More specifically I wanted to talk to the Professor about Patent Foramen Ovale’s, or as most who know about them, refer to them as PFO’s. The most simple way to understand what a PFO is, is to picture the heart in your head as four chambers, two up, two down, and between the upper left and right chambers, there lies a pesky little flap, a flap that shouldn’t be there… a PFO.
And although people shouldn’t have PFO’s, it might be surprising to hear that around 20% of the population have them, and in the majority of cases of people who do have them, they cause no trouble at all. Most could go their whole life without realising that there’s a bit of a draft in the upstairs rooms of one of their most vital organs.
My PFO was discovered after I had an unsuspected, paralysing stroke at the age of 21, just over two years ago. After being rushed to hospital unable to move the left side of my body, and after an ischemic stroke was determined by an MRI scan, I then underwent a multitude of tests, for doctors to try and understand why a young, healthy girl had suffered a stroke. It wasn’t until I had a Saline Contrast Study, or as I like to call it, the Bubble Test, that we started to get some answers. This test involved saline solution being shaken in to tiny bubbles, which was then injected into a vein in my arm, all the while my heart was being watched by ultrasound. Due to my PFO I could watch these tiny bubbles flow through the flap, from one side of my heart to another, on the screen in front of me. With this discovery, the next step was to discuss what to do about my flappy heart.
When I met Professor Ray for the first time before my op he explained it was possible my stroke might have been caused by a blood clot passing through my PFO and up to my brain. So the question was whether my PFO should be closed. He went on to say that although closure of a PFO is reasonable in some people who have a stroke with no apparent cause, in others it is not advised. I just couldn’t understand this, why would they not fix something that’s wrong! So in my recent visit to see the Prof. I was eager to understand the reasoning behind not fixing all PFO’s.
Most doctors involved in the field believe that a PFO is related to unexplained stroke in some patients, but the fact of the matter is that, with a few exceptions, it is impossible to prove that a PFO is the cause of a stroke. With this in mind, I asked the doctor if he personally believed that there is a link between PFO and stroke, and he didn’t hesitate to say, ‘Yes.’ But it is not straightforward! The difficulty is that at the moment there is no hard and fast evidence that closing a PFO is more effective than treatment with medication in most people with unexplained stroke. So recommendations have to be made on an individual basis.
He went on to explain that because my MRI scan established a stroke, my PFO was on the large size, I was under 50 years of age, and there were no other apparent reasons for me to have had a stroke, I was a good candidate to have a PFO closure. Other stroke survivors who also have PFO’s but whom are significantly older than I was when I had mine, may be advised that having the operation isn’t very beneficial for them, and it’s more likely that there is another more likely cause for a stroke to have happened.
I wanted to know all about the operation and Professor Ray was more than happy to talk me through the ins and outs of the procedure, and I couldn’t believe my luck when he told us there was an operating theatre free for us to go and have a look round. He first showed me a model of the device that sits in my heart as I’m writing this, and will stay in there forever. It’s called an Amplatzer and is in the shape of a small silver jammy dodger. Two almost flat circles, made of intricately, intertwined threads of metal, that when placed, fits round either side of the PFO. Think of the Amplatzer as the two biscuit spheres, and the flap in my heart as the jammy centre… I hope I haven’t put you off your biccies. In between the woven wire in both sides of the Amplatzer, lies a permeable membrane, (it looks like really thin pieces of cotton wool,) that allows blood to pass through it and encourages it to clot which in turn causes tissue to grow around the device. Then after around 6-12 weeks, the Amplatzer is completely covered.
The Doc talked me through the operation that although it only takes around 45 minutes- an hour, still requires 2-3 cardiologists, a radiographer, a physiologist, an anaesthetist, an anaesthetist assistant and 2 nurses, all present and correct.
To place my 18mmx18mm jammy dodger the doctors made a small incision in my groin. Through this hole they carefully threaded the Amplatzer, which stretches out in to a straight line while making its journey up my vein. When it had reached its destination; my heart, the device was then flattened out again, and carefully slotted around the flap between the two chambers. To make sure it was in its rightful place an xray, as well as a camera that had been placed down my throat at the beginning of the op, both showed evidence that all was successful. The doctors gave one final tug and pull on the tiny metal object that now lives in my heart, just to make sure it was secure, and then, their job was done.
On our tour of all things PFO, Professor Ray allowed me access in to the imaging suite, where on the computer he brought up an array of ultrasound and xray images of my own heart. Most of what he showed me just looked like wavy black and white lines, but when he came to the ultrasound image of my fixed heart, he pointed out the Amplatzer, sitting pretty, and I could see it, I could see the shadows of this alien object right in the middle of my heart.
I felt so privileged to be spending time with such an important doctor, and I felt honoured that he was happy to spare a couple of hours of his busy day to talk me through everything and anything I wanted to know about PFO’s. But what made my visit more special and more personal, was that this doctor who had given his time up for me, was the same doctor who fixed my heart. He’d played a massive part in my stroke journey, and I’d come such a long way from when I’d first met him in his consultation room.
Though really just a small operation in Professor Ray’s repertoire, closing my PFO was a big deal for me. There was no obvious cause for my stroke, no answers for why I had to learn to walk again at the age of 21, no reason for why a trainee hairdresser could no longer move her hand and fingers… until the PFO was discovered. And although I understand there will never be any evidence to prove that the flap in my heart let a clot through to make its way up to my brain, I feel comfort in the knowledge that the same thing won’t happen again. My heart is whole again, thanks to the Prof.
The visit to meet Dr Simon Ray was organised by the Stroke Association, in the lead up to Science Stroke Art 2014, a partnership between the Stroke Association and The University of Manchester to support Action on Stroke Month in May 2014.
For more information about Science Stroke Art 2014, visit www.sciencestrokeart.co.uk. For more information about stroke, ring the Helpline on 0303 30 33 100 or visit www.stroke.org.uk.