CARE’s Dr. Camden Rouben recently completed heartworm extraction surgery with excellent results.


When Pebbles was adopted off the streets, the 11-year-old Chihuahua had heartworms. Sometimes, especially in mild cases, it is possible to kill off the parasites slowly with gentle heartworm preventative. This is what Pebbles’ family tried at first. However, Pebbles’ case was too severe for this plan. In fact, even harsher drugs were unlikely to help Pebbles unless doctors could first remove the worms in her heart.

What Is Heartworm Disease?

Heartworms are parasites transmitted by mosquitoes. A single mosquito bite can infect an animal with heartworm larvae. Once an animal is infected with heartworm disease, the worms begin to grow inside her blood vessels and cause permanent damage. Heartworm disease is very serious and can be fatal. However, it is preventable through medications.

Treating Heartworm Disease

Veterinarians usually treat heartworm disease with drugs. These medications are tough on dogs even when they have mild heartworm infections. As young worms die off inside the dog, they can cause blood clots and other complications. But, in advanced heartworm disease, when there are long, mature worms inside the dog’s heart, treatment can be toxic. In such cases, surgically removing worms from the dog’s heart can give the dog a better chance to survive treatment.

Pebbles with cardiology nurses Brandi (left) and Sydney (right)

Pebbles with cardiology nurses Brandi (left) and Sydney (right)

Risks of Heartworm Extraction Surgery

Heartworm extraction carries high risks with many potential complications. According to Dr. Rouben, only about 50% of dogs who undergo this surgery survive. Without a cardiac catheter lab and a highly trained specialist, the chance of survival is even lower. For this reason, veterinarians consider this option with care. “Typically, dogs that we recommend for this surgery are at a very advanced stage of heartworm disease, where they have enough heartworms — particularly inside their hearts and their lungs — to cause very abnormal symptoms that diminish their overall quality of life,” says Dr. Rouben. “In order to make them feel better, improve their overall ability for their hearts to function normally and reduce the burden of the heartworm infection, we have to remove those heartworms from their hearts.”

High risk is not the only barrier to the surgery. The financial cost is also significant. Not everyone can afford the surgery, and many dogs do not survive it. Furthermore, in even the most successful cases, heartworm extraction puts significant physical stress on the patient.


CARE has one of only two veterinary interventional cardiac catheter labs in North Carolina and the only one in Charlotte. That is part of why Pebbles was referred to Dr. Rouben at CARE.

Dr. Rouben made a tiny incision in Pebbles’ neck. Then, using the lab’s live x-ray for guidance, he threaded a catheter through her blood vessel and into her heart. There, Dr. Rouben carefully removed the worms. After overseeing her recovery for a day, he sent Pebbles home.

Prevention: A Better Alternative

Pebbles’ case is a happy success story. “We were able to send Pebbles home the next day with a very small incision in her neck and jumpstart the journey toward ridding her entire body of heartworm disease,” Dr. Rouben said.

But despite the thrill of this positive outcome, Dr. Rouben prefers to avoid heartworm disease altogether. He says if he had one message to share, it would be that heartworm disease is very serious and potentially fatal. “The great thing about it is that it is very preventable just through heartworm prevention medications,” he says. “Those medications are affordable and easily accessible through general veterinarians.”

The story was recently featured on WBTV. You can see the full report at this link.

For more information about heartworm disease, prevention and treatment, please visit the American Heartworm Society.

Think of CARE as the animal equivalent of a human medical center, providing all forms of treatment for pets through emergency care 24 hours a day,365 days a year. It also offers board-certified specialty care after a referral from your primary veterinarian. Take a visual tour of the practice at

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