PFO, To close or not to close?

[JT_Marlin]

PV JAK2+, I’ve had an MI (4 years ago) and TIA (3 months ago)

Docs thought the TIA was caused by a clot traveling through a PFO to my brain. Had two TEE (very invasive) and one TTE - believe it or not all with different results.

Spoke with the interventional cardiologist today (by phone of course) - he thoroughly reviewed my tests and suggested that I dont close it (if its in fact there) and that I stay on my 2x daily baby aspirin, switch from eliquis (apixaban) to plavix (clopidgrel) and continue the Pegasys to fight the PV.

He suggested if I wanted, I could have him stick a catheter up my groin to see if the PFO is there and large, and if so, they’d close it right then and there.

I’m not super pumped about the idea of an implant in my heart especially if its possible that clots can form on both the venous and arterial side.

Other folks have thoughts - similar experience?

Thanks.

[jillydabrat]

Good morning my lovely. To be honest I haven’t understood what a PFO is but I can see that you have had a horrific experience with your PV. I just wish you the very best with whatever decision you make and I hope someone can help you who have the relevant answers.

Take care

Jill

X

[hunter5582]

My own experience with heart issues and PV are rather different. I had paroxysmal atrial tachycardia and had problems with the meds to control it. I opted for a catheter ablation of the heart to deal with the tachycardia. This is where they pass a catheter up through the femoral artery in the groin, into the heart, find the bad nodes, and ablate them.

The surgery itself was not difficult to endure. I was conscious for most of it and could watch what was happening on the monitor (very cool). The ablations triggered atrial flutter which we also dealt with at the same time (my decision). The surgery was successful and curative. The only adverse effect was some low-grade reactive thrombocytosis, which was expected and resolved within a couple of months after my heart healed.

Your situation is different and it sounds like your risks are higher. You will have to weigh the risks of a PFO Closure vs the risk of just waiting and watching for more TIAs or a stroke. You have already had two invasive diagnostic procedures and I am assuming echocardiograms, etc. as well. You and your treatment team likely know as much as you can know without going in and looking with a catheter procedure. It sounds like there will not be a black-and-white definitive answer in the absence of something else bad happening as a result of the PFO. No matter what, it is going to be a judgement call on your part and a decision about which set of risks do you choose to take.

The best suggestion I have is to use your head to understand what is going on, but trust your gut about what to do. Make a rational reasoned decision based on your thinking and intuition, but not based on fear.

All the best to you and do let us know how you get along.

[Curlyman83]

Just being diagnosed with PFO after bubble echo and my cardiologist has suggested a small operation for closing it (he said it’s keyhole surgery a small umbrella like contraption is inserted in to close the hole).

Surgery there doesn’t really bother me - I’ve already had an ICD fitted and I’ll tell you that was nothing compared to my TIA in February!

I see you wrote this twelve months ago, would be really interested to see how you’re getting on and what route you took in order to correct your situation.

Hope you’re well!

[JT_Marlin in reply to Curlyman83]

Hey Curly - after discussion with my whole medical team they advised against having the implant. The fact of the matter is there is no way to know where the clot formed, i.e., whether on the venous or arterial side of the heart, so why close a hole which had it been closed may not have prevented anything? In addition, I wasn't crazy about the idea of a chunk of metal mesh in my heart for the rest of my life...can it get dislodged? What happens to it as it ages over 5, 10, 20 years? Rather, the focus for me ever since then has been on treating the PV (2x daily baby aspirin, weekly pegasys shots), and keeping blood numbers in line through therapeutic phlebotomies.

Thats my situation, and everyone is different! I wish you the best, and please report back on what you decide and how the procedure goes if you move forward.

[Curlyman83 in reply to JT_Marlin]

Thanks JT....some things to think about there.