Tuesday, August 02, 2016

Another chapter of: To close or not to close

A still from the video of my PFO closure.
Click here to watch a video.
The arguments continue: To close or not to close.

Back in 2007, after a mini-stroke that spring, I had a heart procedure designed to close a hole in my heart called a patent foramen ovale (PFO). It's a hole between the upper two chambers of the heart and was blamed for my 1998 stroke and the 2007 mini-stroke. I was taking a blood-thinner at the time.

You can read the story about the procedure, including video, by following this link.

Now, the American Academy of Neurology says we should not routinely close the hole. Others disagree. Click on the link after reading this snippet on how AAN nixes routine PFO closure:
Patent foramen ovale (PFO) closure is not recommended as a routine therapy for patients with cryptogenic ischemic stroke, according to the American Academy of Neurology (AAN).
A systemic review of the literature for the Academy's stroke care guideline update published in Neurology turned up no stroke prevention benefit with the STARFlex PFO occluder compared with medical therapy alone ... .
With the Amplatzer, however, there was a decreased risk of recurrent stroke ... at the cost of more new-onset atrial fibrillation ... and a procedural complication risk of 3.4% ... .
Thus, "in rare circumstances, such as recurrent strokes despite adequate medical therapy with no other mechanism identified, clinicians may offer the Amplatzer PFO Occluder if it is available (Level C)," the guideline development subcommittee of the AAN wrote.
Yet "this practice advisory is out of date," warned John Carroll, MD, of University of Colorado Hospital in Aurora, because the AAN did not have access to the latest 5-year data from the RESPECT trial. "The composition of the AAN group did not include one interventional cardiologist," he added. "In 2016 it is odd to have a proclamation about the value of a procedure without anyone on the group ever having performed the procedure."
Bottom line: I waited for nine years before having the hole in my heart closed until it became clear that I had a real risk of a follow-up stroke. Talk with multiple professionals about your risks and your decision.

I'm convinced that my stroke risk is now down to the general population instead of a higher risk due to my PFO. But those decisions must be made individually.

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