PFO Closure or Coumadin after stroke

[Dawn]

I am a 30 year old female who suffered a stroke this time last year.  There was nothing found that could have caused this other than a small hole in my heart.  This PFO could be the reason a small clot that went to my brain.  I have been on Coumadin for a year now and I do not want to take it for the rest of my life.  No one seems to know if I should go off of it or not.  They say this stroke was just a freak thing that may never happen again, but it happen once and I believe since it did that it could happen again.  

I just recently learned of a new procedure to close the hole with a CardioSeal through a catheter.  This procedure is quite new and I am worried about long term risk.  I want to be able to exercise and have more children.  I am afraid of this thing causing me additional problems in the future.  I go back and forth about the pro's and con's of this procedure and about staying on Coumadin and the chances of having another stroke.  I constantly worry about having another stroke.  If I have this procedure, I will probably worry about having this device move or break over time in the middle of my heart during exercise.  I am really scared!  What do you think is the less risky?  What should I do?

[CCF-M.D.-CRC]

Dear Dawn,

The answer to your question would depend on several things.  First, what is the size of the PFO?  With larger PFOs the answer would tilt towards closure.  Second, is there a right to left shunt with the PFO?  If so this would be another reason for closure.  Third, how sure are your doctors that the stroke was due to an embolic clot and not due to another cause (e.g MS, small bleed, etc)?  The more certain they are that it was a clot the more likely I would recommend closure.

The procedure itself is fairly low risk but it is not without some risks.  There are risks to coumadin and you would have to be off it to have children.  If there was enough data to support an embolic clot crossing the PFO I would favor proceeding with a closure device.  

If you would like to see someone here I would recommend Dr. Latson in pediatric cardiology.

[skipabeat]

I am the biggest fan of the cardioseal procedure.  My daughter is
11 now and has 5 seals closing a total of 9 holes; one of them an inch in diameter.  At age 7 she was in need of a transplant.
We were referred to Dr James Lock in Boston who pioneered the surgery.  This was the best thing in Melissa's life.  She now plays competetive softball and competes with her dance team.
At the time  of her surgery she was 3' 6" and weighed only 39 pounds;
now she is almost 5' and 90 lbs.  Her doctors say a check up every 2 years is all she needs and she will be able to have her own children and do anything she wants. This procedure took just a little longer than a cardiac cath and she was home less than a week after it was done.  And no medications are no longer needed.
Good luck.

[zippy]

Hi Dawn,
Like you I suffered a sudden and unexpected mild stroke in October 2000, followed by a couple of TIA's. I am a 34 year old female who has an unremarkable past medical history. So it was all a bit of a shock as I'm sure it was for you too! Initially I was put on aspirin and told they were not really sure what had happened as all initial tests were negative. I too was left worrying if this was possibly going to happen again in the future. After getting a transoesophageal echo they found I had a small hole or patent foramen ovale with a right to left shunt. They pondered over whether to close it or not. After a catheter test they said it was big enough for the device to work and decided to go ahead as they couldn't rule out for sure if I might have suffered further more significant strokes in the future. I was only too happy to get the procedure done. I felt a weight had been lifted off my shoulders. I only had my procedure done here in the UK about 6 weeks ago. Everything was straightforward and so far so good. Mine was closed using an Amplatzer device which you can find info on the net about. Hope this gives you some help as what to do. Doctors here seem happy with doing it, said it will grow over with new heart cells and become an integrated part of the heart.
Regards,

[MaryRose]

Dear Dawn,
Your story is all too familiar to me. I was diagnosed with a PFO in April 1998, after suffering a stroke. I was 40 at the time.  Diagnosis was made on the results of a TEE,after spending 5 days in the hospital and exhausting many tests to determine the cause.I was basically given the option of the percutaneous procedure that you are considering or Coumadin therapy probably for the rest of my life.  I decided on the drug therapy because at the time the other procedures were considered experimental. I went on a mission to locate as much info as I could regarding my good health and future.  I chose coumadin Therapy to buy time until more studies were completed in reference to the various closure devices. In December of this past year, I once again started to experience multible TIA's (mini strokes).  I failed Coumadin Therapy. After more research and references from this medical forum, I made my decision to go ahead with surgical closure. I am now only two months post open heart surgery. I had many opinions Cardiologists vs Cardiac Surgeons. I now never have to worry about another stroke due to PFO. I learned from my surgeon that my PFO 12to14mm in size. The TEE only revealed a 1mm size hole. My surgeon informed us that this is very common. Having had it surgically closed truely has ended all the fears that are associated with the other experimental options. While making your decision please keep in mind that this PFO/Stroke link is still in research and study. Good luck to you, Mary