PFO?

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Seaton

VR.org Supporter
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May 12, 2015
Messages
618
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London, UK
Had my planned half year cardiology check-up today. Which included an echocardiogram. All looked good on the valve front. Everything seemed tuned nicely.

Cardio says everything has remained stable since my last echo. My gradients looked fine and have stayed reduced, thanks to the warfarin. Which is good news.

It seemed my heart rate was a tad too low. I mentioned I’d been experiencing fatigue and episodes of dizziness. Cardiologist told me to stop taking the (1.25 mg) bisoprolol going forward. My daily warfarin prescription is to continue permanently, along with my daily atorvastatin.

All in all, a good result.

There was one other thing of note today. The cardiac sonographer doing my echo said she was suspicious of one of my readings and showed me something on the screen. She said she thought the reading showed a possible PFO - patent foramen ovale. She wasn’t sure, so was going to get a colleague to double check and pass the info to the cardiologist, who I was seeing after the echocardiogram. A PFO (hole in the heart) can be a source of strokes (which I had in December 2023), among other things.

Later, after looking at the echo results, the cardio said that although she couldn’t be totally certain, she felt I probably didn’t have a PFO. But as it wasn’t her particular area of expertise, she’d refer my echo to a congenital heart specialist and report back. Either way, it will be good to get the congenital specialist’s opinion.

As all is stable with my heart valve (and potential PFO aside!), the cardiologist wants to see me again in a year’s time, which is great.
 
, she felt I probably didn’t have a PFO. But as it wasn’t her particular area of expertise, she’d refer my echo to a congenital heart specialist and report back. Either way, it will be good to get the congenital specialist’s opinion
It's amazing they didn't spot this during the slew of testing done at your first surgery.

Fingers crossed
🤞
 
Had my planned half year cardiology check-up today. Which included an echocardiogram. All looked good on the valve front. Everything seemed tuned nicely.

Cardio says everything has remained stable since my last echo. My gradients looked fine and have stayed reduced, thanks to the warfarin. Which is good news.

It seemed my heart rate was a tad too low. I mentioned I’d been experiencing fatigue and episodes of dizziness. Cardiologist told me to stop taking the (1.25 mg) bisoprolol going forward. My daily warfarin prescription is to continue permanently, along with my daily atorvastatin.

All in all, a good result.

There was one other thing of note today. The cardiac sonographer doing my echo said she was suspicious of one of my readings and showed me something on the screen. She said she thought the reading showed a possible PFO - patent foramen ovale. She wasn’t sure, so was going to get a colleague to double check and pass the info to the cardiologist, who I was seeing after the echocardiogram. A PFO (hole in the heart) can be a source of strokes (which I had in December 2023), among other things.

Later, after looking at the echo results, the cardio said that although she couldn’t be totally certain, she felt I probably didn’t have a PFO. But as it wasn’t her particular area of expertise, she’d refer my echo to a congenital heart specialist and report back. Either way, it will be good to get the congenital specialist’s opinion.

As all is stable with my heart valve (and potential PFO aside!), the cardiologist wants to see me again in a year’s time, which is great.
I had OHS in 2022 for an AVR and aortic aneurysm repair. Had testing prior to include a full heart cath. 9 months later I had a stroke and after the stroke they did an echo with a bubble test and found I had a PFO. Still blows my mind that that somehow was never found before my OHS. There are a few things that stand out to me that they didn’t test for prior to cracking me open. Another thing that bothers me is not being tested for any clotting disorder prior to getting a mechanical valve and having to take warfarin indefinitely.
 
They only found my PFO when they opened me up to replace my valve. I’ve had countless scans in my heart and it was never spotted. They closed it over as well as the VSD (which was picked up at birth). I believe to test for a PFO they need to do a special scan which involves bubbles.
 
Received a prompt digital report today of yesterday’s cardiology review.

It appears I most likely have a PFO.

A summary at the end of the detailed report said:

Summary
… largely asymptomatic from a cardiac point of view with stable parameters of mild to moderately stenosed six years old bioprosthetic aortic valve replacement, which is reassuring.
We had a detailed discussion today, including possible finding of small hole in the heart at the top chamber. This was not very obvious on echo and was not reported on his previous cardiac CT, but difficult to completely rule out. I explained I will ask opinion from one of our ACHD (Adult Congenital Heart Disease) colleagues about that.
I think it would be reasonable to stop his small dose bisoprolol, since his heart rate is on slow side and underplaying conduction abnormality.
We will continue his follow-up in our Valve clinic with an annual echocardiogram, meanwhile he can always contact us earlier if any issues.


There was an addendum:

Addendum
I discussed with my ACHD consultant colleague and we reviewed again the echo and previous cardiac CT. The feeling is there may be a small PFO/ASD (atrial septal defect).
However, even if present, this does not require closure, since not causing any significant haemodynamic effect on the heart with normal RV function, only mildly dilated RA/RV, no pulmonary hypertension.
Patient will require lifelong warfarin for his aortic valve, this will protect him from a risk of paradoxical emboli/stroke. Therefore, again no indication of further investigations or consideration of possible PFO/ASD closure.
No change in current follow-up plans needed.


So the most likely cause of my cerebellar infarction was that I had an undiagnosed PFO?

It appears warfarin is now my protector.
 
Last edited:
Hi

So the most likely cause of my cerebellar infarction was that I had an undiagnosed PFO?
Assuming there was nothing irregular found about your valve, then most likely.

It appears warfarin is now my protector

...and probably a more reliable one than one of the NOAC variety (certainly cheaper).
 
...and probably a more reliable one than one of the NOAC variety (certainly cheaper).
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clearly I'm older.
Reminds me of a song I like
 
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