The project is coming to an end. After staying up for several nights, 34-year-old Ms. Wang has another severe headache. It had been several years, and this familiar feeling always appeared when she was physically tired and nervous, repeatedly. After doing various examinations such as head CT, no problems were found, but I was told to take a good rest.
By chance, Ms. Wang discovered that the crux of the problem was actually in the heart—patent foramen ovale. With a small minimally invasive surgery, the problem was solved.
Headache caused by patent foramen ovale
In Zhujiang Hospital of Southern Medical University, Ms. Zhang and Ms. Li in similar situation, both underwent interventional closure of the foramen ovale 2 years ago The symptoms of unexplained headaches were significantly relieved.
What is the foramen ovale? Wang Xiaowu, Director of Cardiac and Great Vascular Surgery, Pearl River Hospital of Southern Medical University, explained that there are four cavities inside the human heart, which are called left atrium, left ventricle, right atrium and right ventricle from top to bottom and from left to right. Under normal circumstances, the atrium and ventricle on the same side are connected, but the atrium and atrium, ventricle and ventricle are blocked and cannot communicate. The fetus cannot breathe through the lungs, and a hole is formed between the two atria to ensure the normal circulation of blood in the heart. This hole is the foramen ovale.
Usually, between 5 and 7 months after birth, the foramen ovale will gradually close and the two atria cannot communicate. However, various reasons, such as abnormal development, may cause the foramen ovale to not close in some people.
As for the reason for the headache caused by patent foramen ovale, Wang Xiaowu said that there is no clear explanation in the academic circle at present. There are mainly three possibilities. One is that patients with patent foramen ovale have transient right to left. During shunting, hypoxemia causes irritating migraine; it may also be that when breathing deeply and coughing, the unclosed foramen ovale opens, and tiny thrombi from the venous system enter the systemic circulation through the foramen ovale, causing cerebral ischemia and cerebral cortex irritability. , leading to cortical spreading depression and a migraine attack; or when blood is shunted from right to left, the vasoactive substance serotonin enters the arterial system directly to cause a migraine attack.
Patent foramen ovale is uncommon or increases risk of stroke
Patent foramen ovale is a common cause of daily headaches, and more and more studies show that it is also a cause of unexplained stroke an important cause and an independent risk factor. Statistics show that the detection rate of patent foramen ovale in patients with cryptogenic stroke under the age of 55 is as high as 40%-50%.
In fact, in clinical practice, patent foramen ovale is not uncommon, and the incidence of patent foramen ovale in general adults is about 20% to 25%. Usually, the diagnosis can be made by ultrasonography, including transthoracic echocardiography, transesophageal echocardiography, and contrast-enhanced transcranial Doppler ultrasonography.
Does all patent foramen ovale cause severe headaches and must be treated? uncertain. Wang Xiaowu said that when there are no obvious symptoms and no complications, regular outpatient follow-up is enough. However, if there is an unexplained stroke, cerebral ischemic attack, intractable or chronic headache, etc., it is recommended to treat as soon as possible according to the situation.
An effective treatment for this type of headache is to close the foramen ovale to avoid right-to-left shunting of blood in the atrium. Currently, interventional closure of the foramen ovale is the main treatment method for patent foramen ovale. In simple terms, it is through the femoral vein, and the occluder is sent to the designated location with a catheter to block the foramen ovale to prevent abnormal blood flow in the atrium.
Written by: Southern Metropolis reporter Li Wen, correspondent Wu Xiaodan, Han Yurou