patent foramen ovale (PFO)

I was recently diagnosed (finally) with a small PFO with right shunting and mitral valve regurgitation (1st echo indicated a large PFO; TEE indicated a small PFO with mv regurg).  I have a history of irregular heart rhythms, rapid heart beat (100 normal, 80 resting)(all of which drive me crazy and are supposedly benign) and irregular E.K.G.  About 25 yrs ago I was diagnosed with a pulmonary embolism and placed in intensive care with heperin I.V. They could not substantiate the embolism and as I was still feeling bad weeks after the hospitalization, they diagnosed T.B. All skin tests and lung tissue cultures were negative, but X-ray looked suspicious - - - so I took the medication for 1-1/2 years.   My questions are:  Isn't it logical that it probably was an embolism because of the PFO and that I could possibly have another? I understand that the risk of closing the hole is high, but who wants to live with the risk of a stroke? I was not told to take an asprin or put on blood thinners.   I was cautioned to watch for swelling in my ankles because of the possiblity of a stroke and they would echo again in 5 years. Should I get a second opinion?  And what I really want to know is how would a cardiologist feel if they were given this diagnosis in a ten minute office visit and what treatment would they want to have?

[CCF CARDI MD - CRC]

The potnetial concern with a PFO is a stroke which is a left sided embolism.  You had a pulmonary embolism which is right sided and not related to a PFO. Conservative treatment for a small PFO is aspirin alone.  Some are recommending more agressive treatment such as closure but the benefits and risks must be weighed for each patient.  I would suggest a second opinion, perhaps with a pediatric cardiologist who is using some of the new minimally invasive closure devices.

[shannon]

As a PFO patient myself, I really think you should get a second opinion.  Did this first opinion come from a cardiologist, a neurologist, or a surgeon?  Five years is a long time between echoes for someone with a documented PFO and mitral valve regurgitation.  

For what it's worth...

Shannon

[Cleveland Clinic, MD]

Thanks Shannon.

[frustrated]

Thanks for your comments.  I really appreciate it.   I saw a cardiologist.   She did not seem to be concerned at all about the pfo and mitral valve regurg.   Even though they were documented in the TEE, the pfo was small with small amounts of right shunting and the mitral valve regurg was there, but very slight according to the TEE.   Question:   can either get larger or worse over time (I am 51)? and Should I really get a second opinion, if the cardiologist didn't really seem too concerned?  (By the way, I work for an academic health science center and the cardiologist is on the faculty and has a very good reputation)
Again, thanks so much!

[Cleveland Clinic, MD]

It can progress over time and will need to be followed.  In general we will follow patients such as yourself on a yearly basis.  If the PFO is small and there is no right to left shunting conservative management is probably OK.

[gretchen73]

A related discussion, holes in heart was started.