Like a hole in the…heart

By | 14th October 2010

To update Hannah’s progress somewhat…

The Cardiac Care Unit (CCU) at Royal Berks were great at taking care of Hannah during the 8 days she was in the hospital. Work were excellent at giving me time off to deal with it all and family rallied around to help us out.

The first consultant did a bubble echo and found evidence of a PFO. This is a defect between the atria, which could explain how a blood clot got in the main branch of her coronary artery. The consultant decided to put her on Warfarin to prevent another clot from occurring (we don’t know why she got a big clot in the first place) and to schedule a Transoesophageal Echocardiogram (TOE) to try to get a clearer idea of how big the PFO is. Interestingly, there may be a link between PFOs and migraines.

Unfortunately, the senior consultant decided against the TOE, as he felt that there was a risk involved and there was little compelling evidence that she would experience any benefits from closing the PFO. We argued the toss, but in the end we couldn’t force him. So she stays on Warfarin, probably lifelong, and is seeing a haematologist to try to find out why she got the clot in the first place (and to make sure it doesn’t happen again).

However, we saw her GP and asked for a referral to a different consultant for a second opinion. Long story short, she went to the London Heart Hospital yesterday and the story’s changed quite a bit.

They did another Bubble Echo and the result was startling.

Essentially, they inject saline bubbles into the bloodstream and then watch where they go. In a normal heart with no problems, one side of the heart goes from black to white on the image as blood is displaced with bubbles. Indeed, this is what happened for Hannah’s heart. However, the nature of the PFO is that it mostly appears in certain conditions, which can be replicated with a Valsalva Manouevre. This creates the same sort of effect as coughing, straining on the toilet or giving birth, and creates a pressure change, drawing the bubbles across the PFO (if there is one).

In a Grade I PFO, you would expect to see maybe a handful of bubbles move across to the other atrium.

In a Grade II PFO, you would see more bubbles.

In a Grade III PFO, you would see a stream of bubble.

When Hannah performed her Valsalva Manouevre, first there was a stream of bubbles, and then the whole atrium turned white. The consultant said it was the largest PFO she’d seen, and a Professor came to see her.

In short, there’s no question that they want to close it. Hopefully they’ll do it before christmas. Hannah will have to be in hospital for a couple of days at least so they can do the procedure and monitor her afterwards. She’ll have to come off the Warfarin and start injecting herself with Heparin. The procedure involves placing a device to occlude the defect. It is relatively low risk, in that it does not involve open heart surgery, but does carry risks.

We still don’t know why she had the clot, she’s tested negative for everything so far so she’s going to Bart’s next week for another appointment with a haematologist.

In herself, she still tires easily and is far from fully recovered but she soldiers on.

[UPDATE: I’m not desperately happy about the cardiologist at Royal Berks, but the London Heart Hospital are sending him the information and were clearly not happy. Will decide whether to make a complaint or not.]

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