March 16, 2004, St. Louis - While a stroke can be debilitating at any age, for those under the age of 50 it can be particularly devastating.

Imagine being in the middle of a career and raising young children like Debbie Hazlett of Fairview Heights, IL.  At age 44, she seemed to be the picture of health when she first noticed something was wrong.

“I was at my mom''s house and I fell off the couch and was unable to get up,” Hazlett recalls.  “I had left sided paralysis, my mouth was pulled downward, my speech was slurred.”

Fortunately for Hazlett she made it to the hospital in time for the clot-buster TPA to be administered, but doctors found the reason for this seemingly healthy person to suffer a stroke:  patent foramen ovale (PFO).

Now, doctors at Barnes-Jewish Hospital have a new weapon in treating PFO, the leading cause of stroke in people under age 50.

The Amplatzer septal occluder is a device used in a non-surgical intervention to close PFO, a small opening between chambers of the heart.

Ordinarily the hole closes shortly after birth, however in about 25 percent of patients, the hole does not close.  This can create blood clots that pass through the hole and end up in the brain causing a stroke. 

“I believe in aggressively treating patients with PFO,” says Dr. John Lasala, director of cardiac catheterization at Barnes-Jewish Hospital and Washington University School of Medicine.  “With the Amplatzer device, we have a good, non-surgical alternative that lowers the threshold for percutaneous treatment and allows patients to enjoy their lives more fully with reduced worry over another stroke.”

Dr. Lasala closed the hole in Hazlett''s heart with the Amplatzer device and she was able to get back to work and her four children.  “I actually feel stronger than prior to the procedure,” says Hazlett.

The Amplazter device is inserted through a vein in the leg and run up to the heart.  The device opens like an umbrella with a mesh-like metal covering the hole in the heart from both chambers.  From there tissue grows around the Amplatzer closing the hole.

Currently, Barnes-Jewish Hospital is approved to treat PFOs under a Humanitarian Device Exception (HDE).  To be qualified for this procedure, patients must have had a stroke or embolic phenomenon, and all other traditional sources of clot formation have been eliminated.  Patients also must be evaluated to see if they produce procoagulants, such as those produced by lupus patients, and have an echocardiogram showing demonstrable PFO or atrial septal defect.

PFO usually is treated with the drug Coumadin, however some physicians do not like to prescribe Coumadin to young and active patients.  There is a randomized trial underway at Washington University to study the Amplazter device versus treatment with Coumadin and aspirin.

Dr. Lasala says he begins almost every cath lab day with at least one patient receiving the Amplatzer and is a big believer in the device''s capabilities.  “If you close that area with the device we think the recurrence happens in one percent of patients or less,” says Dr. Lasala.