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Sealing a Hole in the Heart

When a person is born, there’s a naturally occurring hole between the two upper chambers of the heart. In about 25 percent of the population, that hole stays open to some degree. The condition is known as patent foramen ovale (PFO) and is the most likely cause of stroke in patients under age 55. Most patients have no symptoms and never know they have the condition until something serious occurs.

“PFO is one of the simpler defects that affect the heart,” says John Lasala, MD, PhD, Washington University interventional cardiologist. “With PFO, when you exercise or exert yourself, a change in pressure pushes blood from the right venous side to the oxygen-rich left arterial side.”

If there is a clot or other material caught in that blood, it can lead to serious consequences and possibly travel to the brain, where it causes a stroke.

“We have the technology to close these PFOs without the need for major surgery,” Lasala says. Physicians are also participating in trials to determine the best treatments for the condition, such as a new minimally invasive surgery. In the procedure, a catheter is inserted through the inner right leg and directed to the heart where a small device is placed to seal the hole. The procedure only takes around 20 minutes.

“In over 90 percent of patients, the seal will be complete,” Lasala says. “In the rest, there’s enough of a correction to prevent another event.” 

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