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Patent Foreman Ovale
My husband (49 yrs. old) was scheduled to have surgery last month to close this PFO he has. They found it in Oct. 2000, after he had a stroke, and they did a TEE test. He also had a TIA in January of 2001. The morning of the surgery, he changed his mind, but did have the angiogram, which came back fine. This cardiologist & surgeon are very upset with him because he won't have the surgery. They pretty much told my husband, if he doesn't have the surgery, they guarantee him that he will have another stroke within the year, and next time be paralyzed or dead. A few weeks ago, we went back to the original cardiologist that found the PFO in the first place to see what he had to say. In his opinion, he feels the hole did not cause these strokes (being it is so small), and feels that my husband shouldn't have surgery. So, now we are totally confused!
I guess what i'm asking is do you think he is at risk of having another stroke if he doesn't have this hole closed? Or is he better off having it closed, and getting off the coumadin? Thank you for your time, you are very helpful, as you gave me information awhile ago on the procedure for this surgery. Dana
I guess what i'm asking is do you think he is at risk of having another stroke if he doesn't have this hole closed? Or is he better off having it closed, and getting off the coumadin? Thank you for your time, you are very helpful, as you gave me information awhile ago on the procedure for this surgery. Dana
A related discussion, to close or not to close patent forman oval with anersym associated was started.
I had a stroke March 08 2002, at age 47. I have very low cholesterol, low-medium blood pressure, never smoked, I have no observable plaque, and am quite fit. Apart from a small PFO, my heart is healthy and normal.
A TEE identified a "small" PFO with an apparent occasional "jet". The cardiologist who performed the test did not recommend closure of the PFO, but others have (surgeons, perhaps predictably). I have a history of migraine with aura, which correlates with stroke and PFOs.
The other "dark horse" candidate for a cause: dissection, or injury, of the vertebral arteries. I has a neck injury and neck and eye pain 5 days before the stroke, which are often precursors. My infarction was in the PICA (posterior inferior cerebral artery) distribution area; supposedly, 66% of strokes, in this area of the brain, are due to dissection of the vertebral arteries (in fact, there is a lower chance, because of geometry, that a clot from a PFO will end up in the PICA).
I have scanned the actual radiological output, and have read the writeups, and I know they didn't do enough to discern a dissection (at least, they didn't do enough to discern a partially-healed dissection that released a portion of clot). The MRA didn't even image the PICA or vertebral areas; the full-head MRI had no FAT suppression, and lacked the resolution to see a dissected artery wall. Because of my slurred speech, and the general madhouse atmosphere, I doubt the ER personnel ever caught on that there was a chance of recent injury. Unfortunately (or fortunately!), the evidence of a dissection quickly disappears in a few days, unless the artery is such that it gets reinjured easily (some people have the PICA in a place that admits easy injury).
The follow-up treatment, and benefits from heart surgery, are radically different for a PFO vs. a dissection (especially the anti-coagulant therapy). Thus I am interested in getting an accurate estimation of the probability of each cause.
I'm really curious to find where (in terms of the part of brain) you PFO people had your strokes...? Mine was in the cerebellum.
A TEE identified a "small" PFO with an apparent occasional "jet". The cardiologist who performed the test did not recommend closure of the PFO, but others have (surgeons, perhaps predictably). I have a history of migraine with aura, which correlates with stroke and PFOs.
The other "dark horse" candidate for a cause: dissection, or injury, of the vertebral arteries. I has a neck injury and neck and eye pain 5 days before the stroke, which are often precursors. My infarction was in the PICA (posterior inferior cerebral artery) distribution area; supposedly, 66% of strokes, in this area of the brain, are due to dissection of the vertebral arteries (in fact, there is a lower chance, because of geometry, that a clot from a PFO will end up in the PICA).
I have scanned the actual radiological output, and have read the writeups, and I know they didn't do enough to discern a dissection (at least, they didn't do enough to discern a partially-healed dissection that released a portion of clot). The MRA didn't even image the PICA or vertebral areas; the full-head MRI had no FAT suppression, and lacked the resolution to see a dissected artery wall. Because of my slurred speech, and the general madhouse atmosphere, I doubt the ER personnel ever caught on that there was a chance of recent injury. Unfortunately (or fortunately!), the evidence of a dissection quickly disappears in a few days, unless the artery is such that it gets reinjured easily (some people have the PICA in a place that admits easy injury).
The follow-up treatment, and benefits from heart surgery, are radically different for a PFO vs. a dissection (especially the anti-coagulant therapy). Thus I am interested in getting an accurate estimation of the probability of each cause.
I'm really curious to find where (in terms of the part of brain) you PFO people had your strokes...? Mine was in the cerebellum.
My mother age 67 had her first stroke in 1995 and another October 2001 and by the Grace of God, she fully recovered from both. The neurologist referred her to a cardiologist. She was referred by the local cardiologist to a cardiologist at Duke University. We made two visits; the first was for a heart echo and the second was for a heart echo done by placing an instrument down her throat to get a better picture. The MD's showed us the films and we could see the blood flowing through the openings. The hole is not round like you would think. You can look at it like this, place one hand on top of the other like this is the interior heart wall and the leakage flows between the walls (hands).
She had the PFO done February 1, 2002 and was discharged the next day feeling fine and has done well since. She sould be off all thinners in three months.
She is glad she had the procedure and hasn't looked back.
She had the PFO done February 1, 2002 and was discharged the next day feeling fine and has done well since. She sould be off all thinners in three months.
She is glad she had the procedure and hasn't looked back.
Your Dec. 2001 posting is helpful. In December I had a stroke. After complete testing a PFO was determined to be the cause. I am 55 years old, in good health (had just completed my 4th marathon). I am currently on coumadin and do not want to remain on it for the rest of my life. I am reviewing my surgery options and am leaning to open-heart surgery vs. the less invasive techniques that implant devices to repair the opening. I would appreciate your view on the options and the post operative recovery. Your posting mentioned that open heart surgery is indeed serious surgery with the accompanying recovery issues. I live alone and hope to return to work as soon as possible. Thank you.
I just happened upon this thread... I consider myself extremely fortunate, having only recently been part of a clinical trial of the Amplatzer PFO Occluder device.
Almost four years ago, at 53 years old, with no history of high blood pressurre, no high cholesterol, nor any of the other symptoms that are commonly associated with stroke, I had one. The in-hospital workup included a TEE, in which a PFO was discovered.
Over two years later, with an insurance-induced change of cardiologists, my new doctor put me (back) on Coumadin, but said he had heard of a study of a new device. Sure enough, he finally found the name of a cardiologist at Children's Hospital (in Washington, DC) who was part of the study. In July of this year (2001,) I underwent cardiac catheterization for emplacement of the Amplatzer device. From Dr. Michael Slack's demonstration of the device in his office, I can see where it would have several advantages over the "clamshell" device, and for me, the even nicer part is that I no longer need the Coumadin; just one standard aspirin a day for six months, and that's all!
Have your cardiologist look into the Amplatzer device -- I don't know if the trial is over, or how longer it will be before it is generally available, but it surely beats any surgical procedure!
Almost four years ago, at 53 years old, with no history of high blood pressurre, no high cholesterol, nor any of the other symptoms that are commonly associated with stroke, I had one. The in-hospital workup included a TEE, in which a PFO was discovered.
Over two years later, with an insurance-induced change of cardiologists, my new doctor put me (back) on Coumadin, but said he had heard of a study of a new device. Sure enough, he finally found the name of a cardiologist at Children's Hospital (in Washington, DC) who was part of the study. In July of this year (2001,) I underwent cardiac catheterization for emplacement of the Amplatzer device. From Dr. Michael Slack's demonstration of the device in his office, I can see where it would have several advantages over the "clamshell" device, and for me, the even nicer part is that I no longer need the Coumadin; just one standard aspirin a day for six months, and that's all!
Have your cardiologist look into the Amplatzer device -- I don't know if the trial is over, or how longer it will be before it is generally available, but it surely beats any surgical procedure!
Hi Dana:
Except for a modest sized aneurysm by the PFO, the situation with your husband could be a description of my own. There certainly is a cause and effect relationship between atrial-septal defects (like a PFO)and stroke and your husband and I are living testimony of it. I did have mine repaired via open heart surgery and have no regrets. However, AND THIS IS IMPORTANT, I did not go into surgery until after a rather extensive battery of tests to eliminate other possibilities and pretty much narrow it down to the PFO. Just becuse the PFO was found doesn't necessarily guarantee that to be the cause of the stroke in the absence of other tests centered upon finding another possible source of a clot(s). After the echo which revealed the PFO I hope the doctors simply didn't dismiss any oher possible causes without testing. Having been there myself, I was made a little uncomfortable by your post about any doctor who said not having it repaired was a "guarantee" of another possibly debilitiating stroke.
As I said I did heve it surgically repaired but not by the "clamshell" becuase I found more apparent efficacy with the full open heart procedure. Some can do this with a mini-sternotomy as opposed to a full midline. Today 2 yrs later, my full midline scar is not particularly bad at all to look at. One more thing, if your husband does elect to have it repaired surgically, it is
real open heart surgery and he will need some care and support as he heals as will you as his spouse.
I have posted on this a time or two before because it is of particular personal interest to me to help others with this dilemma. Let me know if I have helped at all.
Except for a modest sized aneurysm by the PFO, the situation with your husband could be a description of my own. There certainly is a cause and effect relationship between atrial-septal defects (like a PFO)and stroke and your husband and I are living testimony of it. I did have mine repaired via open heart surgery and have no regrets. However, AND THIS IS IMPORTANT, I did not go into surgery until after a rather extensive battery of tests to eliminate other possibilities and pretty much narrow it down to the PFO. Just becuse the PFO was found doesn't necessarily guarantee that to be the cause of the stroke in the absence of other tests centered upon finding another possible source of a clot(s). After the echo which revealed the PFO I hope the doctors simply didn't dismiss any oher possible causes without testing. Having been there myself, I was made a little uncomfortable by your post about any doctor who said not having it repaired was a "guarantee" of another possibly debilitiating stroke.
As I said I did heve it surgically repaired but not by the "clamshell" becuase I found more apparent efficacy with the full open heart procedure. Some can do this with a mini-sternotomy as opposed to a full midline. Today 2 yrs later, my full midline scar is not particularly bad at all to look at. One more thing, if your husband does elect to have it repaired surgically, it is
real open heart surgery and he will need some care and support as he heals as will you as his spouse.
I have posted on this a time or two before because it is of particular personal interest to me to help others with this dilemma. Let me know if I have helped at all.
Dear Dana,
It would depend on the size of the hole and what other risk factors he has for stroke as to the possibility of having another stroke. There is an increased risk of stroke in individuals with patent foramen ovale (PFO) but there may be other factors in your husbands case that contributed to his stroke. If the hole is on the larger size and he has no other risk factors he may wish to reconsider having surgery.
There is a new minimally invasive option called a "clam-shell" that can be placed in the heart across the hole through a needle stick in the leg and this may be another option for him. Dr. Latson is the doctor here who performs this surgery and you can make an appointment with him by calling the number below.
It would depend on the size of the hole and what other risk factors he has for stroke as to the possibility of having another stroke. There is an increased risk of stroke in individuals with patent foramen ovale (PFO) but there may be other factors in your husbands case that contributed to his stroke. If the hole is on the larger size and he has no other risk factors he may wish to reconsider having surgery.
There is a new minimally invasive option called a "clam-shell" that can be placed in the heart across the hole through a needle stick in the leg and this may be another option for him. Dr. Latson is the doctor here who performs this surgery and you can make an appointment with him by calling the number below.
There was an article published today in the New England Journal of Medicine talking about your exact question.The authors support the repair due to a higher incidence of ischemic stroke occurring in this population.I did not have forman ovale but I have had open heart surgery at age 45 to repair a valve .Unfortunately at age 47 I had a massive stroke thateven after two years has left me disabled.Seek a cardiac surgical opinion from a cardiac suregon in a large academic teaching facility before making a final decision. The congenital defect is repaiarable and your husband will recover from the surgery.He may not recover from the stroke.
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