PFO & MITRAL REGURG-SURGERY?

[mattie16]

Hi, I am 61 yr old female. 2004 & 2006 I had what was called suspected TIA's but all tests showed healthy, normal results as far as my heart went. My family dr just recently sent me to a cardiologist to be positive & a TEE showed the following: PFO w/shunting noted from left to right on color doppler & right to left on bubble contrast study. Also, Moderate mitral regurgitation, atrial septal aneurysm.  I will note that every other area checked out normal.
They have recommended a closure procedure and not thinners (I had a GI bleed 8 yrs ago & am on med for a peptic ulcer & barrett's esop).
My question is: how serious is this? In researching, I see that the hole (PFO itself isn't that big of a deal, so assuming that the 2 other issues contributed to the TIA's.  My big concern is, if the procedure is really necessary & whether the closure will take care of the aneurysm, shunting also?  Thanks so much for your help.

[Forum-M.D.-bkj]

mattie,

thanks for the post.

The closure is done with a device that crosses the PFO and generally decreases the mobility of the septum.  The device also seals the septum and prevents the shunting  of blood across the hole.

There isn't definite data that closing the PFO will work to decrease the definite risk of future events. In someone that is older with cardiac risk factors, there is also some risk of stroke from atheroembolism.

When I look at patients that are cantidates for closure, I look at all of risk involved and try to balance these with the risk of the procedure. A stroke is a very debilitating event so I am pretty aggressive with treatment options.

Speak with your physician and express your concerns.

good luck

[Momto3]

I am so glad to see that you were able to post your question to the doctors. I kept hoping someone would be able to offer some suggestions/advice.  I hope you are able to get some answers on this forum and that you are able to make the best decision for your potential surgery.  Best wishes!

connie

[mattie16]

Connie, Thanks - I feel silly-the specialist explained the procedure itself, but I am still in such shock since I have always thought my heart was healthy (non smoker, etc)& want to be sure this is really necessary.  Thanks again. Glenda

[Momto3]

I don't blame you one bit.  Surgery is a big step and one you want to be sure will be beneficial.  Here's hoping the doctors on the forum can offer some suggestions to help you with your decision.

In 1998, my GP told me it was time for mitral valve surgery.  I panicked!  I was scared to death...I could not believe what I was hearing.  Anyway, I went to a specialist and have had wonderful cario care since.  So far, I don't need the surgery, but I'm told it is probably in my future.  For now, I'm "on hold" and that's just fine with me.

I hope you are comfortable with your cardio; the stress of hearing "heart" problems is enough to stress us out.  A compassionate cardio makes a world of difference.

Have a great day!

[EchoTech]

There is no reason to feel silly.   Remember that you are the boss of your doctor and if you don't understand what's going on, you have the right to ask questions until you are satisfied.  If I were you, I would heavily lean towards having the procedure.  The part that would convince me is the two TIAs.  You know how not fun those are, so I would try to take steps to prevent them.  Word on the street from the facility I work at indicates that it may help some people.  The problem lies in the fact that there isn't a huge number of patients that have been walking around long enough to give very definitive answers, and the results also depend on how the statistics are done (cases that you leave in andncases that you exclude from the study.  Preliminary evidence suggests that it is helpful, but I've also heard that it has no effect too.

Take care and good luck.

[mattie16]

Thanks for your comments (everyone else's as well). Weighing the facts & speaking w/my cardiologist I did schedule the procedure to have the closure done. I don't want to live in fear of what could be a debilitating stroke (the 2 mini's were scary enough).  I appreciated this forum and being able to ask my questions and vent my fears.  Thanks again & Good luck to all!

[finetilthree]

Hi EchoTech.  Would it require TEE to diagnose a shunt?  My standard echo revealed tiny pfo with left to right shunt.  But I'm wondering if a bubble test would reveal more info.  Any thoughts?

[EchoTech]

IF the regular echo that they did identified a shunt, and you've had no symptoms, then I don't really see a TEE giving you any more benefit.  Literature suggests that roughly 20% to 25 % of the population has a PFO (shunt).  That makes roughly 75 million people in the US that has a PFO.  However, if you have had a stroke or mini stroke, then that is a concern.  A TEE would be able to eliminate a few other probable causes for the stroke and identify where the shunt is in the interatrial septum (wall between the top two chambers).  If you have a PFO and no other identifiable source of where the clot came from, you would be a candidate for the PFO closure device.  This device prevents clots from crossing over across the shunt (presumably from clots formed in the venous system of the blood circulation) and going upstairs to create a stroke.

Good night and good luck.

[mattie16]

Hi - One final question.  Is there any significance to the fact that my shunting was both ways (doppler was l/r & bubble contrast study was r/l)?  Sounds like you would know if that more or less of a threat?  Thanks Glenda

[EchoTech]

It is not  a super huge concern, it means that the pressure in your top two chambers is roughly equal. For some people that would be an issue of slight concern, but your hole is pretty small from what I'm guessing. I wouldn't see it as a major threat.  If you choose to get the device, then that won't be an issue anymore.

Good luck, Glenda.

[vicky121]

A related discussion, PFO was started.