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Bubbles Help Detect Heart Condition

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About one in four of us is walking around with a medical condition that sounds really frightening but is not usually as dangerous as you might think. That condition is called patent foramen ovale, or PFO. It is often mislabeled as a “hole in the heart,” but that’s not really the case.

Before we’re born, we get the oxygen our body needs from our mother’s blood via the umbilical cord. In order to transfer that blood from the right atrium (upper right side) of the heart to the left atrium, there is a tiny opening between the two chambers of the heart covered by a flap. Within three weeks after birth, that flap usually closes, sealing the opening between the right and left sides of the heart. However, in about 25 percent of people, the flap never seals shut. As a result, blood continues to flow between the two chambers.

The vast majority of people with PFO never know they have the condition and never experience any complications from it. A person can live a full and healthy life even if they have PFO. On rare occasions, however, the condition may play a role in such medical issues as stroke, migraine and syncope (fainting).

In the case of migraine and stroke, substances that would normally be filtered out of the blood before it reaches the left atrium instead cross over through the PFO and get circulated throughout the body. When these substances reach the tiny blood vessels in the brain, they can get stuck there, limiting the flow of blood. This is of particular concern for people with deep-vein thrombosis, or DVT, which creates clots that might have the opportunity to get to the brain through the PFO.

Regarding syncope, it is thought that PFO may contribute to unexplained fainting spells because oxygen-poor blood from the right atrium mixes with oxygen rich blood from the left atrium, which lowers the overall level of oxygen in the blood that circulates through the body.

It is important to emphasize that PFO is not considered a major cause of migraine, stroke or syncope. If you’re experiencing any of these issues, there is probably another explanation. However, if you have gone through extensive testing and your physician still can’t find the cause, you might want to discuss the possibility of PFO with him or her.

Diagnosing PFO is a relatively simple and pain-free process. It starts with injecting salt water that has been filled with tiny air bubbles into the bloodstream. With an echocardiogram—a completely painless technology that uses sound waves to see inside the body—a technologist watches as the bubbles enter the heart. If a PFO exists, the bubbles can usually be clearly seen passing from the right atrium to the left.

For some patients, a slightly more invasive procedure is required to get a good image of the heart. Called a transesophageal echocardiogram (TEE), the procedure uses a very small scope (a camera with a light on it) that is passed through the mouth and down the throat to an area close to the heart. From there, the same bubble technique is used to determine whether or not the patient has PFO.

Even if PFO is found, your physician may or may not recommend closing the flap in your heart. Although the repair procedure is extremely safe, it simply may not be medically necessary, depending on your health history and other medical issues.

The repair involves inserting and opening a small, umbrella-like device that holds the flap in place. Physicians may recommend the repair procedure for stroke patients as a way to possibly lower the risk of future strokes.

At a certified stroke center like Simi Valley Hospital, which recently received the Get With The Guidelines Stroke Silver Plus Quality Achievement Award and was named to the Target: Stroke Honor Roll from the American Heart Association/American Stroke Association, patients can typically get emergency stroke care, PFO testing and a wide range of other types of care, all under one roof.

Helen Movsisyan, RDCS, BA, is manager of Cardiology and Neurodiagnostics at Simi Valley Hospital.