How Findings Apply to Patients with PFO
Due to the lack of association between PFO and later stroke found in this study, the Mayo Clinic investigators indicate that closure surgery should not be reflexive.
"We now see that a hole in the heart leading to stroke is not borne out in our study, the largest transesophageal echocardiogram-based study of the general population," says Dr. Khandheria. "Just because you have a hole, you don't automatically need to have it closed. You don't need to panic."
Dr. Meissner agrees. "More people are now getting PFOs repaired unnecessarily," she says. "Some don't need to be fixed. For patients who know they have a PFO and have not had neurologic symptoms, I'd advise them to sit tight. They don't need heart surgery to close the PFO.".... http://www.sciencedaily.com/releases/2005/12/051209113618.htm
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Treatment of an ASD depends on the size, location, degree of symptoms present and the effect the defect has on the heart muscle.
Observation and monitoring
Patients who have a small ASD without symptoms or heart rhythm disturbances, may only require periodic monitoring by a cardiologist specializing in adult congenital heart disease. A typical evaluation would include a thorough physical exam, electrocardiogram, chest X-ray, echocardiogram, and an exercise test. A Holter monitor or event recorder may also be used to check for irregular heart rhythms.
Medical management
In some circumstances, closure either by surgery or catheter-delivered occluder is not recommended. In these situations, medical management is important to decrease the risk of complications of the atrial septal defect or to reduce symptoms.
When an ASD is associated with high pulmonary pressures, closing the defect may not be appropriate. Early detection and regular evaluation are very important to avoiding high pulmonary pressures....http://www.mayoclinic.org/atrial-septal-defect/treatment.html
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There are even instances when fixing a hole in the heart in adulthood can harm the organ, which will be thrown by the changed hemodynamics, or blood circulation, says Professor Richard Harvey, head of developmental biology at the Victor Chang Institute at Sydney's St Vincent's Hospital....http://www.smh.com.au/news/Health/Theres-a-hole-in-my-heart/2005/04/28/1114635664338.html?from=moreStories
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Heart Surgery Risks
The development of heart surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low levels. For instance, repairs of congenital heart defects are currently estimated to have 4-6% mortality rates.
The biggest risk associated with heart surgery is brain damage. Despite the advances in CPB techniques, it is estimated that as many as 60% of all patients demonstrate varying levels of brain damage following the surgery; in 25% of patients this damage becomes permanent. It can range from fine motor skill dysfunctions to mental retardation....source: http://cardio360.com/heart-surgery.html
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