Associate Professor from Memorial Antalya Hospital, Department of Cardiology. Dr. Selçuk Küçükseymen talked about what should be known about Patent Foramen Ovale (PFO) and its treatment before the “World Stroke Prevention Day on May 10”. Some people develop a hole at birth between the left and right atria (upper chambers) of the heart. This gap happens to everyone before birth, but often closes shortly after birth. The hole that cannot close naturally after birth is called patent foramen ovale (PFO). From the PFO, that is, through this hole, small blood clots in the veins can travel to the heart, from there to the brain, and block blood flow, causing ischemic stroke. PFO is treated with an interventional procedure without the need for surgery, providing significant comfort to patients. Associate Professor from Memorial Antalya Hospital, Department of Cardiology. Dr. Selçuk Küçükseymen talked about what should be known about Patent Foramen Ovale (PFO) and its treatment before the “World Stroke Prevention Day on May 10”.
Increases stroke risk by 50%
During the development of the baby while in the mother's womb, there is a foramen ovale opening, which is a valve-like structure between the right and left atrium of the heart. In infancy, this valve closes on its own, but if it does not, a condition called patent foramen ovale (PFO) occurs. About 20% of healthy adult people have PFO, and young adults (under 60 years) with PFO have a 40-50% higher risk of stroke than those without a PFO. In addition, the frequency of PFO in these patients was reported to be higher than in healthy individuals.
If the cause of stroke under 60 years of age cannot be found (cryptogenic), serious investigation is required for PFO. In addition, the incidence of clot formation in the veins of the legs (deep vein thrombosis-DVT) is higher in patients who have had a stroke of unknown origin. The association between PFO and stroke of unknown origin is more pronounced in young adults than in the elderly. A person with a PFO who has had a stroke of unknown cause has a reported 2.5% risk of having another stroke for each next year.
Migraine patients with aura beware
Divers with PFO are 5 times more likely to be hit than those without. Apart from these, although the relationship between PFO and migraine is still not fully resolved, there are data suggesting that PFO has a role in migraine cases with aura. It is known that the frequency of PFO increases up to two times in patients with migraine with aura compared to healthy individuals, and closure of PFO reduces migraine-related headaches. Most people do not have symptoms of patent foramen ovale. In rare cases, PFO migraine can occur, as can shortness of breath when standing up and standing. PFO presents as a higher risk for certain types of stroke.
Diagnosis is made with a multidisciplinary approach
Young-adult patients (under 60 years old) who have had a stroke are subjected to an intensive investigation by the neurologist for the cause of the stroke. Neurology and cardiology specialist physicians evaluate cases for which the cause cannot be found. Since normal echocardiographic examination does not provide very clear imaging in adult patients, echocardiographic examination of the esophagus (transesophageal echocardiography) should be performed in these patients. During this procedure, the passage can be monitored by administering serum from the arm veins.
PFO closure reduces stroke risk
Transcranial Doppler scanning performed by neurology is a method that indirectly shows the presence of PFO. It is performed by measuring the ultrasonic signals generated in the cerebral artery by the serum given from the vein in the arm. Although it is a more comfortable method, the diagnosis should be confirmed by echocardiography when the test is positive. If all these tests are positive or suspicious, if there is evidence of active or previous clots (deep vein thrombosis) in the legs of the patients, the PFO closure procedure is decided after the patient's risk of stroke again and the foreseeable risks of the possible procedure are shared with the patient.
PFO can be closed without surgery
In the non-surgical closure of the PFO, a needle is inserted through the inguinal vein (femoral vein) and a wire is sent through the PFO, extending all the way to the heart. The closing device, which is selected in the appropriate size for the PFO, is advanced through the groin and passed through the hole. The device closes the hole by sitting on it from both sides. Before the device is released, it is checked that the PFO is closed properly and that the inserted device does not harm other parts of the heart, and the process is terminated. Within 3-6 months after the procedure, the cell layer (endocardium) covering the inside of the heart covers the closing device and the device now becomes a part of the body.
Things to consider after the procedure
PFO closure takes about 1 hour on average. Depending on the devices used, the patient may be awake or slightly asleep during the procedure. After the procedure, the patient stays in bed for at least 6 hours and one night in the hospital and is discharged in the morning. It is recommended to use blood thinners for a short time to prevent clot formation on the closure device. After resting at home for a few days, the patient can return to his daily activities. Situations that cause them to be hit and contact sports (such as karate, boxing, wrestling, weightlifting) should be avoided for 6 weeks.