Patent Foramen Ovale (PFO) Closure: Diagnosis, Symptoms and Treatment Options

Intro: MemorialCare Health System, Excellence in Healthcare, presents Weekly Dose of Wellness.

Bill Klaproth, Host: Okay, here's a stat that may blow your mind. According to the American Heart Association, more than a quarter of the population has a hole in their heart. Now, for most, it causes no adverse health effects, and the majority of the affected don't even know they have it. With us is interventional cardiologist, Dr. Sarah Elsayed. She is going to discuss how these PFOs, that's what they're called, it stands for Patent Foramen Ovale, that's what they call a hole in your heart. She's going to discuss the signs, the symptoms, and the treatment options available. Dr. Elsayed, welcome.

Sarah Elsayed, MD: Hi Bill, thanks so much for having me.

Bill Klaproth, Host: You bet, Dr. Elsayed. So let's start here. This is really interesting. Can you tell us what a PFO is and how does it develop?

Sarah Elsayed, MD: Yes, absolutely. A patent foramen ovale known as PFO is a small hole in the heart communicating between the upper two chambers of the heart. It is present before birth, aiding in oxygenation to the fetus, baby, and usually closes after birth, but can remain open in 25% of the population.

Bill Klaproth, Host:So when we say this is a hole in your heart, it's not actually a real hole in your heart, right? There's something mechanically not correct. What is it? How does this work?

Sarah Elsayed, MD: I appreciate your interest and enthusiasm in that it's actually a flap. So this hole is between two pieces of tissue between the right side of the heart and the left side of the heart. When this flap opens under certain circumstances, a piece of clot or debris can pass from the right side of the heart to the left side of the heart and then potentially up to the brain causing a stroke. So this little flap is internal in between two chambers.

Bill Klaproth, Host: Well that makes sense. So thank you so much for explaining this to us. So you mentioned someone could have a stroke because of this. Are there common signs and symptoms that we should look out for? And how is a PFO typically detected and diagnosed?

Sarah Elsayed, MD: That's an excellent question, Bill. The common signs and symptoms include an unexplained stroke, meaning no clear cause has been identified for the stroke, and this is known as a cryptogenic stroke. Difficulty speaking, blurry vision, weakness in an arm or leg can be signs of a stroke. The evaluation of a stroke is usually performed by a neurologist, brain doctor, and cardiologist, heart doctor. Diagnostic testing, including images, scans of the brain and arteries of the brain, is performed. An ultrasound of the heart, which is called an echocardiogram, is done to evaluate and visualize the PFO. Heart monitoring is also done.

Bill Klaproth, Host: So for someone who has had a stroke because of a PFO, do you then go in and fix the hole or the flap as you call it?

Sarah Elsayed, MD: That is correct. The ideal candidate for PFO closure is a patient who has had a stroke that is not due to a blockage in the arteries of the neck or brain due to hardening of the arteries and not due to an irregular heartbeat called atrial fibrillation, thus very likely due to the PFO.

Bill Klaproth, Host: So are there circumstances where a patient's PFO would not need to be closed?

Sarah Elsayed, MD: Yes. The circumstances in which a PFO would not be closed is no history of stroke or a stroke due to a brain bleed, severe blockage in the carotid artery, or atrial fibrillation.

Bill Klaproth, Host: So can you tell us about the PFO closure procedure and what does the follow-up and recovery look like?

Sarah Elsayed, MD: Sure. During the PFO closure minimally invasive procedure, the patient will be under general anesthesia or moderate sedation, known as twilight. A small tube like an IV will be placed in the upper thigh groin area into the femoral vein. A catheter will be directed to the heart and the PFO closure device will be advanced under X-ray visualization to the appropriate position and released. Then the catheter will be removed and the IV removed. The patient will stay overnight for observation and be discharged next day in the morning after an ultrasound of the heart is performed confirming good position. Two blood thinners will be given, aspirin and Plavix, for six months. Patients will be able to walk and do activities normally after discharge actually.

Bill Klaproth, Host: So since there are no initial warning signs before the onset of a stroke, what stroke symptoms should we be aware of?

Sarah Elsayed, MD: I'm glad you asked that, Bill. My recommendation would be to seek medical attention immediately if you think you're having symptoms of a stroke. Call 911. If you have already been diagnosed with a stroke, then seeing a cardiologist is key to rule out a PFO as a potential cause.

Bill Klaproth, Host: Got it. And then what support and resources are available post procedure to a patient through the MemorialCare Heart and Vascular Institute?

Sarah Elsayed, MD: Post procedure, our staff will help the patient with education about the new blood thinners. Follow-up echocardiography to visualize the device is typically done at intervals such as three and six months as an outpatient and can be done at the MemorialCare Heart and Vascular Institute. I would like to make note though, Bill, that the PFO closure procedure is a simple method to prevent future strokes that can be life-threatening or life-disabling in the appropriate patient. And we are here to serve the community and it is an honor.

Bill Klaproth, Host: Well that's important to know the support and resources that you offer. And as we wrap up, Dr. Elsayed, since a quarter of the population has this, one in four people, people might be thinking to themselves, oh my God, I might have this. My loved one might have this. This condition doesn't result in a stroke very often, is that right?

Sarah Elsayed, MD: That is correct. It's actually very rare to have a stroke due to a PFO. But once the workup is completed and no other cause is identified, then pursuing closure of the PFO is very important.

Bill Klaproth, Host: Right, you want to get it fixed. Well, Dr. Elsayed, this has really been informative and very interesting. Thank you so much for your time.

Sarah Elsayed, MD: Thank you, Bill. Thanks for having me on the show, and I appreciate your time.

Bill Klaproth, Host: That's Dr. Sarah Elsayed. And for more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. I'm Bill Klaproth. Thanks for listening.