Repair of a Patent Foramen Ovale

[Mary]

I am a 45 y/o female suffered a stroke in 1998 and recently hospitalized for recurrent TIA's.  Dx in 1998 with PFO, coumadinized since. I would like an opinion on having the percutaneous procedure to close the hole as opposed to open heart surgery which is already scheduled at Nothwestern Hospital in Chicago. Dx presently is failed Coumadin Therapy.  Thank You

[CCF CARDIO MD - CRC]

Dear Mary,

Given your history I agree that the PFO needs to be closed.  The approach will depend on the size of the PFO and the general approach of the doctor.  Generally smaller PFOs (<25 mm) can be closed with a percutaneous procedure.  Larger PFOs require surgery, which is a simple surgery.  If you would like a second opinion here at the Cleveland Clinic I would recommend Dr. Latson.  You can make an appointment with him by calling the number below.

[Dan]

Dear Mary:



Except that I am male and now 54 (52 when PFO/stroke emerged) my situation was enough like yours that I feel compelled to give my input in the hope that it will help you. While a college-level biology professor, I am not a physician, so take what I say as simply a shared experience and not medical advice.  



Several inquiries into my own situation did not shed very favorable light on percutaneous repair regardless of the size of the PFO.  The reason is that the "clamshell" and other such devices aren't particularly efficacious.  I do admit that I, like you, was looking for the most non-invasive procedure.  After several consultations including a Cleveland Clinic trained heart surgeon, I elected surgery.  The two surgical approaches are the minimally invasive mini-sternotomy or the complete midline open chest procedure. I understand that most women - and lots of guys too - want the least amount of scarring and that is the reason for the evolution of the "mini." However, as my surgeon stated it, the complete is more tried and true and why give the guy working inside your heart any less than the optimum amount of room within which to work ?  I did have the complete midline and within several weeks the scar faded to just a hairline in width and about 8 inches long and is not at all disfiguring.



Now, regarding the Med Help Doc's response to you, I believe his statement about the simplicity of the surgery may be a little misleading and out of line.  Technically, for the surgeon it may not be one of his greatest challenges and the success rate of the surgical closure is very high.  But, make no mistake Mary, if you go surgical, it is open heart/open chest surgery and has the same protocols and recovery as any other serious open heart procedure. I don't want you to go into this thinking otherwise.  You will need support, understanding people around you and time to recover, and will need to work back into your normal routine moderately.  I acknowledge everyone is different.  I have always been fairly fit and, in addition to my academic background, I have done some cowboying and ranching.  Still and all, it has taken a while to get back up to speed.  The good part is, Mary, once the PFO is closed, its fixed and we have at least made a positive move toward good health and a long life.



Best of Luck

[CCF CARDIO MD - CRC]

Thanks for your comments Dan.  You are correct that surgery is still open heart surgery.  I was refering to the technical aspects of the procedure which are relatively simple.  Dr. Latson is a cardiologist here who can perform the "clamshell" procedure if appropriate or can refer to a surgeon who can do the surgery.

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