The PFO chatter around TCT may indeed be a bit more popular this week than in previous years, but RESPECT will only get PFO closure back to “base camp” at best if the results show promise.
-DP Dansereau, Know-Stroke.org
I am remided of the “base camp” reference made for PFO closure that stuck in my brain from the First Annual PFO Summit back in September 2010 in Washington DC. I would of preferred to use a running analogy myself, perhaps a marathon vs. a sprint, but I’ll explain the reference to climbing in this post.
During Session #3 of the First PFO Summit Regulatory, Reimbursement, and Device Industry Topics were presented.
Billy Dunn, MD of the FDA gave a brief overview of the Neurology perspective of stroke and PFO closure.
In one of Dr. Dunn’s slides (snagged from my camera here) entitled “Where do we go?” he mentioned we were still at base camp if we put it in climbing terms in route to the top of Mt. Everest. I believe Dr. Dunn was suggesting at the time the path remaining towards identifying PFO as something other than a coincidental finding in the heart instead of a possible pathological risk for stroke was still a long way off. Dr. Dunn did disclose at the start of his talk that his position at the FDA was related to the drug side of the stroke equation, or I assume he meant the medical management end of stroke prevention/treatment. Anyway, with that in mind, even with positive RESPECT outcomes, the results reported this week may only give us PFOers a little more oxygen to start the climb again. Closure 1 certainly emptied our oxygen tanks and perhaps we’ll breathe a little easier now but please be cautious and don’t EXPECT too much from RESPECT.
It is too bad we are not allowed to make these videos available because several presenters would not sign off on the video release. The best I can do for you for now is show you a shot I took from my phone of “base camp”. Hope we all don’t run out of oxygen before we reach the Summit (or can afford another PFO Summit) as we do sometimes have issues with hypoxia you know.
We’re conducting our second PFO-Research-Foundation-Survey for PFO Patients. This survey is only for patients diagnosed with patent foramen ovale (PFO). If you have a PFO your answers to this survey could help other patients and the medical community alike to understand how PFO’s are being diagnosed and treated. The survey takes only a few minutes to complete and your answers will be completely confidential. Please fill out this survey only once and be sure to answer every question so we can keep the data as clean as possible.
This survey is sponsored by the PFO Research Foundation, an organization launched by patients with PFO for the advancement of care of patients with PFO.
In my opinion, the most important part of the PFO-Research-Foundation-Survey
is in the closing sentence:
“If you like what we do please support our efforts by making a tax-deductible donation to our all-volunteer organization by sending a check to PFO Research Foundation, PO Box 20849, Boulder, CO 80308 in order to help us continue providing services to patients like yourself.”
The PFO Research Foundation is a completely voluntary group that receives no salaries and no donations from large organizations like AstraZeneca,Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Merck, Novartis, or Pfizer to name a few. Therefore, we need your donations, we rely on YOU!
So please, take our survey but donate if you really want to help.
We’ve even made it easier than mailing us a check, go to pforesearch.org and click the donate button on our homepage right now!
This question (and the answer below) appeared in today’s Resident e-Bulletin / Teaching Topics from the New England Journal of Medicine
Patent foramen ovale (PFO) is the most frequent cardioembolic risk factor for stroke in young adults. Others include congenital heart disease, infectious nonbacterial thrombotic endocarditis, rheumatic valvular heart disease, cardiac surgery or catheter intervention, arrhythmia (e.g., atrial fibrillation or sick sinus syndrome), cardiac tumors (e.g., atrial myxoma or papillary fibroelastoma), recent myocardial infarction, and dilated cardiomyopathy.
Up to 14% of all strokes occur in children and young adults. The incidence rates are 10 to 23 ischemic strokes per 100,000 young adults (18 to 50 years of age) and 3 to 9 hemorrhagic strokes per 100,000 young adults. Unfortunately, stroke remains under recognized and often misdiagnosed in young adults, particularly those less than 35 years of age and those with abnormalities in the posterior circulation.
To read more and to review a case study of an 18 year old patient at MGH that NEJM is featuring in their current issue click here