Often-Undiscovered Hole in the Heart Can Lead to Stroke

Everyone is born with a whole in their heart which closes for most, but for some people, it doesn’t, and they may not know it until it causes major problems.

Tracy Dean was at a rest stop on the way home from vacation with her family when she collapsed.

“My legs kind of went out from under me a little bit, and I couldn't speak for a quick second,” she said.

Her husband thought they should call 911, especially when Dean got a crushing headache, but it soon went away and she felt fine. She wasn’t.

“I had four strokes,” Dean said. “A clot ran up from my leg, broke off a piece into my lung and the other half went into a hole in my heart that I didn't know I had and it went into my head and sprayed into four strokes.”

It’s called patent foramen ovale (PFO), Latin for “open oval window.” It is a small hole located in the upper chamber of the heart, which makes it possible for a baby in utero to get blood from the placenta through the umbilical cord to the heart, but it typically closes a few months after birth.

Pediatric cardiologist Dr. Jim Thompson of Inova Fairfax Hospital also performs surgeries that close up those holes in the heart in adults.

“About 20 percent of all adults have PFO,” he said. “Now most people have very small PFOs, they're not clinically significant, and they'll go their whole life without even knowing they have it, however if you look at young people who have strokes for no reason and doctors can't find a reason that you had a stroke, about 50 percent of those patients have a PFO.”

Thompson said you have to look for the PFO in a stroke patient.

“You can form a clot somewhere in one of your veins that you don't even know about, and that small clot can travel up your vein, go into your heart, and without a PFO, the clot would normally just go out to your lungs,” Thompson said. “Your lungs act as a filter against clots, but if that same clot pops through a hole in your heart, it can go up to your brain and cause a stroke.”

Thompson is trying to raise awareness about looking for PFOs after a stroke because once found, it can be fixed.

Thompson operated on Dean once the hole in her heart was discovered last year. She'll be on a blood thinner for the rest of her life and will need regular checkups, but she feels lucky she was able to see Thompson.

“I'm very grateful and I’m grateful, honestly, that it was Dr. Thompson because what he does, he's the best at it,” Dean said.

Thompson has performed more than 1,000 of these surgeries and will be attending a conference this month to learn about the latest on the procedure.

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