They call it paradoxical embolism. A blood clot is created which then, through a sort of anomalous “duct” between the right and left atrium, what is technically called the patent foramen ovale, enters the cerebral circulation – and can block the flow of blood in a vessel of the brain, causing an ischemic stroke. This sort of “path” can be the basis of a cryptogenic stroke, that is, without a well-defined cause.
Obviously, to arrive at this hypothesis, it is necessary to exclude situations such as atrial fibrillation, the most common arrhythmia especially in the elderly for which specific treatments are implemented to keep the blood fluid, and the presence of other factors that could affect coagulation. At the end of this process, almost one in four stroke cases can be defined as cryptogenic, and about 30-40% of people who undergo a stroke have a patent foramen ovale, which is also very widespread but completely imperceptible.
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What is it about
“Patent foramen ovale is a congenital condition, present in about 25% of the adult population, characterized by persistent communication between the right atrium and left atrium of the heart, which should not exist in the adult person, while it is normal during fetal life. – explains Ciro Indolfi, president of the Italian Society of Cardiology (Sic). This “way”, in itself, does not give any symptoms, in fact many people never realize they have it. Sometimes, however, it can be the cause of a stroke at a young age “.
What can happen? Think of a small blood clot that forms in the veins of the legs (for example during a long plane ride or due to being immobilized in bed from an injury or a fracture). If this enters the venous circulation of a subject without patent foramen ovale, in the vast majority of cases it does not cause relevant consequences, because a small clot in the pulmonary venous bed remains asymptomatic.
On the contrary, if this communication persists between the right and left side of the heart, the small clot can pass from the venous district (right heart) to the arterial one (left heart) and from there travel inside the vessels that carry oxygenated blood to the organs and travel from the heart to the brain, causing a stroke due to lack of blood supply.
“When a stroke is diagnosed in a healthy under-65, it is always good to go in search of the patent foramen ovale – says Indolfi. In this case there is an indication for the percutaneous closure of this hole existing in the heart. But be careful: not all patients with patent foramen ovale will have a stroke, therefore this should never be closed if the person has never had a history of stroke, Tia (transient ischemic attack) or evidence of ischemic brain injury on brain MRI. ”
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How can the anomalous duct be “closed”
“The operation is carried out with a minimally invasive procedure carried out by a vein in the leg, through which a tube (catheter) is introduced, inside which a” device “is advanced which allows to close the communication between the atrium left and right – notes the expert.
There are several techniques to obtain this result: the most used is to place an “umbrella”, formed by two discs that are positioned astride the wall containing the hole. One disc is opened in the right atrium and the other in the left atrium with the heart wall on which there is the patent foramen ovale which remains closed between the two discs).
This parasol will remain forever in the patient’s heart. After the procedure the patient remains hospitalized for 24 hours and afterwards he can be discharged and return to normal routine. These are low-risk procedures, which in any case must be carried out only by identifying precisely who can really benefit from them.
Appropriateness is crucial as it is for the eventual closure of the left auricle, a sort of “appendix” of the atrium that can be considered in specific cases in patients with atrial fibrillation who cannot or cannot follow the anticoagulant treatment. It is a non-pharmacological alternative for the prevention of stroke in high-risk patients with atrial fibrillation in which drug therapy is contraindicated to maintain fluid blood, the first treatment strategy for those at greater risk of stroke due to the presence of of atrial fibrillation.
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