DEAR DR. ROACH: Articles on strokes or TIAs rarely mention that they can be caused by a congenital heart defect. I had a family member with a patent foramen ovale, found at age 54, after he’d had several strokes. He had surgery to repair it and has been well ever since.
I would like to know why a PFO isn’t often mentioned or considered. When I see an obituary for a young person who died suddenly, it makes me wonder if there was an undiagnosed hole in the person’s heart. One in 6 people has a hole in the heart; that is a high percentage. I think the public should be educated and made aware of this congenital condition. — J.R.
ANSWER: A patent foramen ovale (which literally means “open oval-shaped window”) is a remnant of our embryology. The foramen ovale is a small open flap that is necessary to send oxygenated blood from the placenta to the body of the developing fetus. In about 25 percent of people (that’s 1 in 4, even higher than you thought), the “hole” doesn’t completely close. PFO is the most common of the “holes” in the heart (ventricular septal defect and atrial septal defects are the other common ones).
A stroke is caused by the death of brain cells. PFOs are certainly implicated in strokes. In general, the younger and healthier the person, the more likely it is that a “cryptogenic” stroke (one with no obvious cause) may be due to a PFO. What is likely is that a blood clot can pass through the foramen ovale and go to the brain’s blood vessel, blocking off blood supply to an area of the brain, causing a stroke.
The absolute increase in stroke risk is hard to quantify. For people who have never had a stroke, it is generally not recommended to close the PFO. This surgery has risks, and these risks probably outweigh the small potential benefit. For people who have had a stroke, the risk of recurrent stroke from PFO is higher. One group has created a model (the RoPE score) to help predict the likelihood of recurrent stroke. This can help the clinician examine the benefits of surgical repair of the PFO. Surgery is most likely to benefit younger people without traditional risk factors for stroke.
DEAR DR. ROACH: I recently changed primary doctors, and I saw the report of my echocardiogram. It said I have “mild left ventricular hypertrophy with some diastolic dysfunction.” Could you tell me what this means and if it is serious? — C.B.
ANSWER: An echocardiogram uses sound waves to take precise images of the heart. The cardiologist interprets those images to make statements about the anatomy of the heart, including thickness of the walls of the heart, as well as its function.
The left ventricle is the chamber of the heart that pumps blood to all of the body, having received oxygenated blood from the lungs. Consequently, it is the thickest of the chambers. “Hypertrophy” means “too much growth” — that the wall is too thick. “Diastole” is the part of the cardiac cycle where the ventricles fill up. This should happen at very low pressures. In diastolic dysfunction, which commonly accompanies left ventricular hypertrophy, the left ventricle requires higher pressure to fill that thickened and stiffer wall.
LVH and diastolic dysfunction are most commonly results of high blood pressure. Some of the many medicines we use to control high blood pressure are good at helping the heart fill at lower pressure. Not everybody with these findings on an echo needs treatment. The key word in your report is “mild,” which generally indicates no need for treatment beyond careful blood pressure monitoring.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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