Patent foramen ovale (PFO) is a heart defect at birth. It shows a hole in the wall between the heart’s upper chambers. Normally, this hole closes soon after a person is born. But 25% of adults may still have it open. This open space can lead to a stroke. A clot can pass through this hole and harm the brain. The exact reason why PFO happens is not clear. It could be due to the wall not fully closing while a baby is still growing in the womb.
Diagnosing PFO is done with an echocardiogram. This test uses sound waves to see into the heart. Doctors might also do a bubble test to check for the PFO hole. Treatment for PFO includes taking blood thinners like aspirin. Or, a doctor can close the hole with a special device placed through the skin. Another option is using stem cells to try and repair the heart’s damaged tissue.
Key Takeaways:
- Patent foramen ovale (PFO) is a congenital heart defect characterized by a persistent opening in the interatrial septum.
- PFO can be responsible for cryptogenic strokes, where a blood clot passes through the PFO, causing a stroke.
- Diagnosis involves echocardiogram and additional tests to confirm the presence of PFO.
- Treatment options for PFO include medical therapy, percutaneous PFO closure, and stem cell therapy.
- Stem cell therapy has the potential to repair and regenerate the heart tissue affected by PFO.
Percutaneous PFO Closure – Controversies and Trials
Doctors have debated percutaneous PFO closure, especially in the U.S. They often suggest using aspirin or warfarin first for those with a PFO and a past cryptogenic stroke. Yet, for people who still have strokes even with the best medicine, they might consider PFO closure.
In some studies, using STARFlex or Amplatzer Multi-Fenestrated Septal Occluder devices alone was better at preventing strokes when compared to just taking medicine. But, when they compared PFO closure to medicine directly in trials like Closure I, PC, and Respect, the results were mixed.
Closure I showed no big difference in stroke or TIA rates between those who had their PFO closed and those who took medicine. The PC trial also couldn’t clearly prove PFO closure’s benefits. But, the Respect trial hinted that selecting patients based on detailed clinical and imaging results might lead to better closure outcomes.
The debates and mixed trial results suggest more studies are needed. These are crucial to figure out the best way to treat patients with a PFO.
Summary of Randomized Trials:
| Trial | Outcome |
|---|---|
| Closure I trial | No significant difference in stroke or TIA rates between closure and medical therapy groups |
| PC trial | No clear benefit of percutaneous PFO closure |
| Respect trial | Potential benefit of closure in carefully selected patients |
PFO Closure Procedure and Potential Risks
The percutaneous PFO closure procedure is a minimally invasive, catheter-based method. It involves entering the PFO through the groin’s blood vessels. A specialized device, known as an “occluder,” closes the PFO opening in the heart’s septum. This method shows good results in lowering stroke risks for some patients.
Yet, this procedure has its risks just like any other medical treatment. Serious risks include the device moving, bleeding, stroke, and infection. It’s also possible for the heart muscle to gather fluid, which might need more treatment. Other risks are blockages in blood vessels, allergies, arm or lower neck nerve damage, and the potential for needing a pacemaker.
Before doing the PFO closure, it’s key to talk with your doctor in depth. The doctor should explain all the risks and benefits of the procedure.
Patients need to realize that careful watching and follow-up are crucial after the PFO is closed. This is to check the procedure’s success and to spot any complications early.