PF, Mayo Clinic, Mayo Clinic Radio discussed on Mayo Clinic Radio


Back. To Mayo Clinic Radio, I'm Dr Tom jibes. I mean, we are talking. With mayo clinic interventional cardiologist, Dr Peter Pollock director of structural heart disease. At the mayo clinic in Florida a Payton for Ayman ov- alley or PF. Oh is a hole in the heart. That didn't close the way it should after birth PF. Oh occurs in about twenty five percent of the normal population the whole never completely closes. But most people with a condition don't even know they have it. So Dr Pollock, but we are all born with a hole in her heart. Yes, we are the PF oh is really more of a flat than a whole. And we all have this before we're born. And let me explain why we have before we're born we can't breathe in a fluid filled bag amniotic sac. So our lungs aren't doing the same kind of work. They're doing once we're born we get all of our oxygenated blood from mom through the placenta. So it's coming down the umbilical cord coming into our what's now our belly button. So. Coming up from underneath the heart and the heart as it's developed is designed to take that flow of oxygenated blood from underneath the heart and deflected at the thin wall that separates the two top chambers. So the right atrium receives what's normally Venus blood. But in this case is richly oxygenated blood from underneath the heart, and there's a little rigid tissue called the station region. It deflects that oxygen rich blood from through the wall between the two chambers which grow from either side kind of overlap, and so there's a flat between them and this constant flow of blood holding that flap open over to the left side, which is supposed to be the oxygen rich side, and where it can get pumped out to the body. Now when we're born we cry, and if we don't cry they kind of stimulate the kid to make them cry because they've got to fill their lungs with Aaron expand their lungs for the first time, and we cut the umbilical cord, and when we cut the umbilical cord all sudden, there's a lot less flow blood coming to the right side of the heart because that flows no longer. There. And now we've expanded the lungs a lot of blood flow goes to the long so the pressure with all that blood going to the lungs the pressure on the rights of the heart drops in comparison to left and that flap and seals, but it seals in most people. Now, you've got to think that twenty five percent of the world population about two billion people. And statistically that means someone in this room. Has it PF? Oh, and that is a lot of people that means twenty five percent of people with any condition are likely to have a PF. Oh and most people walking around. Don't know you can't hear it on exam doesn't cause any problem normally. So the vast majority of people is just there doesn't require anything. Besides reassurance. If it's found and hasn't caused a problem, but it is a potential source for problems if something goes through that potential connection. So if that flap opens if if the pressure on the right side of the heart is ever higher than the less, for example, if you cough gag wretch bear down that can push temporarily the pressure on the right side, the hard to be higher, and then bump that flap open. So that if something such as Venus blood, or if there are little bits of cloud, and that Venus blood they could transit through the PF. Oh and get over to the arterial side the left side with. They can go to anywhere in the body and causes stroke, for example. Yes. So we call that paradox. Embolism if a a small bit of clot moves from the right side through the PF, oh to the left side, if it goes to the brain, we call, the struggle plugs, up a blood vessels and causes injury to brain tissue. It could go to anywhere in the body though, these tend to be smaller size clots, and so most noticeable place for a smaller size clout to go would be the brain. And how do you figure out that it was a problem? But that the PF oh was the source of the disease that is the real challenge. And so our approach here male clinic is very collaborative what we advocate for is that you work with an analogy. So we have these heart brain clinics where folks like me cardiologists work hand in hand with a stroke neurologist of aspirin or artists to really evaluate patients and figure out was the PF. Oh, an incidental finding an. Innocent bystander or was it a potential culprit was this really likely to be a stroke that was caused by paradox. Does doing device closure of the PF? Oh is that going to decrease the risk of a recurrence stroke? Can't do anything about the stroke that happened. But can we reduce the likelihood that this patient with a PF? Oh is going to have a second or third event. And how do you do that? We create kind of a sandwich. There are two different kinds of devices. What they both work mentally the same way. There's a disk that is placed on the left. Atrial side a disc that opens on the right atrial side, and they close with that flap of tissue in the middle, and they hold it closed the body grows over the both of the discs on either side. It stays with you. It's permanently part of the heart. And this is done in the cath lab. It's a procedure with very high success rate is very low complication rate patients, stay overnight tend to go home the next day. And then we monitor afterwards. So you don't have to open up the heart to fix the defect. Now, this is done with catheters in the cath lab. Patients are kind of sleepy but not all the way asleep after breathe on their own incredible. You do it through a catheter that you snake up through the groin, and you can close at defect the real challenge. With PF owes identifying the right patient because it's so common. I think you have to do a diligent evaluation and a collaborative evaluation with neurology to figure out which are the patients that are most likely to benefit from closure. Twenty five percent of people might have this the things that you described that can cause problems are pretty routine or mundane things that seems kind of alarming is this something that people could or should go get tested should. I know if I haven't PF, oh in case something like that happens to me. I would say no, I think we don't screen for something. That's so common. Now, I do think that people especially younger, folks, if they've had a stroke. They should you should look to see whether they have a PF. Oh, but you should also look to make sure that it isn't due to anything else. Now a word about aging. It's interesting because you have this before your whole life. You've had it since before you were born. But we know that closure of PF Ohs is less likely to be helpful in preventing recurrent events as you get older because every other cause for stroke. Gets more common. So atrial fibrillation is more common atherosclerosis in the order. In the karate in the cerebrovascular. They get more common, hypertension as a cost for stroke gets more common. So all of those other causes of stroke, get more communist, get older. And so the benefit is really limited to folks who are younger than.

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