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PFO Closure Question
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PFO Closure Question

I am an avid cyclist (38 year old male) that rides over ten hours a week and is currently training for the Leadville 100 mountain bike race in August. During my longer training rides I often develop migraines that severely affect my ability to complete and finish long bike rides
(over 5 hours in duration). I visited with a neurologist and he suggested that I get tested for PFO. I should point out that I have tried various drugs(relpax, imitrex, etc.,etc.) and various combinations of foods and hydration products and nothing worked to reduce my migraines.

Yesterday I had a TEE and was diagnosed with a small PFO. The cardiologist that administered TEE said he would not bother getting my PFO closed. However, my neurologist thinks I should explore the option as he think it will likely cure my migraine problem. He thinks the right to left shunting of blood is exacerbated by high intensity training.

Knowing this I have a few questions:

1. Will a PFO closure device negatively affect me as an athlete? Are their risks of the device dislodging under high intensity racing? Or are there other risks I should be aware of that are associated with a PFO closure implant and athletes?

2. If I do get a PFO closure device installed will I see an improvement in my cardiovascular performance by eliminating the right to left shunting I am likely experiencing now during high training and racing?

3. What does the recuperation process look after a PFO closure? How long before I can return to my normal training regime? Are their long-term affects I should be aware of?

Regards,

Ted    
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Hi - I have had a PFO closure, and I can give you my experiences, if that will help.  (My husband does the 100 bike rides often, so I can relate to what it is!  I do the smaller ones - 25, 35's and 50's.  I can't keep up on the 100's)

1.  No, I don't think a PFO closure will hurt you as an athlete; on the contrary, I think it will HELP you.  When my PFO would 'act up', I felt like I had high-altitude sickness; harder to breathe, headaches, migraines.  Very difficult.  In looking back in time, my PFO acted up only due to physical activity (tennis, lifting heavy items, etc.)  After my PFO closure, I can BREATHE!!  It's so easy!  I have NO headaches, and I have NO MIGRAINES!  (The Dr's say that's a great side effect the've seen -- no more migraines).

2.  I have no idea, but I'd trust your neurologist.

3.  I can tell you my experience for recooperation:  During the procedure, I was awake and watching the process on the large screens.  No pain.  Fun to watch, actually.  Two catheters are inserted into your veins at the hip - one on each side. no pain, no real sensation.  The device (I had a clam shell device call Amplatzer inserted) is put in, and the catheters are removed.  You're done; 10 minutes maybe?.  Some doctors put in one stitch on each site; others use pressure.  For 12 to 24 hours, you lay flat, so the insertion sites heal and close.  (You don't want to have those pop open!).  For 6 months, I had to take Plavix, which helps somehow having your heart tissue grow over the device and not reject it (still not sure what / how the Plavix works, but it makes sure you don't have any clots). The only side effects I had from the Plavix is some colorful bruises, and an occassional stomach ache (nexium or pepcid took care of that, but I have a sensitive stomach anyway).  I had NO physical restrictions, other than to be careful about injuries and the bruising.  (But I also have a blood disorder that predisposes me to blood clots, and I had had a stroke -- a clot went THROUGH my PFO to my brain.  No physical effects, just sensation effects -- tingly on my left side, so maybe you won't even have to be careful about that; I'd trust your doctor).  When I went to the Dentist during those first 6 months, I had to take a tablet of something the day before to help assure there wouldn't be any bacteria from the cleaning going into my bloodstream, but now the Dr's are questioning if this is really necessary.  So for me, it didn't effect my physical activity at all -- it actually made it much better, since I could breathe so much easier (and had more oxygen!) and the fact that I was migrain free was a miracle for me.  I don't even have regular headaches any more, and I have had a headache of one type or another for 30 years!)  I'm THRILLED with my PFO closure.  My oldest daughter has migraines, and I want her to get a Amplatzer just for that, even if she doesn't have a PFO, it's that good.

My only long term effect?  I have to see the cardiologist once a year.  I would do that anyway during an annual physical.  No meds; no restrictions.  Just freedom!

All in all, based on MY experience, I'd recommend  you follow the advice of your neurologist and have the PFO closed.  It's a wonderful, wonderful thing.
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