2012 ISSUE 3: PREVENTION
Understanding the Connection between PFOs and Stroke
By Lisa Pogue
An estimated one in five Americans has a Patent Foramen Ovale (PFO) or, in simple terms, a hole in the heart. Since PFOs often have no symptoms, many people don’t know they have one until a medical condition like a stroke or transient ischemic attack (TIA) occurs. When someone with no obvious risk factors suddenly has a stroke, doctors will check to see if it was caused by a PFO.
Having a PFO may actually increase your risk for stroke and TIA by up to 25 percent. Because they are the most common type of heart defect, it’s important to know about PFOs and how to treat them.
Where Did This “Hole” Come From?
All people are born with flap-like openings in their hearts. The opening typically closes by itself shortly after birth. But in some cases an open flap remains between the two upper chambers of the heart and can eventually allow a blood clot from one part of the body to travel through the flap and up to the brain, causing a stroke.
Getting Diagnosed and Finding Treatment
An ultrasound of the heart can show doctors if a PFO is present. The next step is to ask about treatment options. Currently, there are two main treatments for PFO: medicines or PFO closure, which can include open-heart surgery or a newer procedure that closes the flap without major surgery.
Medications don’t treat the actual PFO, but they can control clotting factors in the blood, making stroke-causing clots less likely to form. These blood-thinning drugs must be taken daily to be effective.
Open-heart surgery is another option to close the PFO. But, as with any major surgery, you should weight the benefits and risks with your doctor.
A new approach has been developed enabling doctors to seal the PFO without major surgery. An implanted closure device, resembling a tiny two-ended umbrella, is delivered to the PFO using a small tube that is threaded to the heart from a vein in the thigh.
The implant is inserted through the flap and released from the tube. It expands and tissue grows in and around the implant to seal the PFO from both sides. This procedure requires minimal recovery time. The U.S. Food and Drug Administration allows this treatment method only for people who don’t respond to the medicines and have already had a second stroke.
Research on whether medicine or PFO-closure procedures are the better option is ongoing. Doctors are working to find out which is better at helping reduce the risk of recurrent stroke and, in order to produce meaningful and productive studies, researchers need clinical trial participants.