Possible PFO?

[jewel1231]

I am a 25 year old female and recently I have started to get some strange health problems.  Two years ago, I suddenly went numb on the entire left side of my body.  I went to the ER and they were unsure of the exact cause of my problems, but some ideas were a complicated migraine, TIA, or early onset of MS.  A brain MRI showed a non-specific periventricular white matter lesion on T2 weighted images.  My numbness lasted for approximately a week, and during that time I also could not move my toes, and had significant memory loss (and trouble remembering words).  A year later I had another similar incident.  The neurologist following my case left the practice, so I saw a new neurologist who told me it was most likely related to stress and not to worry about it.  After this incident, I started developing extreme fatigue, to the point where I still feel exhausted sometimes after sleeping for 10+ hours.  I had a bunch of blood work done, but the only thing that came back was low-positive ANA (1:80 speckled), and low-normal B12 (240).  

After I went numb for the third time (this happened a few months ago), I decided to see a new neurologist.  This neurologist seemed much more interested in my case and didn't attribute everything to stress.  He suggested that I see a cardiologist to be evaluated for a PFO (patent foramen ovale) since it can cause TIA's, as well as migraines with aura (which I started getting a few years ago...around the same time the numbness started).  I couldn't get an appointment with the cardiologist that he suggested for over a month, so I saw a different cardiologist first.  He decided to do a transesophogeal echocardiogram with bubble study.  He said that he saw no abnormalities, and no PFO or ASD.

I decided to keep my appointment with the cardiologist that the neurologist recommended for a second opinion.  She agreed that a TEE is the best test for detecting a PFO, but when she looked at the other doctors images she said that some necessary views were missing and based on what she saw in his images she couldn't rule out a PFO.  She did a transthoracic echo with bubble study and saw shunting on color doppler, as well as shunting after saline injection (on 2 out of the 4 injections).  She feels these findings are consistent with a PFO and is sending me to an interventional cardiologist for a consultation about closure/treatment.  She feels that it is very possible that the PFO is causing my symptoms.

I decided to call the first cardiologist and discuss the new findings with him, and he still feels strongly that I do not have a PFO.  He says that a TEE is the gold standard for detecting a PFO, and if it wasn't seen on his test that the shunting seen on the transthoracic echo must be a false positive, or due to something else besides a PFO.  He seemed quite annoyed that I was doubting him.

One more issue... I will be on a long plane flight in two weeks.  The neurologist and the cardiologist (the one who feels that I do have a PFO) say that I will be okay to fly with some basic precautions (hydration, etc).  The other cardiologist (who said I didnt have the PFO) says that if this cardiologist is correct and I do have a PFO that flying is dangerous, and I should have a repeat TEE before the flight and possibly start taking coumadin!

I am very confused now because I have contradicting test results.  Has anyone here had a similar experience with diagnosing a PFO?  Can anyone share their experiences with me on their symptoms, diagnosis, treatment?

I'm sorry if this is confusing and long.  I'm pretty confused with all of the different opinions right now, so it's difficult to put it into a concise story!  Any help or opinions would be greatly appreciated!

Thanks in advance!

[bubbles642]

I had a bubble test with a grade 5 positive.  Then I had pfo closure surgery for it. Guess what? The. Doc could not find the hole. He looked for 2 hours. Has this ever happened to anyone else? Now I have to repeat tests, not a happy camper especially if it means another surgery. Anyone have any ideas?

[kenkeith]

The thoracic echo may not see what a TEE observes as a thoracic may not have clear image based on some blockage or obstruction.  However, the bubble test with the doppler (color coded blood flow) can plainly see any shunting of blood from one chamber to the other.  The shunting of blood between upper chambers is almost always due PFO, but there can be a pattern of blood flow through the septum (wall that separates lower chambers).  An echo can determine where and how large the opening is, as well as how much blood is passing through it. In addition, the echocardiogram can help determine if other problems are present or if the defect can be closed with a minimally-invasive catheter device.

I don't know of any limitations such as avoid flying....