Can a PFO cause a stroke?

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Dr. Robert J. Cubeddu is the Medical Director of the Structural and Adult Congenital Heart Program at Aventura Hospital and Medical Center, Miami, Florida. Dr. Cubeddu trained at the Massachusetts General Hospital in Harvard Medical School where he acquired expertise training in minimally invasive catheter-based technology to treat multiple structural heart related conditions.

In this transcribed interview Dr. Cubeddu speaks about PFO closure.

Q: What is a PFO?

A: A PFO is the abbreviated term for “patent foramen ovale”; a small “tunnel-like” hole or communication present along the septal wall that separates the upper two chambers of the heart. Typically this hole closes shortly after birth, however in some people the hole may never close and can remain open throughout adulthood, possibly increasing the risk of stroke.

Q: How many people have a PFO?
A: It is estimated that approximately 20% of adults have a PFO, that is 1 in 5 people. In most cases, having a PFO is medically not important. However, in a small percentage of patients with a PFO it may be associated with the development of stroke and/or migraine headaches.

Q: How do you check for PFO? 
A: A PFO can be diagnosed with a conventional echocardiogram using the administration of “agitated saline” . This diagnostic test is simple, routine, non-invasive, and takes approximately 10-15 minutes.

Q: Who should be checked for a PFO?
A: Patients with unexplained strokes or history of debilitating migraine headaches should be evaluated for a PFO.

Q: Can patients have their PFO closed?
A: Yes, PFO closure is possible and recommended in some patients. The objective of closing the PFO is to prevent future strokes in patients who have not had success with blood thinners or simply cannot take them.

Q: How can patients have their PFO closed?
A: Nowadays, PFO closure may be performed by skilled operators with expertise training in structural heart interventions. The procedure takes approximately 1-2 hours and is performed through a minimally invasive 5 mm incision at the level of the groin under local anesthesia. A long catheter is carefully maneuvered up to the heart across the PFO. A special double-umbrella device is then delivered through this catheter to close the PFO successfully. The procedure is pain-free. Recovery times are short with nearly all patients discharged by the following morning.

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