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Old 09-03-2008, 10:14 AM   #1
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GregPasadena HB User
why not to do pfo closure

I recently suffered from a TIA and have been diagnosed with a PFO. My Cardiologist is a specialist in the PFO closure procedure; admits he is biased but thinks anyone with this problem should jump at the chance to have the PFO closure procedure. I am still waiting to see what my Neurologist and Hematologist recommend (and also a 2nd opinion from a different Cardiologist) but am trying to find information on why not to do a PFO closure. Have you had problems resulting from the procedure? How has your insurance covered? My doctor told me that the closure is only approved by the FDA in situations where blood thinning medications (to reduce risk of clotting) have failed and a second stroke or TIA has occurred. Has anyone had problems doing this as a first course of action?

Last edited by GregPasadena; 09-03-2008 at 10:26 AM. Reason: to be more specific

 
Old 09-03-2008, 06:23 PM   #2
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agalloway HB User
Re: why not to do pfo closure

I had a PFO closed in June of this year. The first set of Dr suggested i do not do it, says it will cause more problems that it was worth. I was seen at Mayo in MN after the first set of drs. Saw a cardiologist, a hemotogist and a neuorologist. I do have a blood clotting disorder that can cause DVT. After all three saw me, they discussed and decided I should have the PFO closed up, otherwise I would be on Coumadin for the rest of life. It was closed up in June. the procedure was rather simple. they started it around 7 and they released me about 4:30 (my husband is a paramedic, otherwise they would have kept me overnight and I did have to stay is a hotel in town till the next day as a precaution.) A far as the insurance goes, I have medicare because of my two last stokes, some nero deficits. All of the bills have been paid and it was not much of a problem. Cost was about $40,000. I am glad i had it done. Took some of the stress off knowing at least a pathway had been closed that could lead to a blood clot passing though. there are no gaurantees of not having another stroke, but I have to do whatever i can do try to prevent another stoke happening.

i hope this answers a few of your questions. if you have any more, just ask. Good luck!!
Annette

 
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Old 10-01-2008, 08:26 PM   #3
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AliceT HB User
Re: why not to do pfo closure

Hi,
Last week my father had two small strokes (TIA). He is fine with no effects thank goodness (we are all considering he extremely lucky). However he has since been diagnoses witha PFO that is 4mm. He is 70 and is very fit and does a lot of activity. He is more like a 55 year old!
He is seeing a cardiaologist tomorrow and he neurologist have been vey conservative in their recommendation about whether to close the PFO or not.
So, in a nut shell, I too am interested in others expereiences and advice. What are the potential complications of a closure? He has been living perfectly well for 70 years with it so is it worth the risk?
Thanks. Greg I hope you're OK...
A

 
Old 10-01-2008, 08:57 PM   #4
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Re: why not to do pfo closure

Quote:
Originally Posted by AliceT View Post
Hi,
Last week my father had two small strokes (TIA). He is fine with no effects thank goodness (we are all considering he extremely lucky). However he has since been diagnoses witha PFO that is 4mm. He is 70 and is very fit and does a lot of activity. He is more like a 55 year old!
He is seeing a cardiaologist tomorrow and he neurologist have been vey conservative in their recommendation about whether to close the PFO or not.
So, in a nut shell, I too am interested in others expereiences and advice. What are the potential complications of a closure? He has been living perfectly well for 70 years with it so is it worth the risk?
Thanks. Greg I hope you're OK...
A
Hi Alice,
I have been really nervous about having any procedure done, but the results of my TEE exam show that the hole is large enough to worry about and my neurologist , hematologist, primary care physician and a second opinion cardiologist all agree it is best to close. I scheduled the procedure (they don't like to call it surgery so it is basically an outpatient procedure with an overnight stay) is scheduled for the 22nd. I just received the paperwork today from the cardiologist and the hospital confirming the time and date so I am assuming it has been approved by my insurance (my doctor told me they wouldn't authorize scheduling the surgery until the HMO signed off on it).

I feel relieved to finally have some "closure" on my closure and am much more confident in the procedure's success after talking to several people and reading about it. The biggest thing is that you have to believe that what you are doing is the right thing and that it will work.

I am extremely healthy otherwise, 48 years old, don't smoke or drink, have low cholesterol, low plaque, good to low blood pressure and all tests show that I am in great shape. I am a massage therapist and active in the gym, have a physically active job day job, make healthy lifestyle choices including diet and exercise, breathwork, rest and meditation. The idea of having a debilitating stroke is unthinkable and the decision has not been easy but the possible consequences could be awful.

Is your father in good health otherwise? Did he get a second opinion? It sounds like this procedure is actually fairy simple (basically a catheterization) and many people have gone through this with good results. I have only had one other surgery in my life; an emergency appendectomy (ruptured) so there was no time to think about it - they just rushed me into surgery from the ER - in one way that was better because there was no time to question everything and wonder what to do.

I wish him the best in whatever he decides - I don't get the feeling it is a very complicated procedure and I am going ahead with it - just depends on what he is willing to go through. It doesn't sound like there is much downtime afterwards and up to 6 months of light duty with regular check-ups and more TEE exams. Thanks for your response
Greg

 
Old 10-03-2008, 01:45 AM   #5
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AliceT HB User
Re: why not to do pfo closure

Hi Greg,
Dont have time to reply just now but I want to...I'll get back to you in a day or too as would like to talk more..
A

 
Old 10-03-2008, 03:21 PM   #6
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AliceT HB User
Re: why not to do pfo closure

Hi Greg,
I cant believe that you are only 48, just goes to show that these things strike without any real rhyme or reason! It must have been a very frightening time for you. From what all the doctors indicate it seems to be the right decision to do the closure, for you and for Dad.

My Dad is extremely fit, young in attitude to life and physically very active. At 70 he runs a farm and a building business (he does the building!) He refuses to think of himself as old and as a result nobody else does either...Last week he lifted somethin heavy like he does all the time but then he hit the deck crying in pain of a severe headache and vomiting. His mates called an ambulance and to cut a long story short it turns out he had had two small stokes in his cerebellum. He was initally taken to the small local hospital where they did all the obvious tests but they couldnt prove anything so they transferred him to a major city hospital where I met the ambulance. My fit healthy father looked like a 90 year old being transferred from a nursing home. It was very confronting. But the next day he looked terrific, him old self again, which was a huge relief.

His neurologist has been lovely. Conservative in approach and it was he who actually sought the second opinion about closing the PFO. The second guy then sort a THIRD opinion!! (We have private insurance, I think the health systems are very different in Austrlia and the US) I think the difficult factor is Dad's age. But they were all in agreement that because of his activity level they need to close it.

They are now waiting on the cardiologist to see Dad. They have a particular one in mind who, apparently, isn't a gun ho type of guy, more likely to look at the big picture and consider the best option for dad as a person rather than a patient...if that makes sense.

But I think one of the important factors to consider for Dad and probably you, is the confidence thing. Dad needs to believe that he has done all he can to reduce the risk of a repeat stroke that might be even worse. He needs to get on with his life and not worry about the hole being an issue next time he lifts something...It isn't a magic bullet but I think it's the best thing to do.

If all goes according to plan, Dad will have the procedure next Monday 6th Oct. I'll let you know whats happening. Hopefully it will be wonderful news to help reduce your nerves!

Are you married, kids, partner? How are they coping?

A

By the way, based on your post I told Dad to ask about what he could realistically do after the proceedure. Mum was very against this as she felt we should just assume that Dad could get back to work as normal in a week or two. I was doubtful and told mum that it is imprtant that Dad has realistic expectations. Mum didnt want to frighten him. She also didnt want the doctors to discuss the risks of the proceedure with him!!!! But I felt it was important that Dad knows the truth so that he can make an informed decision as to what he wants. It's his body and he has to sign the consent. (It's also a legal requirement that he be fully informed...)

Last edited by AliceT; 10-03-2008 at 03:32 PM. Reason: typo

 
Old 10-20-2008, 08:56 PM   #7
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agalloway HB User
Re: why not to do pfo closure

Hi Greg,
So I guess your are going to have the procedure done! It has been 4 months since I had it done. Had a TIA 2 weeks before my checkup at three months. They did an echo and a bubble test and a few bubbles still got through at that checkup. I am not able to do a TEE, have a esophageal stricture, so they did another cath through my leg to see if I had another hole. My first hole they closed was 8mm, pretty good sized. they used a helix devise. they did not see another hole, it just was not closed up quite all the way yet. i still am on coumadin for another 6 months and they will check it with a echo again after the 6 months are over.

Most of my symptom have left. i was having TIA's daily before they closed up the PFO. I am so glad I did it!! Recovery time was nothing, light lifting for for a few days and that was it. I hope you have the same good results as i did. Let us know.

Annette

 
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