By . Roger Dobson . PUBLISHED: . 16:00 EST, 1 June 2013 . | . UPDATED: . 16:00 EST, 1 June 2013 . The key to beating one of the most common causes of stroke could be an umbrella-like heart implant, according to new research. About a quarter of the population are born with a minor cardiac defect – a hole in one of the heart chambers known as a patent formal ovale (PFO) – that usually causes no symptoms but increases stroke risk. The new procedure involves placing a tiny implant that looks like a two-sided umbrella, known as an occluder, to plug the hole. About 150,000 Britons suffer a first stroke every year, and in eight in ten cases it is due to the blood supply to the brain being blocked by a blood clot – an ischaemic stroke. In 60 per cent of these patients, the reason for the stroke can usually be linked to coronary heart disease, and the build-up of fatty deposits on the arterial walls. This furring – known as plaque – hinders blood flow and means clots are more likely to form, then break off and travel to the brain. Yet in half the remaining patients – for whom their stroke has no obvious cause – a PFO may be the trigger. Many stroke patients are young and seemingly fit, such as broadcaster Andrew Marr, who suffered a stroke aged 53 in January, though a PFO has not been suggested as the cause. In cases where a hole in the heart is suspected, the closure operation has now been found to reduce the risk of another stroke by up to 70 per cent. No rain on this parade: The 'umbrella implant surgery' only takes 45 minutes and could prevent thousands of strokes each year . David Hargreaves, a history teacher and housemaster at Westminster School in London, was one of the first people in the UK to have the device implanted to prevent a second stroke. He suffered his first one three weeks after his 50th birthday. At the time, he was fit – running 30 to 40 miles a week – but he was taken ill on the last day of the school term. After four days of investigation in hospital, David was found to have a PFO. ‘I was told that closing the PFO would significantly reduce the chances of a further stroke, so I decided to go ahead,’ he says. ‘The procedure took about 45 minutes and I was awake throughout.’ During the operation, an incision is made in a vein in the groin under local anaesthetic. The occluder device, which is made of two wire mesh discs encasing a polyester fabric, is folded and put into a tube (catheter). It is then inserted into the vein and manoeuvred into the heart via the circulatory system, and into the open hole. Broken heart: The surgery closes a hole in the heart which is a known cause of blood clots . Once in place, the device is released and unfolds so that there is a disc either side of the PFO. A small piece of linking material that connects the two discs is tightened so that the hole is sandwiched between them. The procedure can be carried out as a day case, but most patients are kept in for observation. Dr Iqbal Malik, consultant cardiologist and director of cardiac catheter labs at Hammersmith Hospital, who fits the devices, says the implant offers a ‘belt and braces’ approach, and is given alongside blood-thinning medication. ‘Statistics show that the operation will lower the risk of a second stroke from two to three per cent a year to about one per cent. But none of my patients has had a recurrence,’ says Dr Malik. ‘The procedure is safe and seems a good option for those who have recovered well from a stroke and have a large PFO.’ The new research shows that plugging the PFO is more effective than blood-thinning medication, such as warfarin or aspirin, in reducing risk of recurrent stroke. Patients in the multi-centre study, whose average age was 46, had a 51 to 73 per cent drop in risk. David recalls: ‘I was able to watch the operation as it happened on a TV screen in the theatre. It is quite interesting to see inside your own heart. ‘I had no side effects from the procedure, and nearly four years on I have had no further strokes or mobility problems, and I feel fine. ‘For me, the sealing of the PFO has been a success and I believe it is something anyone in the same boat should seriously think about doing. I went back to work full-time about five months after the stroke. ‘One odd effect of the stroke is that I have poorer visual recognition for faces and paintings. On the plus side, my brush with mortality has made me less prone to anxiety because it puts things into perspective. ‘I still have double vision, but that is corrected with special spectacles. It means I cannot  get the skis out any more, but  that is no great loss to me, nor to skiing.’
New research show 'umbrella' implant could save thousands .
Near 25 per cent of all stroke patients suffer from 'hole in the heart'-defect .
About 150,000 Britons suffer their first strike every year .
By . Roger Dobson . PUBLISHED: . 16:00 EST, 1 June 2013 . | . UPDATED: . 16:00 EST, 1 June 2013 . The key to beating one of the most common causes of stroke could be an umbrella-like heart implant, according to new research. About a quarter of the population are born with a minor cardiac defect – a hole in one of the heart chambers known as a patent formal ovale (PFO) – that usually causes no symptoms but increases stroke risk. The new procedure involves placing a tiny implant that looks like a two-sided umbrella, known as an occluder, to plug the hole. About 150,000 Britons suffer a first stroke every year, and in eight in ten cases it is due to the blood supply to the brain being blocked by a blood clot – an ischaemic stroke. In 60 per cent of these patients, the reason for the stroke can usually be linked to coronary heart disease, and the build-up of fatty deposits on the arterial walls. This furring – known as plaque – hinders blood flow and means clots are more likely to form, then break off and travel to the brain. Yet in half the remaining patients – for whom their stroke has no obvious cause – a PFO may be the trigger. Many stroke patients are young and seemingly fit, such as broadcaster Andrew Marr, who suffered a stroke aged 53 in January, though a PFO has not been suggested as the cause. In cases where a hole in the heart is suspected, the closure operation has now been found to reduce the risk of another stroke by up to 70 per cent. No rain on this parade: The 'umbrella implant surgery' only takes 45 minutes and could prevent thousands of strokes each year . David Hargreaves, a history teacher and housemaster at Westminster School in London, was one of the first people in the UK to have the device implanted to prevent a second stroke. He suffered his first one three weeks after his 50th birthday. At the time, he was fit – running 30 to 40 miles a week – but he was taken ill on the last day of the school term. After four days of investigation in hospital, David was found to have a PFO. ‘I was told that closing the PFO would significantly reduce the chances of a further stroke, so I decided to go ahead,’ he says. ‘The procedure took about 45 minutes and I was awake throughout.’ During the operation, an incision is made in a vein in the groin under local anaesthetic. The occluder device, which is made of two wire mesh discs encasing a polyester fabric, is folded and put into a tube (catheter). It is then inserted into the vein and manoeuvred into the heart via the circulatory system, and into the open hole. Broken heart: The surgery closes a hole in the heart which is a known cause of blood clots . Once in place, the device is released and unfolds so that there is a disc either side of the PFO. A small piece of linking material that connects the two discs is tightened so that the hole is sandwiched between them. The procedure can be carried out as a day case, but most patients are kept in for observation. Dr Iqbal Malik, consultant cardiologist and director of cardiac catheter labs at Hammersmith Hospital, who fits the devices, says the implant offers a ‘belt and braces’ approach, and is given alongside blood-thinning medication. ‘Statistics show that the operation will lower the risk of a second stroke from two to three per cent a year to about one per cent. But none of my patients has had a recurrence,’ says Dr Malik. ‘The procedure is safe and seems a good option for those who have recovered well from a stroke and have a large PFO.’ The new research shows that plugging the PFO is more effective than blood-thinning medication, such as warfarin or aspirin, in reducing risk of recurrent stroke. Patients in the multi-centre study, whose average age was 46, had a 51 to 73 per cent drop in risk. David recalls: ‘I was able to watch the operation as it happened on a TV screen in the theatre. It is quite interesting to see inside your own heart. ‘I had no side effects from the procedure, and nearly four years on I have had no further strokes or mobility problems, and I feel fine. ‘For me, the sealing of the PFO has been a success and I believe it is something anyone in the same boat should seriously think about doing. I went back to work full-time about five months after the stroke. ‘One odd effect of the stroke is that I have poorer visual recognition for faces and paintings. On the plus side, my brush with mortality has made me less prone to anxiety because it puts things into perspective. ‘I still have double vision, but that is corrected with special spectacles. It means I cannot  get the skis out any more, but  that is no great loss to me, nor to skiing.’
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