January 19, 2006
From left, Biswajit Kar, M.D., director of the Cardiac Catheterization Laboratory at the Michael E. DeBakey VA Medical Center studies a monitor during a catheterization procedure with Baylor College of Medicine fellows Rajnikant Patel, M.D. and Sasidhar Guthikonda, M.D.
Photo by: Bobbi D. Gruner, MEDVAMC Public Affairs Officer
HOUSTON - The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) is among the first VA hospitals in the country to close a Patent Foramen Ovale (PFO) using a catheter-based procedure.
A PFO is a defect in the septum (wall) between the two upper chambers of the heart. Specifically, the defect is an incomplete closure that results in the creation of a flap or a valve-like opening. A PFO is frequent in everyone before birth, but seals shut in about 80 percent of all people.
When a person with this defect creates pressure inside his or her chest such as when coughing or sneezing, the flap can open. Blood can then flow in either direction directly between the right and left atrium of the heart. When blood travels directly from the one part of the heart to another, it bypasses the filtering system of the lungs. If debris is present in the blood, such as small blood clots, it can pass through the left atrium and lodge in the brain causing a stroke or embed in another organ such as the heart, eyes, or kidneys.
“The usual treatment course for patients with this serious heart defect is the use of blood-thinning drugs. However, many times a patient’s condition will deteriorate to a point that more dramatic intervention is necessary. Traditionally, open heart surgery was the only alternative. This new catheter-based procedure for a PFO typically takes about an hour to perform. The patient experiences significantly less pain and discomfort following the procedure. Most of our patients are able to go home the next day,” said Biswajit Kar, M.D., MEDVAMC Cardiac Catheterization Laboratory director.
Catheter-based procedures are commonly used to diagnose and treat heart-related problems. In this new procedure, a catheter, a long, thin, flexible, hollow tube, is slowly moved into the heart. The catheter is initially inserted into a large vein through a small incision made usually in the inner thigh. A PFO closure device is moved through the catheter into the heart to the location of the heart wall defect. Once in the correct location, the PFO closure device is allowed to expand its shape to straddle each side of the hole. The device will remain in the heart permanently to stop the abnormal flow of blood between the two chambers of the heart. The catheter is then removed and the procedure is complete.
“PFOs have been quite prominent in the news recently with the case of Israeli Prime Minister Ariel Sharon, who has had two strokes. The first was thought to have been caused by a PFO, and in fact, he was scheduled for the same closure device that Dr. Kar recently implanted. While he was waiting, he had been placed on blood thinners and this is believed to have caused his second stroke. This only emphasizes that the use of blood thinners has its own inherent risks,” said Blase Carabello, M.D., MEDVAMC Medical Care Line executive.
“A catheter-based procedure for a patient with a Patent Foramen Ovale has many advantages. It is less risky and has fewer complications compared to surgery and many procedures can be performed without general anesthesia. Most patients can resume normal activities within a few days and the procedure may be combined with other treatment options,” said Biykem Bozkurt, M.D., MEDVAMC acting chief of Cardiology.
# # #