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PFO acting like ASD
I had an echo and a TEE. The echo bubble study showed that I had 4 micro bubbles go over to left side after about 4 beats so a very little right to left shunt. They had me repeat the bubble part and I was asked to do the valsalva manoeuvre this time and a lot of the bubbles went over to left side. So there is a much larger shunt when I do the valsalva. Another doctor did the TEE and said I had a redundant and mobile inter-atrial septum with fairly large PFO with bi-directional shunting. I have trivial right to left shunt and dominate left to right shunt. Everything was normal except the right and left atrium which where fairly normal and the right ventricle which was grossly normal. I am a 35 year old slender man.

1. From what I understand, ASD are usually closed because of the bad side effects that happen from the left to right shunt. So if there is a left to right shunt does it become less serious if it is happening through the foramen ovale rather than another hole in the atrial septal wall? One can still get all the same harmful effects?

2. So when deciding if I should close this I should not think, “well I have a PFO so I shouldn’t close it unless I get a stroke or TIA or migraines.” I should be thinking, “well I have PFO that is acting like an ASD. So I should think of myself as having an ASD and close it because ASDs are closed.” In other words the amount of left to right shunting should be the main factor used when deciding if I should close this and the fact that the foramen ovale is the pathway doesn’t matter except for location of closure.

3. How am I getting a left to right shunt with a PFO? Could it be happening because my PFO flap is mobile and maybe flapping away from the septal wall instead of lying against it and sealing of the left to right shunt? Or is there another possible reason? If so what?

4. How is there bi directional shunting through a PFO. Because if both sides push on the hole at the same time wouldn’t the strongest i.e. the left to right always wins and stop the right to left. Or do the two atrial chambers push at slightly different times on occasion. So the right atrium starts ½ a beat before the left atrium so there is no pressure from the left for a second so the blood flows right to left  but once the stronger left atrium kicks in everything goes left to right

5. Can I assume that since I have a much larger right to left shunt when I do the valsalva that am I getting the same larger right to left shunt when I exercise? Or when I exercise does the right to left shunt stay small like it is when I am not doing the valsalva?

6. Does the left to right shunt get worse, stay the same, or better then it is at rest? Common sense says it gets worse because the heart is pumping harder so each shunt would get much worse. But when I do the valsalva you can see on the bubble study a lot of blood goes right to left. So since a hole can only carry a certain amount of blood and there is clearly a lot of space being used by the blood going right to left, does that mean that the right to left shunt is reducing the left to right shunting during activity? Or do the two atriums push at slightly different times as described earlier. Thereby allowing a harder beating heart to push that much more blood right to left when the right atrium is pushing first. This would mean that much more blood is going left to right when the other side kicks in.  So the left to right shunt would be staying dominate during activity as well as rest and gets much worse.

7. Is it normal for a PFO to have almost no right to left shunt until the valsa is done and then have a lot of bubbles go over?

8. What are the guide lines to decide if to close an ASD?

9. Is it true that if you have a left to right shunt no matter what size you will have eventually have right side enlargement and the other problems that come with it and as a result shorter life? Or if it’s a small left to right shunt is it likely none of these problems with happen.

10. Is there an age that the damage from left to right shunt is considered irreversible?

11. Will the FDA and laws all a doctor to put a PFO device in a PFO if there is no history of migraines, TIA or stroke if there is left to right shunt?

12. If a PFO was closable with a catheter would the flopping PFO door need to get trapped under the device or does it not matter?

13. Would a doctor ever use an ASD device to close a foramen ovale hole? Would it even fit because aren’t PFOs narrow and ASDs wide? I ask because one doctor said he can use a devise to close mine but it would be off label. So I think he means he would use an asd device to close mine.

14. What brand is considered the safest and best amblaster, cardioseal, helix?

If I have not exercised in two months I don’t have any symptoms. My symptoms come when I exercise as I eventually get painful PVCs, and if I keep running despite them I get SVTs. Once I get one PVC or SVT I can continue to get them later in the day or up to a month or so later at any time doing nothing physical.  Once the two month time frame passes I get no symptoms.

15. Do you think that the extra blood going to the right side of the atrium could be causing the heart tissue to stretch and change the electrical track and thus the electrical rhythm enough to cause PVC and SVT? And after enough time passes the tissue and tracks go back to normal.

I sometimes get mild constant left side chest pain after I have been running for about 5 minutes. As soon as I stop running the pain stops. If I start running again the pain continues and stops one second after I stop running.

16. Do you think the extra blood filling the right side of my atrium could be stretching the atrium, the lungs, or the pulmonary veins causing pain?

17. When I stop running or walking my heart continues to beat for several minutes before it goes back to resting pace. Is that symptom usually a sign of an ASD, PFO, pulmonary hypertension or anything?

18. How big of a hole in mm does and ASD have to be in order to cause shortness of breath with exercise. I get this as well.

19. I learned after awhile an ASD can reverses to RT to LT. Is it possible that I am at that point since there is bi directional shunting? How do you test for this changing direction of shunting?

20. Is it usual for people who have a PFO or ASD and PVC and SVT during activity to have the PVC and SVT stop after the hole is closed? Or get worse after close? How frequent does it happen?

21. It is usual for someone to have a hole closed with no irregular beats but get them after close?

22. Is it true that a PFO > than 6mm with left to right shunt is considered to be ASD?

23. Should someone with a PFO with left to right shunt take antibiotics before dental work?
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