire.com/