Making Hearts Whole

Patent foramen ovale repair procedure patient Ann Hervey of Chico relaxes at home recently with her son Wyatt.

About 25% of humans live with holes in their hearts. Are you shocked?

It’s not necessarily as serious as it sounds. Most people who have a patent foramen ovale (PFO) live healthy, productive lives. Few experience symptoms. In the majority, the hole closes shortly after birth. But what if it doesn’t?

Usually, it has no effect, said Shailesh Nandish, M.D., Enloe Health’s Medical Director of Structural Heart & TAVR and the Cardiac Cath Lab. The interventional cardiologist called PFO “a hole in the heart between the two upper atrial chambers” and said it’s a natural phenomenon for a fetus.

“It’s an open communication inside the developing infant’s heart,” Dr. Nandish said. “Since blood isn’t pumping through the lungs of the fetus, oxygenation comes straight from mother to child (through the umbilical cord).”

However, “once the baby is born, the lungs expand with air, and the hole closes off, but in 25% of people, it doesn’t close,” he said. This means the “flaps” that exist during gestation don’t fuse.

The danger, then, is with the remaining gap. “Some are small, and some are large,” Dr. Nandish said. A clot can form somewhere within the body and get pumped into the arteries serving the brain or heart. If it’s the brain, a stroke is often a result, but the cause of the stroke can confuse clinicians and result in ineffective treatment.

That’s where Dr. Nandish and his diagnosing methodology come in — involving cardiologists and neurologists, in the case of apparent stroke victims, especially if they’re young.

Detective Work

Dr. Nandish said he investigates the cause of stroke before deciding to pursue a closure procedure. The Structural Heart team collaborates with the Neurology team to evaluate every patient with a PFO and stroke.

“If the PFO is the only explanation, we decide to treat the PFO to decrease the chances of a recurrent stroke,” he said. “We have to make sure, from a neurology perspective, that it was a stroke. We determine there were no other causes, like a blockage in the neck or anywhere in the brain. We want to make sure there is no AFib — atrial fibrillation, an irregular heartbeat — causing the stroke, among other things.”

Dr. Nandish said his objective “is not to fix everyone with a PFO, but only people with stroke who have no other apparent causes of stroke.”

This procedure can be critically important. Ann Hervey, 59, of Chico is one beneficiary of Dr. Nandish’s skill. She suffered a stroke in May 2023 and — following evaluation by Dr. Nandish and neurologist Paramjit Singh, M.D. — became a candidate for PFO repair.

“I went through all the normal protocols, and it showed I didn’t fit the normal parameters (of stroke),” Hervey said. “They found I had a hole in my heart and decided to do the PFO procedure. They thought the blood clot went through the hole.”

During a highly stressful time, Hervey said Dr. Nandish eased her mind, explaining everything the procedure involved.

“I didn’t have any worries,” Hervey recalled. “Dr. Nandish has a really good bedside manner, and makes it to where you can understand, even if you’re not a heart specialist.” 

Especially gratifying to Hervey is the fact this procedure is available in Chico. One of her friends also suffered a PFO-related stroke and had to travel to San Francisco for PFO repair.

Dr. Nandish, with more than 25 years of experience and at Enloe Health since 2019, said Enloe Health is “a place for growth and expansion for these progressive procedures to benefit our community.

“We’re making sure we provide the same standard of care as anyone visiting a doctor in Sacramento and San Francisco,” he said.