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.


Deona said...

Hi ,I also have a hole in my heart and a small aneurisym on the right arriam,My docter has told me to wai tand see what happens,he said the surgery is a risk for stroke and heart attack,the catheters surgery is new here and my doctor has told me I should wait a few years until they have performed a lot of them.I can not take blood thinners because of a hiatel hernia,it causes bad stomach problems,I am a 45 year old young woman who was a former Miss figure U.S.A and am in great shape but I am worried about this,I do not know what I should do ,I feel tired a lot,and have a low pulse with skipping beats 46 to 50 beats per minute. I live in Ottawa Canada and suppossibly the Heart Institute here in well knowned.I have moved here from the states and do not know much about it.I would love any suggestions you might have. I hope your surgery goes well! Deona from Canada

Jeff Porter said...

It sounds like you've got some other issues going on -- the symptoms of being tired and skipping beats. I had no such symptoms before or after my stroke. I'm not a doctor, but I strongly suggest a cautious approach. If you are uncertain why you are having those symptoms, you need to get to the bottom of that. I must plead ignorance of the Canadian health system, but would it be wise to seek opinions of other doctors in, perhaps, Montreal? I am not certain which doctor treated Tedy Bruschi, who I mentioned in the posting, but likely would be in the Boston area. That might be another resource to explore. The Web site for the Cleveland Clinic -- http://www.clevelandclinic.org/ -- seems to have a lot of good information to explore as well.

My own recovery is complete -- I'm back to running and, to be honest, I can't tell any difference between now and before the procedure.

Deona, you are in my prayers, and if it is OK with you, I'll put you on a prayer list at my church.

Anonymous said...

Hi I also have had a stroke and open heart surgery I was 19 yrs old and it was due to the hole in my top chamber of my heart they had told my parents when i was younger she'll grow out of it well no one morning i woke and went to take a shower before school (college) and well i felt dizzy and got back out and was going to sit down well it didn't happen like that on the way out of the shower i fell that is when i had my stroke at that moment I was awake not sure what was goingon my daddy heard me an knocked on the door and asked if i was okay he heard a loud noise it was me hitting the bathroom floor i said well no Im on the floor and don't know why and it didn't hurt I can't feel any of my left side then i opened the door with a towel over me and he looked at me an yelled for my mother and she came in to the room looked at me and said we have to take her to the hospital something is really wrong with her so they rushed me to the hospital where they learned i had had a stroke and hole in heart then a week later they found i need surgery like soon the next month or so it was feb and i had surgery in april so little over a month and it was full open heart surgery at duke hospital i had to have a baby doctor since they only see this in babys and they knew that the hole was the size of what looked like dime but the day of surgery they found it was the size of a fifty cent peice which is like the whole top chamber wall so they did fix it i do have some other health problems and they link to the stroke but it has been almost 6 yrs and im doing good I have only a three inch scar but they did cut and break my chest bone so im lace like a shoe but im alive and wel thanks to GOD I give him all the praise for being alive to day it was him that saved me not man they help but GOD did the most of it I did die twice so that is where he came in ..Gina NC

Anonymous said...

Hi there-- thanks for your comment to my blogpost! I will be linking from my post to your site (I hope you don't mind.) It's great to hear from someone who has had a similar procedure and who has gone through some of the same things that I have.

Thanks again!

Jeff Porter said...

It's been some busy few weeks, so sorry I didn't get around sooner and say thanks for the recent comments and sharing your own experiences. You are both in my prayers.