Can Tedy Bruschi return to football?

It has been confirmed that Tedy Bruschi’s stroke was indeed caused by a patent foramen ovale (PFO), as speculated here. He underwent percutaneous repair at Massachusetts General Hospital, either with a Amplatzer PFO occluder or CardioSEAL/STARFlex (picture below) – most likely the latter since this is the preferred PFO occluder used at MGH. Contrary to prior reports, he is not on blood-thinners like Coumadin nor on anti-platelet agents like aspirin or Plavix.

It should also be noted that several staff members were fired from MGH for attempting to look up Tedy’s diagnosis.

There has been speculation that he may return to football this year. Is this feasible? Let’s do some analysis based on this newfound information.

First off, a description of what percutaneous repair of a PFO involves:

The device is folded into a special catheter, inserted in a vein, moved into the heart and through the hole. The device is slowly pushed out of the delivery catheter, allowing each umbrella to open up and cover each side of the hole and close it. When the device is in proper position, it is released. The delivery catheter is then removed. The device remains in the heart and serves to close the hole.

The largest trial to date followed 307 patients with a PFO and history of a thromboembolic event. Percutaneous closure with either the CardioSEAL or Amplatzer yielded no subsequent strokes, but a 0.6 percent annual risk for a transient ischemic attack and 0.2 percent for peripheral embolism.

Normally, both antiplatelet agents aspirin and Plavix are given for 3 months. A repeat echo is done after 4 weeks to determine if clot has formed on the device. If so, Coumadin is needed for 3 months.

Additional complications can include arrythmias – since the PFO occluder is a foreign object that can irritate the chambers of the heart. There may also be an increase in headaches.

One complication of relevance is potential dislodgement of the device. Although the risk is very low – there is no data studying these devices in a high-impact sport like NFL football. Of concern is one case of dislodgement in a patient who played basketball one day after the device was implanted.

So, can Tedy return to football? Perhaps, assuming the following conditions:

1) he has not suffered any of the more common side effects mentioned above (i.e. arrythmias or clots)
2) is not currently on blood thinners nor anti-platelet agents
3) is willing to accept the unstudied, albeit minimal, risk of dislodgement in the face of NFL trauma.

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