A 49-year-old aunt suffered from insomnia, anxiety, and recurrent headaches, all because of an extra "heart eye"!

Aunt Zhu, 49 years old, reported that she had insomnia and trouble falling asleep at night without any obvious cause 16 years ago. Eight years ago, she gradually developed anxiety and depression, and intermittent attacks of dizziness and headaches. During this period, she repeatedly visited several hospitals in the city for treatment, but all her test results were normal. She took a variety of anti-anxiety, sedatives and hypnotic drugs orally as prescribed by the doctor, but the effect was not obvious after a period of time. The symptoms gradually worsened, and she experienced sleepless nights, anxiety and irritability, and could only fall asleep briefly after taking sleeping pills.

Recently, the patient came to the Department of Thoracic and Cardiovascular Surgery of Hunan Provincial Hospital of Traditional Chinese Medicine for treatment due to lung nodules discovered during a physical examination. After inquiring about the patient's medical history in detail, Director Lu Huihui of the department asked the patient to complete a right heart ultrasound angiography, which showed a strong positive result. After a comprehensive clinical evaluation and full communication with the patient and his family, it was decided to occlude the foramen ovale through interventional means.

Preoperative transesophageal ultrasound showed that the foramen ovale was not closed, and an oblique gap was visible in the middle of the atrial septum, about 1.2 mm wide and 8.2 mm long, with a left-to-right low-speed shunt signal visible inside.

After the operation, the patient reported no obvious dizziness and headache, anxiety and depression disappeared, and she stopped taking antipsychotic drugs. She could sleep peacefully for more than 7 hours at night and was discharged on the third day after the operation. After discharge, the patient reported that she could sleep normally for more than 8 hours at night and take a 1-hour nap. She has not taken psychiatric drugs since the operation. The patient expressed her gratitude to Director Lu of the Department of Thoracic and Cardiothoracic Surgery for helping her solve her long-standing problems.

1. What is the foramen ovale?

The foramen ovale is a channel-like structure on the atrial septum during the fetal period, which is closely related to normal fetal blood circulation. After the birth of a newborn, as the pulmonary circulation is established, the atrial pressure changes. 75% of newborns can close on their own. If it is still not closed after 3 years old, it is called patent foramen ovale.

PFO is a common congenital heart disease with an incidence rate of 15%-35%. Most cases have no clinical symptoms. Studies have found that it is closely related to neurological diseases, such as stroke, migraine, insomnia, anxiety and depression, mental disorders, hypoxemia, etc.

2. What is the mechanism by which patent foramen ovale causes insomnia and anxiety?

Current research speculates that patent foramen ovale may cause small blood clots or metabolites in the venous system to enter the arterial system through this unclosed hole, thereby affecting brain blood flow and causing brain hypoxia. When brain tissue is hypoxic, a large number of oxygen free radicals are produced. The damage of oxygen free radicals to brain cells is caused by the peroxidation of unsaturated fatty acid lipids in biological membranes. The central nervous system is rich in unsaturated fatty acids, so peroxidation is more likely to occur.

A large number of oxygen free radicals can cause damage to the brain's structure and function, affecting the integrative function of the cerebral cortex, thereby causing a series of mental symptoms such as insomnia, anxiety, depression, fear, euphoria, and agitation.

3. How to treat it?

Early detection and early treatment are very important for the recovery of patients with patent foramen ovale. With the development of medical technology, minimally invasive surgery to occlude the foramen ovale is the preferred surgical method in clinical practice. The occlusion surgery has the advantages of low risk, small trauma, and fast recovery. Most patients can get out of bed the next day without obvious scars.

After surgery, patients need to take some antiplatelet drugs such as aspirin and clopidogrel for about half a year as auxiliary treatment. Currently, many clinical observations have shown that transcatheter occlusion can effectively improve patients' symptoms such as depression, anxiety and insomnia.

Hunan Medical Chat Special Author: Liu Huali, Department of Cardiothoracic and Vascular Surgery, Hunan Provincial Hospital of Traditional Chinese Medicine

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(Edited by Wx)