When may a PFO or ASD Need to be closed?

Season: 2001

This article may be of particular interest to those individuals diagnosed with PFO or ASD.

Diagnosis of a stroke or a transient ischemic attack is made by a physician. Determining the cause of an unexplained stroke or transient ischemic attack becomes more difficult if there is a PFO (patent foramen ovale) or ASD (atrial septal defect) through which a clot may have passed to the brain. A blood-thinner called coumadin may be recommended while doctors try to determine the cause and then develop a strategy designed to best protect from further such events.

In order to plan the best treatment approach, a neurologist needs to exclude other causes of stroke or TIA.

Next, any clotting abnormality that could have caused the stroke or TIA needs to be checked for.

If neither the neurologist nor the specialist in blood clotting can explain why a stroke or TIA has occurred, and there is a PFO or ASD, it may be time to consider closing the defect or hole in that heart.

Options to treat an unexplained stroke or TIA

The good news is that there are at least three treatment choices available. The bad news is that we have no scientific or factual basis as yet for recommending any of them over the others. The best we can do is give you some information and ideas about the options and the issues.

There are 3 ways to protect oneself that we think one should consider:

  1. Long-term coumadin treatment
  2. Device closure of the PFO or ASD
  3. Surgical closure of the PFO or ASD.

Here are some advantages and disadvantages of each.

Long-term Coumadin Treatment

Advantages:

Disadvantages:

Device Closure of PFO or ASD

This technique is relatively new (significant numbers of device insertions for about ten years). In that time, many device models have been designed and tested. The ones currently in use in our centres are the Amplatzer and CardioSeal devices. As the number of patients requiring a device closure is small, only a few centres in Canada do this procedure. This is to ensure expertise in device closures is concentrated in those few centres.

Advantages:

Disadvantages:

Surgical closure of PFO or ASD

This operation has been performed for over 40 years. In recent years, surgeons have been willing to use a small incision involving the lower 2-3" of the breastbone. This is less painful than a full-length breastbone incision, enables quicker healing, and gives a better cosmetic result (more women than men have ASDs).

Advantages:

Disadvantages:

What might I do now?

You might do any of a number of things: