Muzam Agha
I have something in common with Bret Michaels—we both have a patent foramen ovale, or PFO, which is a flap-covered hole between the left and right sides of the heart. After a string of health problems—an appendectomy, a brain hemorrhage, and, a small stroke (trans ischemic attack) which often precedes a more serious stroke, Michaels’ doctors found the PFO. In the fall he’ll undergo a procedure to repair the defect in order to lessen his chances of having a full-blown stroke.
A couple of years ago I found out during some tests that I have a PFO, so I’m pretty curious about Michaels’ treatment. Should I do something about mine? I’m in my 30s and healthy and I’ve never had a stroke. David Coven, M.D., an interventional cardiologist at St. Luke’s Hospital in New York, NY, (and my doctor) says the vast majority of people who have PFOs don’t have strokes. Though about one in four people have a PFO, few people actually know it.
It turns out every heart has a hole between the left and right atria (the upper chambers) before birth, according to Rich Krasuski M.D., director of adult congenital heart disease services at the Cleveland Clinic Foundation in Cleveland, Ohio. It allows blood to bypass our lungs, which don’t function until we’re born. After birth, the flap seals shut, redirecting blood flow into the lungs. A flap that doesn’t seal is a PFO, but they generally don’t affect a heart’s ability to function because arterial pressure ensures that blood will flow through the lungs for the most part. However, it’s conceivable that a clot could pass through the PFO and head for the brain, blocking blood flow and causing a stroke.
Whether or not closing the flap will be beneficial for Michaels is uncertain. A causal relationship between PFO and stroke hasn’t been established, so the medical community has yet to settle on whether this is the best treatment. At this point, blood thinners such as aspirin or Coumadin are usually the first line of defense. If more warning strokes or an actual stroke occur while the patient is taking blood thinners, then PFO closure is considered. But, if the use of blood thinners seems risky—say in the case of a patient who has a history of heavy bleeding such as Michaels with his brain hemorrhage—PFO closure may be the safer option.
Now what about someone like me who has a PFO but hasn’t had a stroke? Corrective surgery isn’t necessarily the answer—in some cases, its repair has created an even greater short-term risk of stroke. “If you’re asymptomatic there is no reason for an intervention. The best thing you can do is focus on controlling cholesterol levels and high blood pressure, eating right, and exercising regularly. Don’t focus on theoretical risk,” says Krasuski, “PFOs are very common, but it’s very uncommon for them to cause problems.”
So, I’ve taken the advice of these doctors. Whenever I find myself sitting around wondering whether this little old hole can harm me, I get off my butt and go for a run.
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