Tuesday, March 20, 2012

A follow-up about holes in the heart

Almost five years ago - how time does fly - the hole between my two upper chambers were closed by a catheterization procedure.

Doctors had guessed since 1998 that my stroke at that time was caused by a series of actions:
  • A hole in the heart we're all born with - patent foramen ovale - never closed.
  • The wall between the two chambers was not a nice straight, smooth surface, but was more wavy with a divot, also called an atrial septal aneurysm.
  • Normally, blood pumps into the vein side of the heart, then out the lungs to get oxygen and get filtered for clots and debris, the back into the arterial side and eventually out to the brain and body,
  • However, clots and debris could collect in the divot and with a little extra chest pressure - even a sneeze - could push that from vein side to arterial side, bypassing the filtering process.
  • The clot or debris is pumped out to the brain.
  • Stroke happens.
So, after a transient ischemic attack, or a TIA mini-stroke, in 2007, I decided to take an offer to close that hole. (See video below.) It went great. A little over a year later, I finished a marathon.

Now, however, a new study stirred questions about whether the procedure works any better than medication. I was on a blood-thinner called warfarin, or Coumadin.

I think, though, one important takeaway from this research came from an ABC News quote:
Dr. Anthony Furlan, the study's lead author and chairman of neurology at University Hospitals Case Medical Center in Cleveland, said the evidence just isn't there to support a PFO closure procedure over simply giving patients medication.
"We're not saying there are no patients who should have the hole closed, but we are saying the selection criteria have to be radically refined," he said. Ideally, a patient would be under age 45, have a very large hole in their heart and a heart defect called an atrial septal aneurysm.
When my stroke occurred, I was a "young" 39. Plus, the atrial septal aneurysm was - now much more solid thanks to the device implanted - present.

Did I really want to be on a sometimes-dangerous blood thinner for the rest of my life? No. For me, I think the closure was the best choice. Is it  for everyone? The real answer, like many medical answers, is not so clear. Each individual's circumstances should be considered.


Linda said...

It sounds like the procedure was a very good choice for you. I am glad you have done so well.

Jeff Porter said...

Yes - been told that now, my stroke risk is back down to normal, perhaps even better than normal.