Wednesday, January 14, 2009

To plug or not to plug...

Interesting article in The New York Times about lack of solid evidence of whether a patent foramen ovale is a stroke-causing condition.

The patent foramen ovale was one of two heart defects corrected in a procedure I underwent in June 2007. A PFO is a hole in the heart, between the two upper chambers. Everyone is born with the hole and most of the time, it seals up shortly after birth.

Another complication, described from a previous posting:
The wall between the two chambers, called the atrial septum, should be smooth and flat. If so, even a patent foramen ovale is unlikely to cause a problem. In some instances, though, the atrial septum is misshaped, called an atrial septal aneurysm. The hole and the aneurysm combination increases the chances of a problem.
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 patent 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.
To combat the problem, in June 2007, a doctor snaked a tube into my heart through a catheterization procedure, and deployed a device to plug the hole. My mother went through a similar procedure - not a PFO, but another type of hole - late 2008.

Now, as stated in the article, this connection between a PFO and a stroke isn't absolutely proven and that the Federal Drug Administration hasn't approved the specific use for the device. Won't prevent the use - just doesn't officially approve that specific use, according to The New York Times article.

Will plugging a PFO guarantee no more strokes, ever? No. The world doesn't work that way. That being said, no other explanation was ever found for my stroke. I had none of the classic indicators - cholesterol good, blood pressure good, nonsmoker, longtime distance runner, not overweight. I feel good about my decision.

More research needed? Yes, yes, yes. Even those convinced that the PFO and connection exist agree. How will the research be conducted? Who's willing to take the risks of fatal consequences? Questions seeking answers.

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