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.

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