Cardiac Intervention

Will had a consultation this morning with Dr. Michaels and Dr. Efstratiadis of the Division of Cardiology at the University of Utah Health Sciences Center. They had already reviewed all of Will's medical records from Columbus. In addition to Will's patent foramen ovale (PFO) [aka "hole in the heart"], he has an atrial septal aneurysm (ASA). In this instance of medical-speak, aneurysm does not mean something about to burst, but rather that the wall between the left and right atria (atriums?) of the heart moves back-and-forth in Will more than it does in most people.

They acknowledge that the cause of Will's stoke is unknown, but something did cause it, and so far nothing in Will has changed to prevent a new stroke. Perhaps a clot from somewhere else in the body passed through the PFO and went to the brain; perhaps a clot formed in the heart itself because of the ASA. Both these conditions are suspected to be contributors to strokes in general, so they recommend that both be addressed, and sooner rather than later.

The closure device they recommend using is one that is rated for the ASA. It will close the PFO and will stabilize the septum. It is about the size of a quarter. It will be inserted through an incision in the groin that accesses an artery or vein to the heart. The device will be inside a narrow tube that will be threaded through the artery or vein, then inserted into the heart and deployed from the tube. They said this is the least risky of the cardiac interventions that are available today. This procedure has been available over 5 years now and about 50,000 have been done.

The doctors were willing to do it tomorrow, but Will still has his PEG tube. Although it could be done either before or after PEG-tube removal, if it is done before, Will will have to be on a certain medication for three to six months after the procedure. If it is done after the removal, the use of that medication can be avoided altogether. Will already had an appointment Thursday to decide on the PEG tube, so the procedure will be delayed a couple of days for a decision on that.