Tedy Bruschi's patent foramen ovale (PFO) caused his stroke

It was just reported that Tedy Bruschi is undergoing surgery for a hole in his heart:

New England Patriots linebacker Tedy Bruschi — who once played for the University of Arizona – is back in the hospital tonight, according to sources in Tucson and Boston.
The team isn’t confirming this news yet, but KOLD News 13 has learned Bruschi is undergoing surgery to repair a hole in his heart. That’s what may have caused the mild stroke he suffered last month.
The 31-year-old Bruschi was rushed to the hospital complaining of partial paralysis just two weeks after winning his 3rd Super Bowl ring.

He is the Patriots linebacker who was hospitalized for a stroke last month (written previously). There are several explanations for this scenario – where a “hole in the heart” may lead to stroke.

One is a patent foramen ovale (PFO). This is a condition where there is an opening between the upper two chambers of the heart that fails to close after birth. It is detected in about 25 to 40 percent of adults. A meta-analysis has suggested that those with a PFO have more than a 3-fold risk of stroke in those less than 55 years of age. Another congenital abnormality, an atrial septal aneurysm (ASA), can also be associated with a PFO. The presence of both further increases the risk of stroke by 15-fold.

It has been reported that Bruschi is undergoing heart surgery. Most cases of PFO only requires aspirin treatment. If a PFO is associated with a prolonged cerebrovascular event, then coumadin is recommended. Surgery for a PFO (i.e. closure of the hole) is indicated when there is a high risk of stroke. These include the following scenarios (from UptoDate):

* a large PFO (3.4 mm to 5.8 mm in different studies)
* high mobility of the valve of the PFO
* coexisting ASA
* a large right-to-left shunt (i.e. the blood flowing abnormally through the hole from the right side to left side of the heart)
* a right-to-left shunt at rest
* a Valsalva maneuver preceding the event

Again, all speculation at this point – this story will be followed closely in the coming days.

Update:
The Boston Globe with their take, also speculating on a PFO.

Comments

Anonymous
People with PFOs are also at a much higher risk for the bends while scuba diving.
Anonymous
At age 40, and in very good shape, I suffered a mild stroke which was subsequently determined to have been caused by a PFO. While there were trials ongoing with closure devices which could be inserted with a catheter via the femoral artery, the certainty of 100 percent closure was undermined at that time. I opted for open-heart surgery to close the hole, and have no regrets, as I am now 100 percent sure the hole is closed. A week after surgery I was walking a mile a day, and within a month I was jogging two miles. Four months later I was running three miles/day, and even waterskiing!
Anonymous
I am having a heart cath this Friday (10-14-05) and open heart the following Tuesday to close my PFO which was the cause of a mild stroke in June. Have been on Coumadin while researching my closure options. I am very apprehensive about the Cardio Seal for reasons unknown except that I want 100% assurance it is 100% closed. I was wondering how big your PFO was and if you had a right to left shunt. I am trying to rid myself of the idea that I am “taking out the engine to repair a spark plug”. Please reply ASAP. Thank you.
Anonymous
My partner paul, age 29, has recently suffered a stroke due to a hole in his heart. He is now classed as visually impaired due to the stroke, and cannot drive. He is going for open heart surgery at the beggining of next year. If anyone has any information regarding vision loss due to strokes, please advise.
claudia100175
I’ve got a few comments to share with everyone.
To the 40-year old who opted for open-heart: I too wanted open heart for the same reasons as you! 100% closure and 100% certainty. Unfortunately, my PFO is only 2-3mm and no one will recommend it since it’s so small. Glad to know I’m not the only one who actually heard themselves say “I want open heart”! Thanks for making me feel somewhat sane there!
To Paul’s partner: I’m furiously typing my blog to post (it’s going to be long) but I had a stroke and suffered vision loss in my right eye. I’m still allowed to drive but it’s tricky. My depth perception sucks!!! I’ll post again when my blog is done, hopefully tomorrow at the latest.
Also, how old is everyone who has PFO and/or a stroke? I’m 30.
Thanks!
Claudia
claudia100175
Also, how big is everyone’s PFO hole? Trying to see if there’s a change in the type of closure recommended based on size.
Thanks,
Claudia
freddiefokker
I suffered a mild stroke 3 years ago when I was 34. I was in excellent physical condition with no known pre-existing medical conditions. I am a commercial pilot and experienced the event while flying an airplane for a major airline. During the descent, I experienced numbness in my right arm and hand, with loss of dexterity with my hand and fingers, numbness of the right side of my face, and slightly slurred speech. I was not physically flying the airplane at the time (the other pilot was), so I was able to function as the non-flying pilot (talking on the radio, running checklists, etc.) with moderate difficulty.
The airplane had a malfunctioning automatic cabin pressure controller, so I was manually descending the cabin. Because I was experiencing the last remnants of a cold, the fluctuating cabin pressure caused my ears and sinuses some discomfort. To clear my ears, I performed several valsalva maneuvers. After the last valsalva, I suffered the stroke.
At first, I thought I had a pinched nerve in my neck or shoulder from working out the night before. Because my symptoms somewhat diminished after landing, I went to my hotel room for the night to “sleep it off.” 4-5 hours later, I noticed the right side of my face drooping and decided to go to the hospital. I was admitted, placed on blood thinners, and went through the gamut of CAT scans and MRIs. It was determined that I suffered a 1mm infarct on the left side of my brain due to a blockage.
After subsequent discussion with my family doctor two days later, I was referred to a neurologist. He was a former Army flight surgeon, and after hearing my explanation of events, decided to have me submit to a transcranial doppler bubble study with a simultaneous echocardiogram to check for a PFO. It was determined that I had a PFO with right-to-left shunting with valsalva.
I had the PFO closed with a CardioSeal placed with a cath. I regained my pilot medical within a year and am now back flying commercial airplanes, as well as obtaining a medical waiver to fly Air Force aircraft in the reserves.
It sounds like Tedy Bruschi and I experienced exactly the same thing. I wish him and his family good fortune and I hope he can continue to perform at the high level he has maintained after recovering from his stroke.
getalife
Tedy Bruschi showed me if he could come back and play NFL football, I could do more for my rehab.
I had endocarditis, like Coach Mike Martz but a severe case. The infection attached to my aortic valve, broke off and spread to my brain (106 temp. and stroke), lungs , liver and heart. The stroke left a large dead spot on my brain and the left side of my body numb and weak. I had my aortic valve replaced with a mechanical valve in open heart surgery.
Thanks to Tedy for the inspiration to move forward.
Anonymous
I am 20. I suffered a TIA while working, and have no permanent damage. They found a PFO, and now my family and I are looking at options to have it closed. The catheter procedure seems so simple against the open heart surgery. I am still looking for options.
Anonymous
I had a PFO with aneurysm. The hole was 8 mm. No doctor ever heard a heart murmer. I was in a foreign country at the time of my stroke (age 42) and had the hole fixed via catheter with amplatzer. It’s been six months and I’m doing great! I lost about 50 percent of my vision from the stroke, but other than that am doing well. I’m so thankful that I didn’t have to have open heart surgery.
Anonymous
Please tell me how to get PFO fixed without being in a trial via cath method. I am 35 and had stroke two weeks ago. They say it’s not FDA approved. HELP!!!! sweet0allie@yahoo.com
Anonymous
Washington Hospital Center in Washington D.C. is now engaged in two clinical research trials for PFO closure. One is for stroke patients; the other is for migraine sufferers. To be eligible, you must either have had a PFO-caused stroke or suffer from 4 to 14 migraine headaches per month and have failed two migraine preventative medications.
I am a 51-year-old female in excellent health who was diagnosed with PFO this month after suffering dizzyness, extreme fatigue and chest pain. I have long suffered from migraines with aura. My PFO is approx. the diameter of a pencil (how many mm is that?)
I have not had a stroke (yet) so I am hoping to qualify for the migraine group. I have just been started on a Beta blocker, Lipitor and an anti-platelet.
To be evaluated for the study, contact Dr. Petros, the director of research at Washington Hospital Center, office phone (202)877-2146.
Good luck and God Bless all on this forum.

Tedy Bruschi’s patent foramen ovale (PFO) caused his stroke

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