I was a fit and healthy 57 year old enjoying a much needed holiday on a Greek island when I was struck down with a stroke. After exhaustive tests, no obvious cause could be found and, when I returned to the UK, doctors recommended I have a “bubble” test to check for a little-known heart defect.
All babies in the womb have a foramen ovale, a small tunnel in the heart wall that divides the two upper chambers. This hole closes up soon after the baby is born, but sometimes it fails to do so and is then known as a patent foramen ovale or PFO.
To discover whether I had this defect, I was injected with saline and hooked up to an echocardiogram so that doctors could see whether the saline bubbles were crossing from one side of my heart, through the hole, to the other. When I was told I was a textbook case, I was terribly upset. I couldn’t understand why this defect had not been picked up earlier.
I was already on blood thinners and I was told I could either remain on those for life or, if I was a suitable candidate, I could have a procedure known as percutaneous PFO closure, which would close the hole in my heart. It could also lower my risk of another stroke.
They found a hole in my heart, so I figured it was better to fix it rather than put myself at risk of another stroke
There have been no clinical trials proving conclusively that a PFO closure can prevent a second stroke, although anecdotally it does seem to give some protection. I decided to go for the procedure. I had nothing to lose and, since they had now found the hole in my heart, I figured it was better to fix it rather than leave it and put myself at risk of another stroke.
My consultant cardiologist, Dr Brian Clapp, used the very latest cutting-edge technology to perform what appears to be cardiological wizardry.
Somehow he got two tiny umbrellas through a fine tube directly into my heart, through a vein in my groin. Ten years ago such a sophisticated procedure simply did not exist and I would have had to undergo open heart surgery instead.
The operation lasted about an hour-and-a-half. When I woke up, my groin felt a bit sore, but I felt fantastic. Apparently all had gone well and the device had implanted successfully. I got a wonderful night’s sleep and the next day I was able to walk out of hospital and get the bus home – I just felt so glad to be alive.
Tube avoids open heart surgery
Dr Brian Clapp, consultant cardiologist at Guy’s and St Thomas’ NHS Foundation Trust, London, explains the procedure to mend a hole in the heart.
“Around 60 per cent of people who have had a stroke with no known cause have this particular defect – a patent foramen ovale or PFO,” he says.
“Normally blood travels out of the right side of the heart through the lungs which filter out any debris and clots in the blood before it returns to the heart on the left side. However, in people with a PFO, when the hole opens up it allows the blood to travel straight from the right to the left side. Blood clots can then get through this opening to the brain, potentially making people more at risk of stroke.
“The procedure itself is normally done under X-ray guidance as we pass a catheter into the femoral vein in the groin. Then a wire is loaded with a device which looks like two tiny cocktail umbrellas, each the diameter of a 2p coin when opened. This is then passed through the catheter while tracked on screen and into the defect. When it reaches the defect the umbrella is deployed either side of it and once everything is positioned correctly we remove the tubing.
“The device is inert and the body’s own tissues grow over it healing the hole in the six months following the procedure. Sometimes the procedure can be done without general anaesthetic although some patients prefer to be knocked out.”