Before we are born, a tiny hole exists between the two upper chambers of the heart. It helps circulate blood through the heart, because a fetus doesn’t use their own lungs to oxygenate the blood. For most people, this small hole seals itself in time. Even when it doesn’t, most people are fine. But for a few, this hole creates the risk of a stroke. McLeod Electrophysiologist Rajesh Malik, MD, explains how he repairs this hole, Patent Foramen Ovale:
Here’s a summary of Dr. Malik’s discussion:
Patent Foramen Ovale (PFO) means that it’s part of the heart structure when you’re born. After birth, the separation between the right and the left side of the upper chambers is complete as the membranes overlap. A lot of times, you can have a hole that remains and never closes properly. Usually the hole is of no consequence. A problem comes to light when somebody comes in with a stroke of unexplained cause, particularly, a person younger than 45 years of age. When this happens we look for blocked arteries in the heart. If there are no blocked arteries, we look for arrhythmias. If there are no arrhythmias we are left with a diagnosis of stroke with unknown origin.
There are about 200,000 strokes of this type annually in the United States and they generally afflict young people. One of the underlying causes may be a PFO where, given the right circumstances, a blood clot and embolism will cross over from the right to the left side of the heart and go to the brain. This situation is obviously critical and significant. Some people have unexplained shortness of breath, where PFO is the underlying cause. There has been some data to suggest that even in severe migraine cases, it may be an underlying cause, although we haven’t been able to treat PFO to reduce migraines. But PFO can lead to symptoms, including stroke, migraines and shortness of breath.
However, patients who are younger and have strokes of unexplained origin will receive a CT angiogram of the neck vessels. If everything is fine, and we don’t find any atrial fibrillation, those are the patients that need to be screened for PFO.
What we are doing here at McLeod is using an instrument, which is an Amplatz PFO Occluder Device to close the hole. We cross the hole in the heart with a special delivery system, attached with two discs. A mesh disc is released on the left side of the hole to act as a filter. As the device is pulled back to the right side of the heart the second disc opens. So, essentially, you are plugging the hole by having a dual disc mechanism.
This device reduces the risk of stroke over a period of time by about 65 percent.
The procedure itself is a simple procedure and done with sedation, not general anesthesia. The patient is kept overnight for observation and discharged home the next morning. It does require a repeat echocardiogram at six months and I like to keep patients on two antiplatelet agents that includes Clopidogrel and Aspirin.