Unexpectedly! A woman had migraines for more than 10 years, and the reason was a "hole" in her heart

Ms. Zhang, 45, from Yiyang, has had recurring headaches for more than 10 years. Headaches can be triggered by overwork, emotional disturbances, and menstruation. In severe cases, she also suffers from dizziness and even fainting. She has gone to the hospital for checkups many times, but the results were all normal, which made her miserable.

Later, he was introduced to the Department of Neurology of Hunan Provincial Second People's Hospital (Provincial Brain Hospital) . After examination, the doctor gave a diagnosis of patent foramen ovale (PFO).

Subsequently, Ms. Zhang underwent interventional closure of the foramen ovale at the Second People's Hospital of Hunan Province (Provincial Brain Hospital). The operation was successful and she did not experience migraine after the operation. A follow-up examination six months later showed no obvious abnormalities or discomfort.

1. What is PFO?

Liu Youyuan, chief physician of the Ultrasound Department of Hunan Second People's Hospital (Provincial Brain Hospital) , explained that the foramen ovale is a physiological channel in the atrial septum of the fetal heart, which helps the fetus complete the blood circulation between the left and right atria. When the fetus cries, the fetal respiratory and circulatory system changes, pulmonary circulation is established, and the pressure in the left atrium is higher than that in the right atrium, and then the foramen ovale closes. If the foramen ovale of a child over 3 years old still does not close, it is called PFO. About 1/4 of adults have PFO.

What is the relationship between migraine and PFO?

PFO is the most common risk factor for migraine. Chinese scholars have found that the incidence of migraine combined with PFO is 40%-60%.

Most PFO patients are asymptomatic, but there is a potential threat to health or life span. When the chest pressure increases due to various reasons such as coughing, holding breath, diving, etc., PFO can cause obvious right-to-left abnormal shunt in the heart. At this time, emboli (including thrombi, air emboli, fat emboli, etc.) from the venous system enter the systemic circulation through PFO, resulting in a series of clinical symptoms, including migraine, ischemic stroke, myocardial infarction, peripheral vascular embolism, decompression syndrome, etc.

In addition, during the perioperative period of surgical operations, the use of mechanical ventilation increases the intra-abdominal pressure, which may lead to hypoxemia, subsequently inducing pulmonary hypertension, and in severe cases even leading to right heart failure.

How can PFO be checked?

Transthoracic echocardiography has a certain rate of missed diagnosis due to external interference. In clinical practice, transcranial Doppler bubble test and right heart echocardiography are usually performed for screening. If the result is negative, PFO is ruled out; if the result is positive, it is very likely to be PFO, and further transesophageal echocardiography can be performed to confirm the diagnosis.

Hunan Provincial Second People's Hospital (Provincial Brain Hospital) is one of the first hospitals in the province to perform transcranial Doppler bubble experiments and right heart acoustic angiography, and has also mastered techniques such as transesophageal echocardiography, which provides strong technical support for the diagnosis of PFO.

4. Treatment of PFO?

If the patient has no symptoms and it does not affect his life, no treatment is required. If an adult has symptoms, timely intervention is required.

Treatment:

1. Drug treatment: It can only prevent stroke, but the prevention effect is poor and it has no therapeutic effect;

2. Surgical treatment: Surgical thoracotomy to repair the foramen ovale is effective, but due to the large surgical trauma, it has been gradually eliminated.

3. Interventional treatment: It is the preferred treatment for PFO at present. It involves inserting a catheter from the femoral vein in the thigh into the right atrium, and placing an occluder at the foramen ovale under ultrasound guidance to block the foramen ovale. It has the advantages of short operation time, simple operation, no need for general anesthesia, endotracheal intubation, and fast recovery after surgery.

Hunan Medical Chat Special Author: Jin Min, Ultrasound Department, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by ZS)