Ask Dr. Stephan Moll

These questions have been submitted by folks on the mailing list and answered by Dr. Moll, Director of the Thrombophilia Program at the Carolina Cardiovascular Biology Center, Department of Medicine, Division of Hematology-Oncology, UNC Chapel Hill (North Carolina, USA). Why am I doing this?

39. Patent Foramen Ovale (PFO)

Q: "My one year old son had a stroke in October. In the hospital he was found to have a PFO [= patent foramen ovale] and also Factor V Leiden. I recently heard on TV about a patch for hole in the heart. How do we find out if that patch would be OK for my son? If the hole in the heart wasn't there, maybe he could go on aspirin instead of coumadin ® normal?"

A: Yes, if the PFO were repaired the child would likely not need coumadin and could go on aspirin. Depending on the individual circumstances, even aspirin may not be needed. A PFO can either be closed by open-heart surgery or by devices deployed through a catheter. One of the devices is the "Amplatzer occluder". The child should be evaluated and the family be counseled by somebody who deploys such devices (sometimes cardiologists, sometimes cardiothoracic surgeons). Background information on PFOs and the Amplatzer device and names of physicians and their addresses can be found at http://www.amplatzer.com.

I recommend that a patient with a PFO and a paradoxical embolism see (a) a hematologist for thrombophilia work-up and (b) a cardiothoracic surgeon for discussion of surgical (open-heart) repair of the PFO, and (c) a specialist who performs the disk-closure procedure.

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