Can PFOs stretch? and or get worse in some respect?

[Mat1994]

Hi,
well I was diagnosed with a PFO of diameter >10mm (1cm) a couple of years ago. The main reason I went in for the tests (echo cardigraph + MRI + some or ones, or something along those lines - forgive me I'm only 17 now) was due to an "Event" that took place during a VO2 max swimming training set (a result of having a valsalva manoeuvre). An event, as far as I can describe is sharp sudden pain in my upper left/central chest (where I can feel my heart pumping blood) followed my a series of pains down my left shoulder and arm, followed by dizziness, headaches and confusion (sometimes I forget where I am for a second or two, but it always comes back quickly). Incidentally another thing that sometimes happens is that I experience random sharp pains down the inside of my right leg, thought I'd just add that. At the time nothing much happened, I was instructed to stop pushing it hard in training sets, stop my scuba diving (obviously) and just take it easy and see what happens. I had a few more events since then but nothing as serious. Died down, nothing really happened for a while (year ish), but it cropped up again and I eventually decided to just stop swimming, as the events happened mostly whilst exercising. Again it stopped for a while, but recently I've started having sporadic events that seem unconnected e.g. I can be sat in bed doing very little and have what seems like an "event" or I can be in the shower and have similar things happen.
So I was wondering:
1) how come things are getting worse? the doctors said it would most likely go unnoticed.
2) can the diameter expand ( especially in younger patients)
3) is the increasing rate of "events" bad? and if so what does it foreshadow?

[ayl291]

1. Are you on any anticoagulation... To prevent paradoxical stroke?  Even 81 mg of aspirin reduces your chance of vte (pe, dvt).by 50 %.

2. Are you symptomatic in terms of cardiac issues, dyspnea, chest tightness , heart pressure/ pain? Or is just these episodes?

3.  How is your septum, is it anuerysmal, hypermobile?

[JessieMelton1972]

I had my PFO in 2011. It was discovered because of a TIA event.  The bubble test revealed a decent sized PFO. I was 39 at the time and had been very active up until a year before due to a foot injury. During my life Inhad severe cramping even with excessive hydration. Later, it was thought to be totally due to being a sickle cell trait carrier. I trained and hydrated but still had cramping issues. Recovery time for me seemed much longer than my peers so the jock in me said suck it up and work harder.  Leading up to my TIA were a lot of headaches and the neurologist felt it was due to my sleep apnea.  Well once my PFO was closed it was like having a new body about a year afterwards. I would find a good cardiologist and neurologist team and press on this issue

[Mat1994]

yeah, they also said that It probably decreases the depth at which you are likely to nark. I think it's the nitrogen bubbles that are especially dangerous for some reason or another.

[ed34]

I know you said you have 2 Doctors as parents, but neither is a cardiologist. I am not sure where you are from, but in the UK it's not allowed for Doctors to treat or give advice to their own close relatives. If something was to happen to you, how would they feel, and how would their careers suffer as a consequence. I would just go to YOUR GP and give the symptoms. At least that way your parents are covered and of course you may get more tests which is very important.
I am wondering if you know how the research on scuba diving resulted with patients having PFO? They theorised that in people with no PFO, the tiny bubbles formed in the venous system become trapped in the lungs and are expelled. However, with PFO the bubbles can cross into the left side of the heart (bypassing the lungs) and end up being trapped in body tissue, causing brain disorders, weakness, dizziness etc.

[Mat1994]

It was deduced as a result of several tests I had done, sorry but I can't exactly remember all of them + their titles. ed34: yes, at the time the procedure discussed was catheterization but that was almost 2 years ago, if the diameter has increased it may have exceeded the limit for that kind of operation, and open heart surgery is at the best of times risky business (I've heard).

[Occupant]

I can't imagine that you can still funtion with that kind of a leak. But then, I am not a doctor - as an engineer, I would plug it as soon as possible. Did they find that out with a catherization or how was it measured?

[ed34]

I can't find any resources with regards to >10mm, but you would expect the same kind of relationship because the area does stretch over decades.
With regards to the risk of stroke, I would have thought the younger you are, the less the risk? wouldn't there be far less plaque in your arteries at your age for disturbance for example? I'm not sure if the closure procedure discussed was using catheterization or open heart surgery? Catheterization is used much more these days and is very successful, they basically spring a mesh into position which allows your heart muscle to grow over it, sealing the PFO.
This is a good site with pictures of many devices used in catheterization....

http://www.nwcchd.com/catheterizations.php#pfo

[Mat1994]

thanks for the advice and answers. I have two doctors for parents - a General practitioner and a neuro-surgeon - and at the time they seemed kind of worried, but of course played it off as nothing. They gave me the whole spiel at the time about the risks of having it closed and keeping it open, mainly hinting towards the possibility of having a cryptogenic stoke (I think it's called). Though this is what I'm mostly worried about. Some kids are strong, or skilled at sports... My gift is my mind, I'm hoping to apply successfully to cambridge for mathematics this time round (2012/2013), and am likely to do so, but a stroke could end this dream...that's what I'm worried about.
In respect to the increasing size of PFO, how does the increase in diameter relate to age increase, and does the relationship between 3.4mm to 5.8mm hold true for diameters >10mm ?
once again, thank you very much for the response.

[ed34]

I am a bit surprised that you are not getting symptoms with a Patent Foramen Ovale that is more than 10mm ?  I thought usually if they were over 9mm, then symptoms would occur, causing surgery to be a requirement.
1. When people have small Patent Foramen Ovale's they usually go through most of their lives with no problems, and until a scan is done, the condition is unknown. Later in life, the hole can increase, which may start to cause symptoms if large enough.
2. Usually, the hole increases with age, but very slowly. Autopsies reveal that a hole around 3.4mm would increase to around 5.8mm much later in life, many decades later. So, as you age, the surrounding tissue stretches.
3. Perhaps it would be a good time to have a second opinion on your Patent Foramen Ovale. I think you should have more tests now and evaluate if the symptoms are related.