Wednesday, June 27, 2007

Hole replaced by hope

 As mentioned in the previous post, on Monday, June 25, 2007, my patent foramen ovale (hole between the two upper chambers of the heart) was closed via cardiac catheter.

The hole was plugged with an Amplatzer "Cribriform" device, which places two nickel-titanium alloy discs of metal mesh and polyester fabric, just under an inch across, on each side of the hole, shutting off the flow from vein side to arterial side. The video above, which is a depiction of how the device would be placed, came from the Web site, owned by the AGA Medical Corp., the manufacturer.

And the placement of this device, of course, brings hope of preventing future strokes.

For anyone who is considering a similar procedure, the catheterization procedure itself was almost painless and took about 45 minutes. I was vaguely awake most of the time, watching quite a bit of the process on a monitor mounted to my left. But afterward, you'll have some sore legs for several days and restrictions for several weeks. Follow them to the letter. It's hard for a distance runner to be sidelined, but some things can't be rushed. Even hope.

Speaking of hope, my hope is that this experience might give hope to someone in similar circumstance. So here' s to hope, gifted to us by God.

Tuesday, June 19, 2007

There's a hole in my heart

A word to the around-40-year-old set: It can happen to you, too. Strokes are not always confined to the elderly.

I post this not to encourage pity, but rather to issue a warning: Be aware of stroke symptoms, even if you're young and in the best of health. A lurking birth defect can cause trouble, and it's important to act promptly when you even suspect stroke symptoms.

The above video is an experiment, so please forgive my amateur presentation. But considering the information below, it might save the life of someone you love -- or your own.

For nine years, I've had the nagging information that there is a small hole in my heart (more information to follow) that, in all likelihood, contributed to my stroke in 1998. A minor transient ischemic attack in April 2007, though, put that hole back on my radar. And with it, a hope to drastically reduce my stroke risk. Permanently.

Thus the video. It's from a transesophageal echocardiogram, big words to describe a camera that goes down your gullet to capture images of your moving heart. It was conducted at the Missouri Heart Center in Columbia, Mo. This is one snippet and it's my best guess of the location of the hole. At one point of the video, you see no color, then a burst of blue then red, appearing to pass through a small hole. If it's wrong, I'll correct the video. Again, it's my amateur's best guess.

The hole is between the two top chambers of my heart. This is a common birth defect. There are a few complicating physical factors -- based on the characteristics of the wall between the two chambers -- that places me at relatively high risk of stroke. So a doctor in St. Louis will snake a tube through some arteries to the heart and apply a patch device, comprised of two quarter-size pieces of nickel-titanium mesh. This is the same procedure done on Tedy Bruschi, a current New England Patriots linebacker.

The heart procedure is set for Monday, June 25. Dr. John LaSala will conduct this procedure at Barnes-Jewish Hospital.

Warning: This is written by a non-doctor. So please, don't take this as actual medical expertise. It's the best I can do, and it's probably 'way too simplified. If you think you're having or have had stroke or TIA symptoms, see a doctor. Now.

I offer these details to illustrate how it can happen to a relatively young, relatively fit person.

The small hole between the two atrial chambers is called a patent foramen ovale. Everyone is born with the hole and, depending on who you ask, somewhere between 75 and 80 percent of the time, it seals up shortly after birth. That means about 1 out of 4 or 5 people actually have a foramen ovale, which is not a huge problem. For most.

There are exceptions to that statement, though; my particular problem centers on the muscular wall between the two chambers, called the atrial septum. It should be smooth and flat. If so, the vast majority of people with a foramen ovale never know and no problems ever develop. In some instances, though, the atrial septum is misshaped, called an atrial septal aneurysm. That's where the problem arises.

Normally, the right atrium receives blood from the vein side of the circulatory system, then passes it along to the lungs. In addition to processing oxygen for the blood supply, the lungs also use a filtering mechanism to remove debris, such as clots. From the lungs, the blood is moved back to the other side of the heart and pumped out to the arterial system, supplying oxygen-rich filtered blood to the body. However, if the atrial septum has a divot, if you will, then debris can collect. When pressure builds up in the chest -- say, from coughing or sneezing -- then blood and debris can move through the foramen ovale from the right atrium to the left atrium, circumventing the lung's filtering system. Unfiltered blood is pumped out into the body, including the brain.

Because of this, nine years ago I experienced a cryptogenic stroke -- that is, a stroke with no obvious cause. Last April, a much more minor episode occurred, which triggered a round of tests recently completed. As long as the current conditions remain, my risk of stroke is several percentage points higher than the rest of the population, despite the fact that I don't smoke, have low cholesterol levels, excellent blood pressure readings and, being a distance runner going on 20 years, am generally quite fit.

Dr. LaSala will use an arterial catheter to insert a metal-mesh object that, once in place, will expand into shapes that look like two small umbrellas and cover the hole, one on one side and one on the other. Over time, scar tissue should cover the patch and permanently seal it against the atrial septum.

The final result: My stroke risk will fall dramatically and should actually be lower than the general population. I anticipate a complete recovery and, in fact, to be in better health than ever.

That, at least, is the plan. What will happen? It's not up to me. But I trust the one who is in charge.