Scott Webb (Host): Thank you for listening to our HeartSpeak podcast. I'm Scott Webb. And today, we're talking with Dr. Yash Chugh, an interventional cardiologist and structural heart disease specialist on the medical staff at Baylor Scott & White Heart and Vascular Hospital Dallas and Baylor University Medical Center at Dallas.

Host: Doctor, thanks so much for your time today. This is going to be an interesting conversation. And as we get rolling here, what is patent foramen ovale, also known as PFO.

Dr. Yashasvi Chugh: So, PFO is an interesting slit, which is present in our heart between our upper chambers. Almost one in 10 of us are born with one. As a matter of fact, we all have a patent foramen ovale when we're in our mother's womb because this allows blood to go basically to the left side of the heart because our lungs are not working when we're in our mother's wombs. So in essence, it's a rudimentary structure that is seen in adults and it doesn't close in all of us.

Host: That's interesting. It's so good that we have the experts on, right? You say one in 10, so that sounds like that's fairly common, PFO.

Dr. Yashasvi Chugh: It certainly is. It's fairly common. And like I said, it should have closed up by the time we are born. But it doesn't in, you know, one in 10 of us. So, you're in a room with 10 people. One of us will have a PFO, but it doesn't really have any consequences for the most part.

Host: Yeah. No, let's say, direct consequences. But indirectly, it does make, you know, folks with PFOs at greater risk for strokes. And while the PFOs, I guess, aren't actually causing the strokes, they sort of provide that portal in which a clot can pass, which would increase the risk. So, maybe you could explain how that happens.

Dr. Yashasvi Chugh: So, I think it's important for us to know that if you have a PFO and you've never had a stroke, I absolutely don't want you to worry. We don't go looking for PFOs. However, what we've learned is if you've had a stroke and we are not sure, you know, and this is sort of a heart-brain collaboration with the neurologists, and if you are not sure why you've had the stroke, usually one of the last reasons is this PFO.

The way you could have a stroke with this PFO is if you have a clot in the legs. And that clot, which is on the right side, can go up to your heart because, as you know, blood moves from your legs to your heart, and then it goes to the lungs. So, this clot can go from the right side of the heart to the left side through this small slit or PFO. And once anything is loose on the left side, it can go to the brain and give you a stroke. So, this is sort of the pathology of how a PFO can play a role in a stroke.

Host: Yeah. I see what you mean. Like I said, it's maybe not directly the cause, but indirectly. And then, some detective work, if you can't quite figure out, you know, what caused the stroke. So as you say, you don't go really looking for PFO, but how is it diagnosed, what tests do you perform and would would a PFO cause any other symptoms that might proceed a stroke or might give us some reason for concern?

Dr. Yashasvi Chugh: Yeah. At Baylor, we have an algorithm where if you have a stroke and we've done all the routine workup, and in that workup, if you find nothing else except for this hole or PFO, then we say yes, it's probably this hole that provided a channel for you to have a stroke. So, the way it's done, the testing is twofold. So, the initial test is a simple echocardiogram, which is essentially an ultrasound of the heart where we take some pictures of the heart. And while we are taking these pictures, we are also able to inject some bubbles into your vein and see if these bubbles actually travel from the right side of the heart to the left side of the heart. Usually, there should be no mixing of blood between the right and the left side of the heart, outside of the lungs. If there's some mixing at the level of the heart, then we know, you know, there's a "hole" that we're dealing with.

Host: Yes. You say "hole", right? So if a PFO needs to be closed, let's assume that someone had a stroke and the team there realized, "Okay, it was the PFO that enabled this, if you will." How do you do that? What procedures are performed to close PFOs?

Dr. Yashasvi Chugh: So first of all, once we've confirmed that you have this hole, we then need to do a more specialized echo where we put you to sleep, put a camera in your food pipe and really study the characteristics, and then we determine if this is something that we can close by going through the groin or is this something that we need to have our surgeons close with a patch or a stitch? So in my perspective, and I am an interventional cardiologist, so I do these procedures through the groin. The way we do it is it's done with light sedation, it's done in our cardiac cath lab with the help of x-rays. We enter the groin from two points. The first entry point allows us to pass a camera that stays in a blood vessel. And then, the second entry point is for this device, which in essence is two small disks a little bit larger than a quarter that are sort of held together by a raphae or a stem in the middle.

Host: Yeah, it's really interesting. None of us, I think, would be comfortable knowing that we had this hole in our hearts, especially if it was the culprit, if you will, for a stroke. I was just wondering, is there any way to manage PFOs without surgery?

Dr. Yashasvi Chugh: So, I think if you've had a stroke and you've had this PFO and you, for whatever reason, say you don't want to undergo this procedure, you could technically be on blood thinners for the rest of your life. But, you know, there's a big risk. When you're 40 and you commit yourself to lifelong blood thinners, it's quite a big risk that you put yourself in, especially in your 60s and 70s, because you can bleed and the bleeding can be catastrophic. You know, I think the rationalization for this procedure is it's so safe in the right hands. The risk of something bad happening is way, way below 1%. So, I think a lot of patients are motivated to get this closed, obviously in the right scenario, so they don't commit themselves to lifelong blood thinners.

Host: Yeah, motivated for sure. And certainly, we hope podcasts like this help. Really educational, great stuff today, doctor. As we wrap up here, tell us about the closure procedure for a patient, how long the recovery time is and what they can sort of expect afterwards.

Dr. Yashasvi Chugh: Absolutely. So, the closure procedure, it's a day surgery. It's an hour-long procedure. You know, it's done with light sedation. But you don't have a tube to make you breathe. So, it's not general anesthesia. The recovery is short. You usually get to go home three to four hours after the procedure and probably could return to work, you know, on post-op day perhaps two after your groin sites have healed up.

 Again, risks per se are very, very low. We just enter your body through two tubes in the groin. And recovery is short. You're going to have to be on some permutation of blood thinners or antiplatelet medicines, which make your blood less sticky for between one and six months after the procedure. And usually, we like to see you twice in that first year and make sure you're doing okay and make sure that the discs that we've implanted is intending to do the work that we want it to do.

Host: Yeah. Well, as I said, this has been really educational. It's just amazing to me. For us lay people, you know, who don't do this for a living, we think, well, hole in the heart, fixing the hole, preventing strokes, that seems like a big deal. But the way you take us through this and explain this, it's low risk of complications, fast recovery time, and folks are back at it. And as we began here today, that people don't know they have PFOs, right? So once it's repaired, they're on their way with some medication for, you know, a few months, maybe as many as six. So, really good stuff today, doctor. Thanks so much. You stay well.

Dr. Yashasvi Chugh: Absolutely. Thank you again.

Host: To find an interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital, Dallas and Baylor University Medical Center, call 1-844-BSW-DOCS and ask for an interventional cardiologist. To learn more about the interventional cardiology programs and services, visit

Scott Webb (Host): Visit BSW health.com/heart, dfw.  

Host: download the Baylor Heart Center app on your Apple device.

Thanks for listening to HeartSpeak, the podcast from Baylor Scott & White Heart and Vascular Hospital in Dallas and Fort Worth. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest. I'm Scott Webb. Thanks for listening.

 Baylor Scott & White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.