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Stroke and hole in Bret Michaels' heart: what it all means

By Jeannine Stein

Los Angeles Times


More bad health news for singer-reality star Bret Michaels: While recuperating from a serious brain aneurysm this week, Michaels suffered what his doctor called a warning stroke, or a transient ischemic attack. And while tests were being done looking for the cause of the stroke, such as a blood clot, doctors found a patent foramen ovale, or a hole in his heart.

According to a statement posted on Michaels' website, his physician, Dr. Joseph Zabramski, said, "There is no doubt that the positive patent foramen ovale (PFO) is devastating news to Bret and his family. The good news is that it is operable and treatable and we think we may have diagnosed the problem that caused the transient ischemic attack (TIA) or warning stroke; however we feel it is highly unlikely this is connected to the brain hemorrhage he suffered just a few weeks earlier. Once again it is great that he quickly reacted to the severe numbness and got to the hospital immediately."

So what exactly is a patent foramen ovale, and how common is it? We spoke with Dr. Jonathan Tobis, clinical professor of cardiology and director of interventional cardiology at the Ronald Reagan UCLA Medical Center, who explained that this is a congenital condition. Fetuses normally have a hole, or flap, between the left and right atria of the heart that allows blood to flow in between, bypassing the lungs. Once the baby is born and taking in oxygen to the lungs, that flap seals up — or it's supposed to. In about 20 percent to 25 percent of people it stays open, leaving a small to large hole that still allows some blood to flow between the atria.

Most people never know they have this condition. But it may cause strokes, although rarely, Tobis said: "A blood clot can form and travel a pathway from the right to the left atrium and up to the brain, causing a stroke." It's typically corrected these days with a catheter-based method that "is sort of like closing a button hole," he said. "It's a relatively simple procedure done as an outpatient."

Tobis said people shouldn't go running to their doctors demanding an echocardiogram to see whether they have this condition, because most remain asymptomatic throughout their lives. Some people may be diagnosed with PFO if they have severe migraines, because certain types of migraines could be related to the condition.

In his statement, Zabramski, a neurosurgeon at the Barrow Neurological Institute in Phoenix, said, "I realize Bret wants to make a full recovery so that he can be active with his family, attempt to attend the finale of 'Celebrity Apprentice' and especially get back on the road to continue making music. Without a doubt he is very determined to get healthy and make a 100 percent recovery. Medically speaking it is a fantastic attitude both mentally and physically for him to have. However, Bret's brain and body are not quite 100 percent yet, especially with the hole found in his heart. Further tests will be conducted throughout the week and I will have more information next week as to how this patent foramen ovale ... will be treated. For now, Bret will be treated with outpatient care which includes a daily injection of Lovenox (a blood thinner to reduce the chance of blood clots) and blood tests."