Guy Pronesti was just 45-years-old and his wife was five months pregnant with their first child when he had a stroke. At first, he only knew “something was happening…but a CT confirmed I had a full on stroke,” says the otherwise healthy medical device salesman.
Pronesti had been seeing a neurologist for migraines, dizziness and some short-term memory loss. After the stroke, he was referred to Dr. Stephen Heo at the New England Heart & Vascular Institute (NEHVI) to get to the bottom of why a man so young had suffered a stroke.
The answer took some work to find. When blood tests and heart monitoring ruled out the major causes of a stroke, Dr. Heo ordered a special echocardiogram called a “bubble study.” This test monitors the movement of small saline bubbles injected into a vein. When the bubbles reach the heart, they should stop. Unless, that is, the patient has a hole in their heart.
Karena Fournier, MSN, RN, CCN, is a clinical education specialist at NEHVI who performed Pronesti’s test. “I told Guy to look to see if he saw any bubbles cross between the two chambers,” she remembers. “When I saw just how bad it was, I said ‘Whoa’.”
Pronesti was diagnosed with a patent foramen ovale, or PFO. A foramen ovale is a hole in the wall that separates the right and left sides of the heart. Everyone has this hole when they are born, but it typically closes naturally about six months after birth. A PFO happens when that hole fails to close. About a quarter of the general population has a PFO; and, it’s believed about half of people who’ve had a stroke of unknown origin have one.
Many people who have a PFO never need to address it. They have no symptoms and the hole is no cause for concern. But for patients under the age of 60 with persistent dizziness, migraines, and other symptoms, a procedure to close the hole can be like finding the lost piece to a puzzle.
A subsequent MRI of Pronesti’s brain showed multiple lesions, a sign that he had actually suffered many mini-strokes. It was clear that he would benefit from having his PFO closed. ‘You’ve got to get this fixed,” Pronesti recalls his wife saying. “’I need you around to be this baby’s dad!’”
The procedure is remarkably simple and has shown to be effective, says Dr. Heo. “In 2017, there was a study published that examined whether patients who had had a stroke of unknown origin and had a PFO would benefit from closure. The results suggested that patients whose PFOs were closed had a lesser risk of subsequent stroke than those who hadn’t. This study really confirmed what we were already seeing; there are patients who benefit from the closure procedure and can go on to live completely normal, healthy lives”
But the clock was ticking. Pronesti’s was now a new dad and he was awaiting a follow up appointment for his treatment plan when, “I suffered another stroke in Las Vegas while at a work dinner. I flew into Boston and was admitted to Mass General overnight under the stroke protocol.”
His treatment was fast-tracked and, two weeks later, NEHVI’s Dr. Fahad Gilani performed the 90-minute operation to close Pronesti’s PFO. A small device, fed through a catheter that was placed in a leg artery, was set into the hole. Over time, tissue formed around the device to completely close the hole.
Today, Pronesti feels great and, most importantly, he’s able to keep up with his young, busy family. “It was no big deal. I literally feel like a million bucks. There’s no follow up needed. It’s fixed and I can get back to my life. It’s truly incredible.”
Photo courtesy of: Alyssa Duncan