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Stroke Smart Magazine

September/October 2008
Q & A

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A Hole in the Heart: PFO and Stroke

with Salman Azhar, M.D.

What is a PFO?
A patent foramen ovale (PFO) is a small “hole” in the heart between the left and right atrium. Everyone is born with this opening, which resembles a flap. In most people, the flap seals itself shortly after birth. But in others, the flap does not close completely and can open whenever the chest is strained, such as during coughing or sneezing. When there is a PFO, blood that has not been cleansed by passing through the lungs can flow through the flap, carrying debris and blood clots through the opening and into the bloodstream.

How many people have a PFO?
Nearly 20 percent of Americans have a PFO, but many don’t know it because there are no symptoms.

What does a PFO have to do with stroke?
Having a PFO can increase stroke risk. Most strokes are caused by blood clots clogging arteries to the brain and cutting off normal blood flow. When a part of the brain is deprived of blood and oxygen, it begins to starve and die. Blood clots can travel from any part of the body through the PFO to the brain. Every year, approximately 100,000 Americans suffer
PFO-related strokes.

If I’ve already had a stroke, why should I care about PFOs?
Having one stroke automatically puts you at risk for a second. If doctors were unable to pinpoint the cause of your stroke, they may choose to look for a PFO.

How are PFOs diagnosed?
A diagnosis usually does not come until after a stroke or other event has occurred to make doctors suspect a PFO. By taking a picture of the heart, using an ultrasound, doctors can see if there is a PFO.

How are PFOs treated?
You may choose to treat the PFO or do nothing at all. Currently, there are three main treatment methods for PFO.

  • Patients with a diagnosed PFO can take blood thinners. While the drugs do not seal the flap, they may control the amount of blood clots formed and reduce the number of clots that could possibly travel to the brain. The drugs, called anti-platelets and anti-coagulants, must be taken daily and regularly to be effective.
  • The PFO can be closed with open-heart surgery.As with any major operation, patients and their doctors should weigh the risk and complications of surgery against the benefits.
  •  A less invasive procedure can seal the flap. An implanted closure device, which resembles a tiny umbrella, is delivered to the PFO using a small tube threaded from a vein in the thigh up to the heart. The implant is released and expands in the flap, plugging the hole. The tube is then removed. Tissue grows in and around the implant to seal the PFO. Done typically as an out-patient procedure, it requires less recovery time than surgery.

If you have had a stroke, but did not have any obvious risk factors leading to the stroke, ask your doctor about PFO.

For more information on PFO and stroke, go to www.stroke.org/PFO.


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