Since Navy has caval syndrome, he must undergo surgery to remove the adult worms.  Worm removal is the only treatment option for a dog with caval syndrome.  The adult worms are removed via jugular venotomy, as seen in the images and video below!

Flexible alligator forceps are used to remove the worms from the right heart and pulmonary artery. 

The forceps are inserted through the jugular vein to remove adult worms under fluroscopic examination.

80 worms were removed from Navy!

Here are Navy's Pre- and Post-surgical urine samples:

Click the play button below to watch a video of Navy's heartworm removal.

Drug Treatments for Heartworm Disease without Caval Syndrome

Melarsomine: This arsenical is the best adulticide option in a dog with heartworm disease (that is not in caval syndrome).  The drug is given intramuscularly in 2 doses spread 24 hours apart.  For dogs that are sicker and have a higher worm burden, one dose may be followed a month later with the standard 2 dose treatment.  Rapid adult worm death in a dog with caval syndrome will cause death.  Caparsolate is another arsenical which was used historically for adulticide, but melarsomine, with superior safety and efficacy, has replaced it.

Milbemycin: A microfilaricidal drug (500-999 mcg/kg) that may be used to kill microfilariae (usually 1 month post-adulticide).  It may also be used as a preventative at the same dose when given once monthly during mosquito season.

Ivermectin: At 50 mcg/kg ivermectin (off-label basis) is a microfilaricidal drug that can be used 1 month post-adulticide.  At 5-12 mcg/kg dose, ivermectin is used as a preventative. It is given once monthly.