Wednesday, March 9, 2011

A Matter Close to the Heart: Patent Foramen Ovale (PFO)

Most of us are familiar with heart-related conditions such as blood clots, stroke, high blood pressure and heart murmurs. If we haven’t been directly affected by a heart condition, we probably know someone who has had a heart attack or undergone heart surgery. In fact, according an article in CNN Health, “more than 70 million Americans live every day with some form of heart disease, which can include high blood pressure, cardiovascular disease, stroke, angina (chest pain), heart attack and congenital heart defects.”

One heart condition that you may not be familiar with is patent foramen ovale (PFO). PFO is an opening or flap in the heart. It is present in everyone before birth, but it closes spontaneously in 80 percent of people a few days after birth.

A few other facts about PFO:
• The cause of PFO is unknown
• Cases have been found in 50 percent of people who have suffered a cryptogenic stroke (stroke of unknown origin) and 50 percent of migraine sufferers
• People with PFO usually exhibit no symptoms
• It may be diagnosed when a child or adult has a transient ischemic attack (TIA)
• Can only be detected by a specialized test, such as an echocardiogram

Dr. Robert J. Sommer, M.D., Director of the Adult Invasive Congenital Heart Services at New York-Presbyterian Hospital/Columbia University Medical Center, presented at Sinai Hospital Grand Rounds last week on“The On-Going PFO Controversy: Is Closure I the End of the Line?” In the presentation Sommer addressed the results of the Closure I trial, as well as PFO studies related to decompression illness, obstructive sleep apnea and migraines.

Closure I is a 2-year study that began in June 2003. The study compared the effectiveness of using a medical device against using conventional medication to permanently close PFO openings. It compared STARFlex septal repair implants against conventional medications (aspirin and clopidogrel) in 909 patients. At the end of the study it was found that there was no difference in PFO between patients that had received the STARFlex implants and those that received medication.

Some of the questions that Sommer posed that could have affected the study were:
• What if the wrong patients were studied?
• What if the wrong medical device was used?
• What if the 2-year follow-up was too short?
• What if the samples used were too small?

Although the results of the study were disappointing, there are still trials ongoing in the U.S. and Europe.

In addition to the Closure I study Sommer also addressed PFO’s link to:
• Decompression Illness in Divers – It was concluded that the risk for PFO is 5 times higher in divers. This is because some divers produce bubbles in their venous blood before and after decompression. Sommer personally treated New York City policemen and firefighters who were divers who had an increased PFO.

• Obstructive Sleep Apnea – Sommer had closed a PFO on a patient who was suffering from obstructive sleep apnea. She told him that 3 weeks after the operation she was dreaming again!

• Migraines – The MIST (Migraine Intervention with STARFlex Technology) study was a double-blind study that tested the effects of closed PFO on migraines. Some patients were fitted with the STARFlex implant while others were not. The results were that 37 percent of patients with the STARFlex implant had reduced migraines while 17 percent of those without the implants had reduced migraines. Sommer himself had a patient who instantly stopped having migraines the day after closing his PFO.

To conclude, Sommer stated that certain goals need to be met in order to better understand PFO: Doctors need to establish which syndromes are casually linked to PFO, they need to know the benefits of closure therapy, and they need to create proper methods of treating patients selected for PFO intervention. Although he sees the future of PFO at a crossroads, there are still people out there, like himself, whose goal is to expand interest and public awareness of this heart-related condition.

Here is a heartwarming story of a patient who underwent successful PFO surgery:

To learn more about PFO and other heart-related conditions, call 410-601-WELL (9355).
-Trish Smith

No comments: